RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00805
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051212

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Imagery Production Journeyman, medically separated for major depressive disorder (MDD), with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  The 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 – 20051006 	VARD - 20090618	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Major Depressive Disorder	9434	30%	20080930	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Major Depressive Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was initially seen in the military for an adjustment disorder in 1998 due to stress during training.  This resolved in September 1998 without sequelae and she was cleared in 1999 for an overseas assignment without restrictions.  The CI also maintained a TS/SCI (Top Secret/Sensitive Compartmented Information) clearance.  She next came to mental health attention in 2002.  She was seen by a clinical psychologist on 14 March 2002 and reported post-partum depression and marital distress.  The examiner also recorded that the CI had been hospitalized at age 17 for a suicide gesture and then treated as an outpatient for several months.  She was referred to stress management and issued an S2 profile.  She subsequently placed on an anti-depressant and improved over the following months.  She was also entered into the weight management program as she was overweight (59 inches and 149 pounds).  Psychological testing on 29 October 2003 showed traits maladaptive for stressful situations.  Despite this, the CI achieved superior Enlisted Performance Reports (EPRs) in both 2002 and 2003.  On 23 July 2004, the CI was seen in life skills and noted to be doing well on medications, but to have several stressors including: an imminent move; her spouse was on a remote assignment; and, her children were back in the continental United States.  An EPR which closed on 31 July 2004 noted that she was ready for promotion (4/5 rating by both supervisors).  She was marked down for appearance (weight) and conduct.  Previously, she had achieved 5/5 overall ratings.  She was selected for promotion to E-5, but this was held due to her weight.  She continued to do well overall though and her profile was noted to be S1 at a Life Skills Appointment on 30 August 2004.  Following her move, she was assessed at her new duty station on 8 November 2004.  She reported vague suicidal ideation without intent, plan, or means.  She was diagnosed with a recurrent MDD with borderline personality traits.  She was seen by her psychiatrist on 14 January 2005 and requested discontinuation of her anti-depressant medication to begin weight loss medications.  She then tapered off the anti-depressant medication and changed to a different anti-depressant on 25 January 2005.  She denied safety issues (suicidal or homicidal ideation).  The CI entered an outpatient educational and training program from 28 February to 4 March 2005 which she completed successfully.  She denied suicidal or homicidal ideation.  She was again evaluated in psychiatry on 28 March 2005 for persistent and increasing MDD symptoms despite treatment.  An MEB was discussed as it was thought that her military service contributed to the refractory nature of her illness (due to her weight issues, as discussed in the NARSUM).  On 25 April 2005, the CI reported increased symptoms.  She had recently miscarried and her husband was TDY.  She denied suicidal ideation.  At the psychiatric follow-up on 12 May 2005, she reported recent panic attacks.  It was noted that her profile had not been updated to an S4 to initiate an MEB.  This was then done that day.  Her final EPR closed out on 31 July 2005 and encompassed the prior 12 months.  She achieved 5/5 in all categories and in the overall assessments with the exception for “meets standards” as she was still overweight.  The MEB NARSUM examination was dated 15 August 2005, 4 months prior to separation, and accomplished by her treating psychiatrist.  The CI reported that she had been hospitalized for one week in October 2002 for suicidal ideation and to stabilize her medications.  These records were not in evidence and there was no mention of this found in the contemporaneous records.  The examiner also recorded that the CI had been voluntarily admitted from 3-6 February 2005 for suicidal ideation with a plan.  At follow-up on 8 February 2005, she reported that she was distressed regarding her weight management difficulties and impact on her career as well as feeling that her children related to their father (her husband) better than they did to her.  She reported that her weight and marital issues were her primary stressors.  She stated that her promotion was still being withheld and that she and her husband were considering divorce.  The mental status examination was notable for a dysphoric mood (a state of unease or dissatisfaction).  Her thought content was good and suicidal ideation absent.  The examiner noted that the CI had a mood disorder and was less efficient at work when depressed.  It was also noted that she would benefit from continued treatment for her coping skills and personality features.  The squadron commander’s assessment was prepared on 19 August 2005, 4 days later.  He noted that her “duty performance is minimally hampered by her medical condition….It has been determined that the member is fully capable of accomplishing all duty requirements in-garrison, or deployed…I recommend [CI] be retained on active duty.”  The MEB, dated 6 September 2005, forwarded “major depressive disorder, recurrent, moderate,” “borderline personality disorder”, and “migraines” for PEB adjudication.  The next day she had a normal MSE [mental status examination], without indications of homicidal or suicidal ideation, and was an active and attentive participant in group therapy.  One week later, she endorsed moderate to severe depression and fleeting suicidal and homicidal ideation.  Her risk was thought to be mild.  On 31 October 2005, 6 weeks prior to separation, she was again seen by her treating psychiatrist.  She reported an increase in anger and irritability.  She also reported in increase in the marital tension due to her impending separation.  She denied immediate safety concerns.  On examination, she showed a full and appropriate, but non-labile affect.  Her mood was dysphoric.  The thought content was normal.  Her medications were again adjusted.  In Life Skills on 2 November 2005, she was noted to have a normal MSE without homicidal or suicidal ideation.  She was again and active and attentive participant.  The final mental health record prior to separation was dated 22 November 2005 and with her treating psychiatrist.  Her MSE was unchanged.  However, she reported the deliberate ingestion of 12 Naprosyn tablets prior to the previous appointment, in the face of recent marital discord.  This was addressed and the CI again contracted for safety.  Her safety contract was reviewed and the CI informed that it included possible self-harm as well as behavior with suicidal intent.  She voiced understanding of this.  The VA Compensation and Pension (C&P) evaluation was not performed until 30 September 2008, remote from separation.  She had been working as a payroll clerk for the past year.  She also reported military sexual trauma.  The Board noted that the examination was performed well outside the 12-month window after separation accorded higher probative value for rating purposes.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD condition 10%, coded 9434 (Major Depressive Disorder), citing a current rating of 30%, minus aggravating/contributory factors of 20%, for a total compensable rating of 10%.  The Board noted that there actually is no 20% deduction.  However, in Section 15 (Remarks) of the AF Form 356 (PEB Form), the PEB explicitly noted that the impairment would best be described as mild were it not for the non-ratable, non-compensable Borderline Personality Disorder.  The Board observed that this approach is correct, that is to rate the impairment after exclusion of the non-ratable factors which contributed to the total impairment.  The Board concurred with the PEB assessment as outlined in Section 15 of the AF Form 356.  Her job performance was exemplary and her commander recommended retention.  The VA rated the MDD condition 30%, also coded 9434, but based on the VA C&P examination 33 months after separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the mental health condition.

BOARD FINDINGS:  In the matter of the major depressive disorder condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication.  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.  

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
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-2015-00805.

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,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings