RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00366
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, M1 Armor Crewman, medically separated for “major depressive disorder, not otherwise specified” (MDD, NOS) with a disability rating of 10%.  

CI CONTENTION:  “Review all Conditions.”  The CI’s 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 - 20051021	VARD - 20060328	
Condition	Code	Rating	Condition	Code	Rating	Exam	
MDD, NOS	9434	10%	MDD with Anxiety Disorder…	9434	50%	20051220	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Major Depressive Disorder, Not Otherwise Specified (MDD, NOS).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the MDD condition began around January 2005.  The record shows that the CI deployed from 10 April 2003 to 9 April 2004.  A pre-deployment survey dated 19 October 2004 noted that his health was very good.  He denied any current problems or seeking mental health (MH) treatment or counseling the previous year.  The first record in evidence for a MH condition is an emergency room note dated 24 April 2005 in which the CI reported some post-traumatic stress disorder (PTSD) symptoms for the prior 2 months.  He had a normal affect and denied suicidal or homicidal ideation.  He was referred to MH and follow-up was recommended for the next day.  There are no other MH clinical records in evidence prior to separation although it is clear that he was begun on medications for MH diagnoses.  The 23 June 2005 MEB examination (recorded on DD Forms 2807 and 2808), 6 months prior to separation, noted that the CI was in counseling twice a month and on treatment for MDD and anxiety disorder with a possible diagnosis of PTSD.  He was issued a permanent S3 profile.  The commanding officer noted in his assessment dated 12 July 2005 that the CI had recently been relieved of his duties as a tank commander due to a safety incident which was secondary to a lack of attention to standards.  It was also noted that he demonstrated a lack of desire and motivation to help the unit.  He had also shown up late to formation on numerous occasions.  An undated memorandum written by the executive officer and encompassing the period from April 2003 to July 2005, noted that the CI’s performance had been exemplary.  The Board recognized the inconsistency between these two assessments.  The MEB NARSUM examination on 24 August 2005, 4 months prior to separation, noted complaints of “not acting himself” since January/February 2005 and that this seemed to have come on “over-night.”  He reported suicidal ideation without plan or intent.  He reported combat-related nightmares since return from his deployment which had waxed and waned, but were currently frequent.  He had “experienced some notable improvement in his depression and anxiety symptoms” which had also been observed by his wife.  He reported improvement, but had persistent anger at work.  On examination, he was cooperative with psychomotor retardation and depressed affect.  Speech and thought content were normal.  He was diagnosed with MDD single episode and an anxiety disorder NOS.  These were thought to have moderate and marked military impairment, respectively, but mild social/industrial impairment.  He was noted to have PTSD symptoms, but did not meet the criteria for a formal diagnosis.  

The MEB forwarded “major depressive disorder, single episode” and “anxiety disorder, not otherwise specified” for PEB adjudication on 15 September 2005.  An assessment by the commander of the medical hold company dated 18 October 2005 noted that the CI had performed well working as an administrative assistant.  The PEB cited this assessment in its adjudication and also noted that both 10.a. and 10.c. were negative.  At the 20 December 2005 VA Compensation and Pension (C&P) evaluation, performed 8 days prior to separation, the CI reported that his problems all started when he redeployed.  Per the 15 December 2005 general C&P, he was taking Celexa for stress disorder.  He endorsed sleep disturbances, irritability, crying spells, and that he was easily angered.  He reported that his symptoms had improved on medications, but they had recurred after he ran out.  On examination, he was noted to be mildly depressed, but otherwise the examination was unremarkable.  He was diagnosed with depression NOS.  

The CI had a second C&P MH evaluation on 28 August 2006 as directed by VASRD §4.129 (mental disorders due to traumatic stress).  The CI reported that he began treatment for PTSD in March 2004 and that all his problems began after his redeployment (in March 2004).  The Board noted that this is not consistent with the military records in evidence which indicate that his symptoms began in early 2005.  The CI also denied treatment for the MH condition since his discharge from the military.  He reported that he had symptom-free remission which was more frequent than in the past and that “overall he feels like his adjustment to day-to-day life is pretty good.”  The mental status examination was unremarkable.  It was thought that he may meet the criteria for MDD, but that he did not meet them for either a generalized anxiety disorder or PTSD.  He was off medications.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the “major depressive disorder, not otherwise specified” condition 10%, coded 9434 (MDD), for mild social and industrial impairment citing the 18 October 2005 commander’s assessment.  The VA rated the “major depressive disorder with anxiety disorder, claimed as PTSD” condition 50%, coded 9434 (MDD), based on the C&P examination the month of separation, in accordance with VASRD §4.129.  The Board considered if VASRD §4.129 was applicable in this case.  The CI was diagnosed with MDD, single episode and an anxiety disorder NOS, but stressors were noted to be severe from combat, occupational, and marital stress.  Traumatic experiences while deployed were noted.  While some evidence supported a determination that combat stress contributed to the underlying MH diagnosis, this evidence is not consistent and other evidence supported an opposite determination.  However, considering the totality of the evidence and, giving the CI the benefit of doubt IAW VASRD §4.3, the Board determined that the application of VASRD §4.129 was applicable in this case.  The Board then considered the rating at separation following a 6-month stabilization period.  The final commander’s assessment noted that the CI had performed his duties “well.”  The 12 July 2005 commander’s assessment noted poor performance, but this was attributed to poor desire and motivation to do his job.  An undated letter by the executive officer which covered the period from April 2003 to July 2005, noted that the CI’s performance was excellent.  The Board found no record showing that the CI was unable to perform his duties due to the MH condition other than the limitations inherent in an S3 profile (such as no weapons access).  The Board also noted that at the VA examination 8 months after separation, he reported that his overall adjustment to day-to-day life was “pretty good.”  The evidence did not support a rating higher than 10% at separation.  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 condition, coded 9434 for a 6-month constructive TDRL (temporary disability retired list) period followed by a 10% permanent rating at separation.  

BOARD FINDINGS:  In the matter of the MDD with anxiety disorder, NOS condition and IAW VASRD §4.129 and §4.130, the Board unanimously recommends a disability rating of 50%, coded 9343, for a 6-month TDRL period, with a permanent 10% rating.  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.  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
MDD with Anxiety Disorder, NOS	9434	50%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150530, 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX, AR20170002979 (PD201500366)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to  constructively place the individual on the Temporary Disability Retired List (TDRL) at 
50% disability for six months effective the date of the individual’s original medical separation for disability with severance pay and then following this six month period 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 as follows:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of temporary disability effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was separated with a permanent combined rating of 10%  effective the day following the six month TDRL period with no re-characterization of the individual’s separation.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will provide 50% retired pay for the constructive temporary disability retired six month period effective the date of the individual’s original medical separation and adjusting severance pay as necessary to account for the additional TDRL time in service.

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:

Enclosures

CF: 
(  ) DoD PDBR
(  ) DVA