RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00351
BRANCH OF SERVICE: AIR FORCE 	                        SEPARATION DATE:  20051024

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Aerospace Propulsion Engine Journeyman, medically separated for "major depressive disorder (MDD)” with a disability rating of 10%.  

CI CONTENTION:  The CI contends for MDD, chronic urticaria and a shoulder condition not rated by the Physical Evaluation Board (PEB).  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20050831	VARD - 20060531	
Condition	Code	Rating	Condition	Code	Rating	Exam	
MDD	9434	10%	Depression	9434	NSC	STR	
Idiopathic Chronic Urticaria	Cat II	Urticaria	7899-7806	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDTIIONS:  0%	

ANALYSIS SUMMARY:  

MDD. According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI self-reported to behavioral health for anger management and depression counseling in September 2004.  There was one overnight admission to psychiatry for a reported suicide attempt in September 2004.  He was discharged on an antidepressant and subsequently attended three visits to behavioral health through October 2004.  The CI attended a substance abuse seminar in November 2004 and was cleared of any substance abuse diagnoses.  

At the 3 February 2005 MEB NARSUM examination, 8 months prior to separation, the CI was taking an antidepressant and denied depression, difficulty sleeping, and suicidal ideation.  The mental status examination (MSE) noted an appropriate affect and normal thought process with no delusions or suicidal ideation.  

In a 15 February 2005 memorandum for flight medicine, the CI reported the remediation of symptoms while on medications and denied symptoms of depression while on the job or in his personal life.  The flight commander recommended a change of profile to S1 for his MDD condition.  

At the 9 June 2005 MEB NARSUM examination, 4 months prior to separation, the CI reported a “favorable response” to medications and therapy.  The MSE showed appropriate affect, normal thought process, and no delusions or suicidal ideation.  The CI was medically disqualified from flying duties, however the examiner recommended a return to duty without limitation.  

There was no VA Compensation and Pension (C&P) examination in evidence for review.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the MDD, coded 9434 (MDD), citing “mild” social and industrial adaptability impairment.  The VA did not grant service connection for the MDD, citing no evidence of chronicity.  

All panel members first agreed that the preponderance of evidence did not support the application of §4.129 for any “mental disorder that develops in service as a result of a highly stressful event”.  The panel next considered the evidence for rating.  There was no evidence of occasional decrease in work efficiency nor intermittent periods of inability to perform occupational tasks due to depressed mood, anxiety, suspiciousness, panic attacks, sleep impairment, or memory loss.  The NARSUM did not record any evidence of neglected hygiene, impaired activities of daily living, panic attacks, impairment in thinking or judgment, deficits in memory, or periods of inability to perform occupational tasks due to mental health symptoms.  There was no documentation of alcohol/substance abuse, legal difficulties, or psychiatric emergency room treatment or hospital admissions after the initial diagnosis.  All panel members agreed that the evidence did not support a higher 30% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the MDD condition.  

Idiopathic Chronic Urticaria (Category II).  The STR and MEB NARSUM noted that the CI’s urticaria condition began in 2003.  There were three separate urticaria flares noted:  19 September 2003 (2 years prior to separation), 14 October 2003, and June 2004 (16 months prior to separation).  

At a clinic visit on 8 June 2004, the third episode of urticaria was confirmed and treated with systemic immunosuppressive medications.  At a 16 June 2004 clinic visit (2 weeks later), the urticarial lesions were confirmed as resolved.  However, upon discontinuation of treatment, the urticaria promptly returned (17 June 2004) and the immunosuppressive medications were continued.  

There were no more clinical entries regarding urticaria documented between July 2004 and October 2005, and no documentation of continuous immunosuppressive medication therapy during the year prior to separation.  

The 9 June 2005 MEB NARSUM, 4 months prior to separation, noted a P1 profile for the urticaria.  The examiner stated that the urticaria was “favorably responding to medication,” and recommended “return to duty without limitation.”  There was no commander’s statement in evidence that specifically addressed the urticaria.  

There was no VA Compensation and Pension (C&P) examination in evidence for review.  

The panel directed attention to the rating recommendation based on the above evidence.  

The PEB adjudicated the urticaria as Category II, a condition that can be unfitting but is not compensable or ratable.  The VA did not grant service connection for the urticaria, citing no evidence of chronicity.  The panel first addressed fitness.  There were no documented episodes of urticaria in the year prior to separation.  The urticaria was not profiled nor was there a commander’s statement regarding the condition.  The NARSUM examiner stated that the urticaria was “favorably responding to medication,” and recommended “return to duty without limitation.”  Members agreed that there was no performance-based evidence from the record that the urticaria significantly interfered with satisfactory duty performance and that this condition was not reasonably justified as separately unfitting.  

After due deliberation, and in consideration of the preponderance of the evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the urticarial condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the MDD condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended category II urticaria condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150528, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

Physical Disability Board of Review
XXXXXXXXXXXXXXXXXXXXX

MEMORANDUM FOR THE DIRECTOR, AIR FORCE REVIEW BOARDS AGENCY

SUBJECT:  	Physical Disability Board of Review Recommendation on XXXXXXXXXXXXXXXXXXXXX Case Number PD-2015-00351

	In accordance with Title 10 § 1554a and in compliance with DoDI 6040.44, the Physical Disability Board of Review (PDBR) adjudicated the disability rating accompanying the medical separation of the covered individual from the United States Air Force.  After carefully reviewing the application and medical separation case file, the PDBR recommended no re-characterization of the separation or modification of the disability rating previously assigned.

I have reviewed the application and Record of Proceedings and I recommend you accept this proposed decision.

As a reminder, a copy of your decisional documents must be provided to the PDBR at the following address:

XXXXXXXXXXXXXXXXXXXXX
	Sincerely,

Attachments
1.  Record of Proceedings
2.  Case File