RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00494
BRANCH OF SERVICE:  air force 	SEPARATION DATE:  20051109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard E7, Information Management Craftsman, medically separated for “depressive disorder, mild…” rated 10%.   

CI CONTENTION:  The CI requests all conditions be considered.  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 - 20050927	VARD - 20080401	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Depressive Disorder, Mild…	9434	10%	Depressive Disorder	9434	NSC	STR	
Tobacco Abuse	Cat III	No VA placement	
Alcohol Dependence			
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Depressive Disorder, Mild Social and Industrial Adaptability.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s depression condition began in July 2004 with work stress, frequent separations from her husband, problems with her older son, and finance issues as the main stressors at the time.  She was evaluated by family practice on 21 September 2004, diagnosed with depression, and treated with anti-depression and anti-anxiety medications.  She had multiple drug regimens and was treated twice as an inpatient (6 days and 4 days, respectively) in November 2004 for anxiety, depression and alcohol abuse.  She reported the alcohol helped her to sleep and “calm down.”  

The 12 November 2004 MEB psychiatry NARSUM examination, 12 months prior to separation, noted the previous inpatient treatments.  The CI was taking two different anti-depression medications, one in the morning and one at night.  She reported she had been drinking a half fifth of liquor a day “for a few years.”  She lacked insight into her drinking and denied a history of delirium tremens (DTs).  A mental status examination (MSE) noted the CI was anxious and sometimes slightly tremulous, but there was no delusional thought content.  Diagnoses of severe alcohol dependence and depressive disorder NOS were rendered, with a Global Assessment of Functioning (GAF) score of 55 (moderate impairment, symptoms.)  

A NARSUM exam performed the same day as the psychiatry NARSUM, noted that several days after discharge from one hospital the CI had been admitted to the medical unit for treatment of severe hand burns, especially the left hand.  She had a number of life stressors including separation from her husband, and she reportedly fell into the fireplace after cooking while intoxicated and overdosing on three psychotropic medications.  Physical examination showed blistering and burns to the left hand, to include all fingers and to a lesser extent her palms.  Her right hand showed second degree burns over small areas.  A diagnosis of alcohol intoxication with secondary hand burns was rendered.  

A memo from the Acting Chief of Psychiatry to the Medical Board, dated 22 June 2005, noted a diagnosis of depressive disorder NOS (not otherwise specified) and alcohol dependence in early full remission, with a GAF score of 60 (moderate impairment bordering on mild symptoms)  The memo reported that the CI’s was being prescribed two anti-depression medications, and that the she showed some problems at work but was in therapy for depression and also should be seen by an addictions counselor.  Finally, the memo opined that her two diagnoses (shown above) should not be disqualifying, and that the CI had not received appropriate treatment up to that point.  The CI completed intensive outpatient treatment at an addiction program on 11 August 2005 and was then eligible to begin one year of outpatient rehabilitation.  The CI cancelled her VA Compensation and Pension (C&P) evaluations (scheduled for December 20, 2007 and February 25, 2008).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the depressive disorder condition 10%, coded 9434 (major depressive disorder).  The VA considered the depressive disorder condition not service connected (NSC) and used the same code as the PEB (9434).  The VA based their decision on the STR, citing no evidence of permanent residual or chronic disability.  

Application of VASRD §4.129 is considered by the panel for all cases of service-connected psychiatric conditions resulting in separation, but all members agreed that the ‘highly stressful event’ requisite for §4.129 was not satisfied in this case.  The panel then considered if there was evidence for a §4.130 rating higher than the 10% recommended by the PEB.  The §4.130 criteria for a 10% rating includes “symptoms controlled by continuous medication,” while those for 30% include “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  The panel noted that available evidence only reflected treatment for substance abuse at the time of separation, not the depressive disorder.  Additionally, the Acting Chief of Psychiatry indicated that her diagnoses, including depressive disorder, were not disqualifying.  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 depressive disorder condition.  
  
Contended PEB Conditions:  Tobacco Abuse and Alcohol Dependence.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of these is a compensable condition, and alcohol abuse was not implicated as integrally intertwined with the unfitting depressive disorder by any psychiatric examination in evidence.  After due deliberation the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the depressive disorder and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended tobacco abuse and alcohol dependence, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends there be no modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150529, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00494.

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,

Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings