RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

name:  XXXXXXXXXXXXXXXXXXXXX		PD-2015-00368
branch of service:  air force	separation date:  20060816

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Communications Computer Systems Control Journeyman, medically separated for “major depressive disorder,” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 - 20060628	VA - 20070628  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive d/o	9434	10%	Depression	9434	NSC	20070628	
Borderline Personality d/o	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Major Depressive Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s major depressive disorder (MDD) began in March 2005 (17 months prior to separation) during her first pregnancy.  Antidepressant medications were started in the fall of 2005.  The CI was enrolled in a partial hospitalization program (PHP) in early November 2005, 9 months prior to separation, for persistent sadness and irritability in the setting of increased personal tensions.  She disengaged from this therapy and was readmitted to the PHP in December 2005, which she successfully completed.  In March 2006, 5 months prior to separation, the CI was hospitalized for 7 days following a Family Advocacy referral for alleged physical and verbal abuse towards her spouse.  At the 10 April 2006 MEB NARSUM examination, 4 months prior to separation, the mental status examination (MSE) showed a “frustrated” mood, a restricted to dysphoric (depressed) affect, and thoughts that were rigid and ruminative.  The rest of the MSE was normal, with normal cognitive behavior (attention, memory, and judgement) and no evidence of suicidal or homicidal ideation, psychosis or paranoia.  The examiner diagnosed MDD with marked military impairment and definite social/industrial impairment, with a global assessment of functioning (GAF) of 54 (moderate symptoms).  Comorbidity with Axis II, was rated as “major.”  Axis II included borderline personality disorder with the same military (Marked) and social/industrial impairment (definite) for that Axis.  The examiner further stated that “despite a year of aggressive medication treatment, individual and marital therapy, and use of both inpatient and PHP resources, the patient continues to report uncontrollable sadness and agitated anxiety of an unpredictable nature that results in prominent occupational and social role problems” with poor short term prognosis, and the need for continuance of aggressive treatment for mood lability, stress reduction, and development of an understanding social support network.  At a 3 May 2006 mental health visit, 3 months prior to separation, with the same examiner that had done the NARSUM, the CI reported high stress from custody and divorce proceedings and that she had hung up on her first sergeant, but that she was not particularly depressed.  The CI reported “spending regular time with friends and getting moral support from this.”  Social activities included talking with friends, shopping, and playing poker.  The examiner documented a normal MSE with normal mood, speech, and cognitive behavior (attention, memory, and judgement), and reported the CI had a reactive, broad affect and was talkative and well groomed.  A diagnosis of MDD, post-partum type and partner relational problem was made and a GAF of 55 was assigned.  There was no evidence of suicidal or homicidal ideation, thought disorder, psychosis or paranoia.  The examiner concluded by characterizing the problem as an agitated mood, sometimes depressed mood, and impulsivity, which was attributed to MDD and borderline personality disorder diagnoses.  The examiner indicated he expected the symptoms to continue throughout “court matters” (presumably divorce and/or any charges that had been filed), though the examiner indicated they would then reduce intensity if the CI adhered to the planned interventions.

At the VA Compensation and Pension (C&P) examination, 10 months after separation, the CI reported twice monthly crying spells, twice weekly apathy and depressed mood, and difficulty handling stress.  She was divorcing, lived alone with her child, and had been working in telecommunications for the previous 7 months (so the new job was started approximately 2 months after separation).  The CI also reported that her medications were effective.  Social activities included bowling, playing softball, going out to dinner and playing cards.  The MSE was normal with a normal mood and appropriate affect.  The examiner reported that the CI did not appear to be depressed, that personality disorder traits were in evidence, and that marital problems were being resolved by divorce.  The examiner also estimated the impact of psychiatric symptoms on social and occupational functioning was minimal.  A diagnosis of depressive disorder, NOS secondary to personality disorder and marital problems was made.  GAF was estimated to be 67 (Some mild symptoms).

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated MDD at 10% coded 9434 (MDD).  The VA determined the depression was not service connected, stating that the “…condition neither occurred in nor was caused by service.”  The panel first agreed that VASRD §4.129 did not apply in this case.  The panel next considered the evidence for rating.  The panel discussed whether the level of impairment at separation was best characterized by the 10% or the 30% rating criteria.  The diagnoses offered by mental health providers indicated symptoms attributed in great part to particular stressors, and the mental health examination most proximate to separation (3 May 2006 examination, 3 months prior to separation) expected symptoms to decline in severity when stressors were removed.  At that examination, the CI reported good social interaction even in light of the pending divorce.  The record shows the CI was gainfully employed within 2 months of separation even while also raising her child, and reported no difficulties with that employment.  The CI reported at the C&P examination that even though her divorce was still pending, she continued with the social activities reported prior to separation along with some additional ones not previously reported (the addition of bowling, softball, and going out to dinner).  She also reported that medication was effective, and the evidence indicates removal of the stressors of the military environment and her marriage also contributed to reduced symptoms.  Members thus agreed that the 10% rating criteria (“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”) was the most accurate characterization of impairment at the time of permanent separation, and that the level of impairment was better aligned with the 10% criteria than those for the 30% rating level.  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.  

Contended PEB Conditions:  Borderline Personality Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the borderline personality disorder was not unfitting.  This contended condition does not constitute a physical disability, IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending it as unfitting.  After due deliberation in consideration of the preponderance of the evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB determination of the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the MDD condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended borderline personality disorder condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’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 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00368.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings