RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00503
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20030615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Refrigeration and Air Condition Technician, medically separated for “major depressive disorder,” 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 upon a 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 - 20030328	VARD – 20080506	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Recurrent MDD with Generalized Anxiety Disorder	9434	30%	20080122	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

MDD, Moderate, Recurrent.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a history of depressive symptoms since early in her military career with a hospitalization in 1993 for suicidal ideation and depressive symptoms.  She had several episodes of depression with significant worsening of symptoms in 2002.  She was placed on limited duty (LIMU) in August 2002.  Despite treatment with medication and psychotherapy, the CI’s major depressive disorder condition did not improve sufficiently to meet the requirements of the CI’s military specialty and she was referred for MEB.  The MEB forwarded “Major Depressive Disorder [MDD], single episode” for PEB adjudication.

The MEB mental health NARSUM dated 13 February 2003, 4 months prior to separation, noted complaints of depressive symptoms with starting medication prior to her becoming pregnant.  Evaluation in August 2002 had shown severe neuro-vegetative signs and the CI was pregnant.  The mental status examination (MSE) showed a dysphoric mood with congruent affect.  The CI made poor eye contact, was tearful, and talked and moved slowly.  There was no suicidal ideation, delusions, hallucinations or other symptoms suggestive of psychosis, speech disturbance, objective cognitive impairment, or other abnormality.  The psychiatrist diagnosed MDD, moderate, recurrent.  The Global Assessment of Functioning was 50 (serious symptoms).  The CI was placed on limited duty on 8 August 2002, for MDD, included no more than 25 hours of work per week and was further restricted as the CI’s symptoms worsened.

The commanders’ non-medical assessment statements dated 20 February and 3 March 2003 (3 months prior to separation), indicated that the CI’s condition had worsened over the prior 6 months and that “her mental stability is in question.”  The CI had gone from a competent, motivated, fully functional Staff Non-Commissioned Officer to one who is unable to perform even the most basic duties required of a Marine.”

There was no VA Compensation and Pension (C&P) examination proximate to separation.  The first VA C&P examination was performed in 2008, nearly 5 years after separation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD condition 10%, coded 9434 (MDD).  The VA rated the MDD condition 30%, coded 9434 based on the VA C&P examination 5 years after separation.  The Board adjudged that the MEB mental health NARSUM had the highest probative value for rating at separation.  The Board noted that there was no traumatic event causing the unfitting mental health condition and therefore concluded that application of VASRD §4.129 was not appropriate in this case.  All Board members agreed that at the time of separation, the §4.130 threshold for a 50% rating was not approached and that the criteria for a 0% rating were well exceeded.  The deliberation settled on arguments for a 30% versus a 10% permanent rating recommendation.  The Board considered the MEB psychiatrist’s assessment reflecting moderate symptoms, significant duty limitations, and a GAF in the serious range; and the commander/NMAs’ February and March 2003 statements indicating the CI was not able to perform even the most basic duties and was working only limited hours.  All Board members agreed the CI’s condition at the time of separation supports a 30% disability rating, and that her level of impairment was better described as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the MDD condition, coded 9434.

BOARD FINDINGS:  In the matter of the major depressive disorder condition, the Board unanimously recommends a disability rating of 30%, coded 9434 IAW VASRD §4.130.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Major Depressive Disorder	9434	30%	

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

	
MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 17 Nov 16 ICO XXXXXXXXXXXXXXXXXX     
	(c) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 09 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 09 Nov 16 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (g) are approved.  The official records of the following individuals are to be corrected to reflect the stated disposition below:

     a. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List on date of discharge with a final disability rating of 30 percent (increased from 10 percent). 

     b. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List on date of discharge with a final disability rating of 30 percent (increased from 10 percent). 

     c. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List on date of discharge with a final disability rating of 40 percent (increased from 20 percent).   

     d. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List on date of discharge with a final disability rating of 30 percent (increased from 0 percent).

     e. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge.      

     f. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 
     
3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)