RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00165
BRANCH OF SERVICE:  Army	
DATE OF PLACEMENT ON TDRL:  20010109
DATE OF PERMANENT SEPARATION: 20021023

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O-3 (Counter Intelligence Officer) medically separated for major depressive disorder, with a disability rating of 0%.

CI CONTENTION:  The CI contends that his condition continues to worsen and negatively impacts his daily activities.  His 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 upon a 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:  

Final PEB – 20020909	VA Rating Decision1 - 20020515	
TDRL Placement – 20010109	Code	Rating	Condition	Code	Rating
Proximate	
Condition		TDRL
Placement	TDRL Removal			TDRL2
Placement	TDRL3 Removal	
Major Depressive Disorder	9434	30%	0%	Schizoaffective Disorder	9203	30%	30%	
Other x 0 (Not in Scope)	Other x 0	
RATING:  30% → 0%	RATING:  30%	
1. Most proximate to TDRL Placement
2. Rating derived from C&P examination dated 20020515, ~5 mos. post-TDRL placement and based on service treatment record (STR)
3. Rating derived from C&P examination dated 20020515, ~4 mos. pre-TDRL removal.

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  The psychiatric NARSUM was accomplished at the time of the CI’s discharge from the psychiatry inpatient unit on 14 August 2000.  The CI’s mental health history began while he was stationed in Korea.  However, the CI reported his depressive symptoms began approximately 2 years prior, when his “fiancé” a woman he had corresponded with on the internet but never met, reportedly had died of lung cancer.  He began to have symptoms of depressed mood, decreased energy and interest, problems with sleep and appetite with a 15-pound weight loss, and decreased concentration.  His symptoms persisted for a few months and then slowly resolved.  In May 2000, he begun to have suspicions about the reported death of his “fiancé” and began having some paranoia related to the military.  He began to fear that people were talking about him, that he was under investigation, and that he might be facing court-martial for the screenplay he had written and posted on the internet.  These thoughts led to increasing feeling of depression and intermittent suicidal ideation.  Because of his declining work performance and abnormal behavior, he was command-directed to mental health (MH) for evaluation and was provisionally diagnosed with MDD with psychotic features, and admitted to the hospital, with subsequent evacuation to the U.S.  At the time of his admission to the Military hospital in the states, the CI reported a 4-month history of depression, and denied most psychotic symptoms; however, noted that he believed that others may be watching him or monitoring him and he did reportedly state that he could possibly be getting special messages directed at him from the television or from people he had never met.  His mental status examination on admission documented poor judgment, fair to poor insight, and absence of hallucinations, suicidal and homicidal ideations.  His thought process was intact; however, he did express paranoid ideation.  The CI was prescribed an antipsychotic (Risperdal) and an antidepressant (Zoloft) medication, both of noted benefit.  After approximately 3 weeks of in-patient treatment, he was discharged.  At the time of discharge, his condition was improved.  He was not endorsing significant depressive symptoms, but did have intermittent paranoid symptoms, which the physician opined he was able to manage on his own.  The diagnosis of MDD, recurrent, severe with mood-congruent psychotic features was recorded.  The CI was placed on the TDRL, approximately 3 months after the NARSUM.

The VA Compensation and Pension (C&P) initial evaluation was conducted in May 2002, 6 days prior to the TDRL removal examination.  The C&P examination documented the CI’s report that he remained on his medication for approximately 2 months following his discharge and then discontinued them and has had no psychiatric follow-up since then.  He did continue to have symptoms but reported fewer episodes of paranoid thinking and depressed mood through the spring and summer of 2001.  He began to have a more severe episode in September accompanied by paranoid ideations, but did not seek treatment and his symptoms gradually decreased.  He reported that he had learned following discharge that the “fiancé” had not died and had made the story up to end their relationship.  He noted he was feeling as well as he had since his initial hospitalization and was currently employed as a security guard which he believed was a low stress job.  His MSE was normal; however, his affect was noted to be “somewhat constricted,” and mood was mildly anxious.  The provisional diagnosis of schizoaffective disorder was recorded with a Global Assessment of Functioning (GAF) score of 60 (cusp of moderate and mild).
 
The TDRL removal examination documented the CI had discontinued the antipsychotic medication at the time of discharge, and began to taper his antidepressant medication in February 2001.  He had a depressive episode in December 2001 described in the same way as before with some psychotic symptoms.  He denied suicidal and homicidal thoughts, stated he has had some decreased memory skills which he attributed to not challenging himself enough.  His MSE noted he was somewhat guarded during the interview, and there was some slight paranoia but no hallucinations.  He stated his mood is “happier,” and his affect was noted as normal with some slight guardedness.  The examiner opined that his condition was in full remission, and that the condition was stable without medication; however, it was noted that he was working below his educational and skill level.  The physician also noted that while his depression had improved, it was expected that he may continue to experience “episodes of debilitating depression with possible involvement of psychotic features.”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB, on 27 November 2000, adjudicated the condition of MDD, coded 9434 and assigned a 30% disability rating.  The Board first determined if the provisions of VASRD §4.129 were applicable, and all agreed provisions of §4.129 were not applicable in this case (mental disorders due to traumatic stress).  The Board next proceeded with the rating of the condition at the time of TDRL placement.  The higher 50% rating criteria requires evidence of” Occupational and social impairment with reduced reliability and productivity” demonstrated by symptoms such as flattened affect, panic attacks more than once a week, cognitive impairment, difficulty in establishing and maintaining effective work and social relationships, and impairment in judgment or thinking.  At the time of TDRL placement, the NARSUM noted the CI’s condition had improved after his medications had been adjusted.  His MSE was unremarkable, and his condition was considered stable enough for discharge with outpatient follow-up care.   He had no suicidal ideations, but did have intermittent paranoid symptoms; however, there was no evidence of impaired judgment at the time of TDRL placement.  After due deliberation, and in consideration of all the evidence and VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the MDD condition at TDRL placement.  The Board next considered the most appropriate fit with VASRD §4.130 criteria at the end of TDRL for its permanent rating recommendation. The PEB rated the condition of MDD at 0% and noted the condition had been determined to be in full remission and that the CI was not taking any medications.  However, the PEB also wrote, “The present PEB rating of 10% more accurately reflects the current degree of severity of your condition.”  The Board deliberated the evidence for the 10% versus 0% disability rating.  The TDRL removal examination indicated that while the CI was not having symptoms, he would likely have “episodes of debilitating depression”, and noted that his risk for episodes was increased during times of severe stress.  A recommendation to return to care was not documented.  The C&P examiner also noted that his condition was stable, but indicated he would likely have recurrences. This examiner also did not document any treatment recommendations.   The Board noted the absence of psychiatric treatment, hospitalization, visits to the emergency room for MH symptoms, and the presence of employment.  The CI reported no symptoms of depression at either examination, and although, both speculated his condition would likely recur, Board members concluded, at the time of permanent separation, there was no apparent impairment in social or occupational functioning.  However, the PEB wrote that his condition was rated 10%.  The Board acknowledged that the statement might have been made in error; however, there was sufficient reasonable doubt in favor of the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% at permanent separation for the major depression condition.  

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the MDD, recurrent with psychotic features condition and IAW VASRD §4.130 the Board unanimously recommends no change in the PEB adjudication at TDRL placement and a 10% disability rating at permanent separation.  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, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Major Depressive Disorder	9434	30%	10%	
COMBINED	10%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150212, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXX AR20160011362 (PD201500165)

1. I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (DoD PDBR) recommendation and record of proceedings pertaining to the
subject individual. Under the authority of Title 10, United States Code, section 1554a,
accept the Board's recommendation to modify the individual's disability rating to 10%
without re-characterization of the individual's separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be
corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided
to the individual concerned, counsel (if any), any Members of Congress who have
shown interest, and to the Army Review Boards Agency with a copy of this
memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF:
( ) DoD PDBR
( ) DVA