RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX                                                                          CASE:  PD-2015-00279
BRANCH OF SERVICE:  Army                                                                  SEPARATION DATE:  20061031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “major depressive disorder, single episode, moderate to severe,” with a disability rating of 10%.  

CI CONTENTION:  The applicant, via an attached brief prepared by his attorney, contends that he should have been discharged for post-traumatic stress disorder (PTSD), rated not less than 30%.  His complete submission, with attachments, 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. 

In addition, the Secretary of Defense Mental Health Review Terms of Reference directed a comprehensive review of Service members with certain mental health (MH) conditions referred to a disability evaluation process between 11 September 2001 and 30 April 2012 that were changed or eliminated during that process.  The MH condition was reviewed regarding diagnosis change, fitness determination and rating in accordance with VASRD §4.129 and §4.130.

RATING COMPARISON:  

 SERVICE PEB - 20060918	VARD - 20070425	
Condition	Code	Rating	Condition	Code	Rating	Exam	
MDD…	9434	10%	PTSD w/ MDD	9434-9411	30%	20070301	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY: 

MDD. According to service treatment records and the Medical Evaluation Board (MEB) MH narrative summary (NARSUM), the CI sought treatment for his symptoms of depression and anxiety, consistent with MDD, in August 2005.  At the time of presentation, he reported difficulties with sleep, energy, concentration, increased appetite, fatigue, distractibility, restlessness and occupational stress.  In addition he had some symptoms suggestive of PTSD; however, no specific event was documented.  The CI had deployed to Southwest Asia and after he returned home, he began to experience difficulty at work and had problems with his spouse.  The couple had a newborn being treated in the intensive care unit for a congenital condition.  The CI noted he felt stressed over his occupational and psychosocial problems. He was treated with psychotropic medication and psychotherapy with some improvement.  However, his condition did not improve sufficient enough to allow for continued military service, and therefore, he was referred for an MEB.

At the MEB on 15 June 2006, 4 months before separation, the CI related that his occupational stress had continued, although, his medication made it easier to cope.  He noted that he had seen his therapist in the week prior, and stated his wife had left him.  He had come home from work and found she was gone with their son and many of their possessions.  This was stressful.  He had ongoing frustration and stress at work.  The examiner noted that the CI had no history of psychiatric hospitalization, suicidal or homicidal ideation, or domestic violence.  His depression had been present for 9 months and his response to treatment had been inconsistent despite compliance.  

The mental status examination (MSE) was accomplished 2 days prior by the treating psychologist.  The therapist noted that he had a sad demeanor and subdued affect, but noted his demeanor was “overall quite appropriate.”  All other aspects of the MSE were normal.  The diagnosis of MDD, single episode moderate to severe was recorded, and a Global Assessment of Functioning (GAF) score in the serious range was noted.  The examiner documented occupational and partner relational problems, noting his external precipitating stress was severe due to ongoing occupational and interpersonal problems.  However, it was noted the CI’s degree of impairment for civilian, social, and industrial adaptability was mild.

The VA Compensation and Pension (C&P) mental examination was accomplished approximately 4 months after separation.  The examiner reported that since leaving the Service, the CI reported he was last seen in MH 1 month prior to separation, and he was not taking medication because he had run out.  He noted that his medication had helped him to feel calmer and less irritable.  He sleep was better and his anxiety less when he took the respective medications for these conditions.  The CI was looking for employment, and was expecting to take on-line college courses in about 2 weeks.  

MSE noted that the CI presented to the examination accompanied by his wife and baby.  He had full range of affect and no abnormalities.  Though the psychologist noted, “There are no events in the military that ever got him scared,” the examiner assessed PTSD and documented that the CI’s mood symptoms were mild, and that he had mild emotional and social impairment.  A GAF score in the mild range was recorded, and it was noted that the treating psychologist had also assigned a mild GAF score at the time of discharge from the service.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the MDD condition at 10%, coded 9434, and noted that it began when the CI experienced “many external stressors.”  The VA rated the condition of PTSD with MDD at 30%, coded 9434-9411.

The Board, IAW DoDI 6040.44 and DoD guidance (which applies current VASRD §4.129 to all Board cases as appropriate), must consider if the definition of §4.129 is met for any psychiatric condition resulting in medical separation; i.e., “a mental disorder that develops in service as a result of a highly stressful event.”  All Board members agreed the provisions of §4.129 were not applicable in this case.  

The Board next proceeded with its rating recommendation under VARSD§ 4.130 based on the evidence. Regardless of the diagnosis, 4.130 rating is based on symptoms independent of diagnosis, therefore, all MH symptoms were considered in the rating.  

The record demonstrated the CI had no history of psychiatric hospitalizations or visits to the ER.  Suicidal or homicidal ideations were not recorded.  He reported substantial benefit from his medications and although the NARSUM psychiatrist noted his depression was moderate to severe, mild impairment was recorded.  The commander’s statement noted that his performance was adequate, but he required close supervision.  He was not performing the job of his assigned MOS.  No behaviors or symptoms of his illness with the exception of decreased concentration, were recorded in the commander’s performance statement.  At the time of the VA examination, the CI had not taken medications for at least a few months.  He reported good response to medications when he took them.  Despite absence of treatment, his MSE was normal and the examiner stated his symptoms and condition were mild.  The CI was seeking employment and was in the process of beginning online coursework.

Board members concluded that the evidence at the time of separation, was most reflective of the 10% level of disability for “occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication.”

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.

BOARD FINDINGS:  In the matter of the Major Depressive Disorder, single episode, moderate to severe condition and IAW VASRD §4.130, the Board recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.   

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150412, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

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

22 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160019414 (PD201500279)

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, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA