RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00770
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071121

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Chemical Operations Specialist, medically separated for “major depressive disorder,” with a disability rating of 10%.  

CI CONTENTION:  The CI indicates her mental health conditions were diagnosed as PTSD by the VA.  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 - 20071108	VARD - 20080219	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder…	9434	10%	PTSD w/ Depressive d/o NOS…	9435-9411	50%	20080129	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

Major Depressive Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health condition began in April 2004-April 2006 while being stationed in Korea.  During this time she received treatment from mental health (MH) that included therapy and anti-depression medication.  She was doing well and eventually stopped all medications.  One report noted treatment for psychiatric symptoms, including anxiety with panic attacks 2-3 times per week, moderate depression and extreme irritability, in July 2004.  She deployed to Iraq October 2006-July 2007 and began to have problems again with depression, anxiety and panic attacks.  Medications were restarted but she did not do well and was referred to Combat Stress.  She was evacuated to Germany where she became an inpatient for 4-5 days and was then evacuated back to Ft. Carson.  She has been treated with individual and group therapy and medication management.  The MEB forwarded MDD for PEB adjudication.  

The MEB NARSUM examination on 12 October 2007, 1 month prior to separation, noted complaints of anxiety and depression.  The anxiety is very high around other people so she prefers to be alone.  Symptoms had not improved significantly although she was taking an anti-anxiety medication and an anti-depression medication.  She had not worked in her MOS since being evacuated from theater.  She was attending appointments and had extreme anxiety about anything in the military.  Diagnoses of MDD and panic disorder with agoraphobia were rendered with a Global Assessment of Functioning (GAF) score of 55 (moderate symptoms, impairment.)  Impairment for social and industrial adaptability was opined to be moderate.  Psychiatric addendum, also dated 12 October 2007, noted the CI was admitted to an inpatient facility 21 September-24 September due to suicidal ideation and discharged with a diagnosis of PTSD although her admission summary noted she does not have PTSD.  She was followed in clinic on numerus times and diagnoses remained MDD and Panic disorder with agoraphobia.  

At the 29 January 2008 VA Compensation and Pension (C&P) evaluation for PTSD, performed 2 months after separation, the CI reported panic attacks, discrete episodes of intense anxiety with increased respiratory rate, heart rate and extreme anxiety twice per month.  She had a history of cutting as an adolescent and last cut herself July 2007.  She had nightmares about once a month, intrusive thoughts, easy startle, does not like large crowds, sleep issues and difficulty with her temper.  She denied agoraphobia.  She took a sleep aid infrequently since it was sedating, an anti-depression medication sporadically and an anxiolytic medication which helped.  As a radio operator she heard of things that occurred, was exposed to mortar attacks 2-3 times and saw the loading of a deceased person onto a plane.  She had friends, lived with her family, and liked to watch movies.  She was unemployed.  She reported a hospitalization in September 2007 and reported possible paternal sexual abuse.  MSE was unremarkable.  Diagnoses of PTSD, depressive disorder NOS and panic disorder without agoraphobia were rendered with a GAF score of 52 (moderate symptoms, impairment.)  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD with elements of panic disorder condition 10%, coded 9434 (MDD), citing reduced reliability and productivity.  The VA rated the PTSD with depressive disorder NOS condition 50% coded 9435-9411 (Mood disorder NOS with PTSD), based on the VA C&P examination 2 months after separation, citing symptoms controlled by continuous medication.
Application of VASRD §4.129 is considered by the Board 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 Board then considered if there was evidence for a §4.130 rating higher than the 10% assigned by the PEB.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication” for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.” The MEB NARSUM noted she was still reporting anxiety, especially in the presence of others and depression.  She had not returned to work in her MOS since her evacuation from Iraq.  There was little improvement in symptoms despite treatment with two psychotropic medications.  She was not stable on medications.  Both the NARSUM examination 1 month prior to separation and the C&P examination 2 months after separation consistently report functional scores in the moderate range of symptoms and impairment.  Members agreed she met criteria for 30% disability rating.  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 MDD condition, the Board 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 20150602, 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 
XXXXXXXXXXXXXXXXXX, AR20170000264 (PD201500770)

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 re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

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:

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

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA