RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00141
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20030404

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Munitions Storage Journeyman, medically separated for “major depressive disorder [MDD],” with a disability rating of 10%.  

CI CONTENTION:  He was given a higher rating for his condition by the VA.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

 SERVICE PEB -  20030103	VARD  - 20040316 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
MDD	9434	10%	MDD, Recurrent	9434	30%	20030703	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

MDD. According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s MDD condition began in November 2002 after self-referral to mental health services for evaluation of anxiety and paranoid thoughts.  He was hospitalized for 3 weeks for further evaluation.  The MEB forwarded “MDD, single episode severe with mood congruent psychotic features” for PEB adjudication.  

The 20 December 2002 MEB NARSUM examination, 4 months pre-separation, noted complaints of increased social isolation, impaired socialization, loneliness, inability to sleep, anhedonia, decreased concentration and appetite, depression, anxiety and paranoid thoughts.  Collateral information from his command revealed little objective problems with occupational functioning, other than being “overly inquisitive” and paying “special attention to odd details.”  The mental status examination (MSE) showed anxious mood, restricted affect with occasional inappropriate smiling.  Recent paranoid delusions and ideas of reference included thoughts of tapped phones, others talking about him, and cameras monitoring him.  His judgement and insight were fair.  His thought processes were generally goal-directed, with occasional loose thought and some circumstantiality.  He was evasive and selective in the words he used; however he denied suicidal and homicidal ideation.  The examiner stated that the CI demonstrated “significant impairment of functioning” supported by social isolation and an extended inpatient hospitalization.  The CI was taking two medications (an anti-psychotic and an anti-depressant) and had had a partial response, however, he still endorsed a depressed mood.  The Global Assessment of Functioning (GAF) score was 65 (mild symptoms with some difficulty in social, occupational, or school functioning).  

At the 3 July 2003 VA Compensation and Pension (C&P) evaluation, 3 months post-separation, the CI reported persistent depression, trouble sleeping, low energy, and anhedonia, however his medications were helping to keep him from a deeper depression.  He reported 2 months of unemployment since discharge and a recently obtained job as a waiter for the previous month.  The MSE showed a nervous and depressed mood, with inappropriate affect at times.  The remainder of the MSE was within normal limits.  The GAF score was 60 (for moderate symptoms with difficulty in social, occupational, or school functioning).  

At the May 2004 VA C&P examination, 13 months post-separation, the CI reported losing his waiter job after 2 months due to paranoid behavior.  By September 2003, 5 months post-separation, he was unable to work due to suspiciousness, paranoid behavior and delusions.  In January 2004, 9 months post-separation, there was a 7-day inpatient stay that resulted in a diagnosis of schizophrenia, paranoid type.  The CI reported frequent nervousness and depression, with occasional auditory hallucinations, suspiciousness, and religious preoccupation.  Medications included an anti-psychotic and anti-depressant.  The MSE showed normal personal hygiene.  The CI was alert but suspicious, argumentative and negativistic, with irrelevant and illogical thought processes and impaired abstraction.  His speech and communication were coherent though irrelevant at times with occasionally impaired insight and judgment.  The examiner opined that the CI’s “depression [was] part of his schizophrenia, paranoid type,” and considered it “severe.”  The GAF score was 50 (for serious symptoms with serious impairment in social, occupational, or school functioning).  

The Board directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the MDD condition coded 9434 (MDD), citing mild social and industrial adaptability impairment.  The VA rated 30% for the MDD condition coded 9434, based on the July 2003 C&P examination 3 months post-separation, citing occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  

The Board considered the evidence for rating.  First, all Board members agreed that the preponderance of evidence did not support the application of §4.129.  Then, the Board noted that prior to separation, the CI sought treatment for anxiety and paranoid thoughts, and also had feelings of endangerment, difficulty in establishing social relationships, depressed mood, sleep difficulties, and impaired concentration.  Psychotic features continued with thoughts of tapped phones, others talking about him, and cameras monitoring him.  The CI was initially admitted for depression and paranoid thoughts, and diagnosed with “psychosis.”  Anti-psychotic medications were initiated and continued throughout the second hospitalization.  The NARSUM MSE was significant for psychosis, which included a restricted affect, thought content notable for paranoid delusions and ideas of reference; and thought processes that consisted of occasional loose thoughts and circumstantiality.  Although there was some improvement noted at the June 2003 VA C&P examination while on antipsychotic medications, the May 2004 C&P examination provided more details regarding the events occurring during the 12 months post-separation.  There was interval loss of work after 2 months ascribed to his paranoid behavior, specifically suspiciousness, delusions, and religious preoccupation.  There was another hospitalization within 9 months after separation with a subsequent diagnosis of schizophrenia, paranoid type.  Antipsychotic medications were continued and escalated within 12 months of separation.  The MSE was notable for evidence of continued psychosis (irrelevant speech and illogical thought processes, suspiciousness, impaired abstraction, and periods of impaired insight and judgment).  There was no evidence of suicidal ideation, obsessions interfering with routine activities, impaired impulse control, spatial disorientation, or neglect of personal appearance in support of a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 50% for the MDD with psychotic features condition, analogously coded 9434-9203 (MDD; schizophrenia, paranoid type).  

BOARD FINDINGS:  In the matter of the MDD with psychotic features condition, the Board unanimously recommends a disability rating of 50%, coded 9434-9203 IAW VASRD §4.130.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Major Depressive Disorder with Psychotic Features	9434-9203	50%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150206, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00141.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at XXXXXXXXXXXXXXXXXXX to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Principal Deputy Assistant Secretary 
(Manpower and Reserve Affairs)

Attachment:
Record of Proceedings 

cc:
SAF/MRBR