RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00934
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060501

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Tactical Aircraft Maintenance Journeyman, medically separated for “major depressive disorder [MDD], recurrent, existed prior to service [EPTS]” 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 - 20060227	VARD - 20070214	
Condition	Code	Rating	Condition	Code	Rating	Exam	
MDD, Recurrent, EPTS	9434	10%	Bipolar Disorder	9432	30%	20060929	
Substance Abuse: Alcohol	Cat III	No VA Placement	
Tobacco Habituation	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

MDD, Recurrent, EPTS.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first recommended to visit Life Skills Clinic for stress management during an Occupational Health physical examination (PE) on 25 March 2005.  His initial visit to Life Skills was on 21 September 2005 which indicated the CI had feelings of depression and irritability in context of marital problems, pending divorce, and a stressful work environment.  During military service, he was first diagnosed with depressive disorder, not otherwise specified on 23 September 2005.  Due to active suicide ideation with intent, the CI received 10 days of inpatient psychiatric treatment beginning on 15 October 2005.  However, from late 2005 through April 2006 the CI was closely followed by outpatient psychiatry for continuing symptoms of depression with intermittent thoughts of suicide as well as actively participating in periods of self-mutilation via cutting and burning.  Despite intensive psychiatric counseling and frequent use of prescription medication, the CI’s symptoms did not sufficiently improve to allow unrestricted duty.  The MEB forwarded “depression” for PEB adjudication.  

At the MEB NARSUM examination on 24 January 2006, 3 months prior to separation, the CI reported “… a history of mild, intermittent depressive symptoms dating back to high school.”  He additionally reported that past symptoms were generally mild and did not impact his functioning or require treatment.  However, the provider documented the following statement:  “Medical record review, however, indicates a suicide attempt via an overdose while in high school suggesting significant symptoms at that time.”  The CI currently endorsed symptoms of depressed mood, insomnia, anhedonia (loss of pleasure), low energy, and poor concentration.  He denied any further self-mutilation and prior suicidal thoughts were now transient and less intense.  His current stressors were noted as a pending divorce and work stress.  He reported feeling daily job stress and chronic worry about his work on jets.  His NARSUM mental status examination (MSE) revealed a depressed mood with a congruent affect.  All other aspects of the MSE were logical, appropriate, or normal.    

At the 29 September 2006 VA Compensation and Pension mental health (MH) evaluation, performed 5 months after separation, the CI reported continued symptoms of depression mixed at times with anxiety leading up to panic attacks.  His VA MSE revealed objective signs of anxiousness, depression, and flat affect.  Suicide ideation was intermittently present.  Hallucinations were not present.  
 
The panel directed attention to its rating recommendation based on the above evidence.  The PEB originally conceded a 30% impairment rating coded 9434 (MDD), and arrived at a final 10% rating citing a 20% deduction due to EPTS/contributing factors with possible service aggravation.  Additionally, the PEB identified two Category III conditions (conditions that are not separately unfitting and not compensable or ratable) of substance (alcohol) abuse and tobacco habituation.  The VA rated the mental health condition at 30% coded 9432 (bipolar disorder), based on the VA C&P examination 5 months after separation, citing moderate occupational and social impairment.  Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for MH conditions.  Although the PEB and VA applied different VASRD codes, both codes were supported under §4.130 guidelines.  

Panel members first agreed that there was no specific, highly stressful service-related event to invoke VASRD §4.129 for a mental disorder due to traumatic stress.  Nearly all the documented stressors were stemming from his marital/family discord or self-induced worries about working on airplanes.  The panel therefore will consider only the VASRD §4.130 impairment present near separation for a single rating recommendation.  Members then considered if there was evidence for a VASRD §4.130 rating higher than the PEB’s original 30% near the time of Service separation.  Although the CI displayed periods of “mood disturbance”, the criteria for the higher 50% impairment level was not applicable in this case.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), all panel members agreed that a rating greater than the PEB’s original 30% was not supported by VASRD criteria.  

The panel next considered the PEB’s 20% rating deduction.  The PEB’s AF Form 356 rationale for this determination is excerpted below:

The IPEB also notes your EPTS Depression and recent alcohol abuse, a non-ratable/non-compensable conditions under disability law/policy, and opines they significantly affect the severity of your current Major Depression. The Board opines were it not for the non-ratable I non-compensable condition, your Social and Industrial Adaptability Impairment rating would best be described as none to mild IAW DoD/VASRD guidelines.  

The panel agreed to place near exclusive probative value upon the provider’s comment with regard to their own record review which indicated the CI had a drug overdose suicide attempt in high school, as documented in the NARSUM.  Such provider-authored documentation of a suicide attempt (although not listed by the CI upon entrance examination) clearly indicated the severity level of a mental health condition prior to service entry.  Therefore, the panel agreed that such evidence was sufficient as well as fair and appropriate to uphold the PEB’s 20% deduction for a mental health condition that EPTS. 

Contended PEB Conditions:  Alcohol Substance Abuse and Tobacco Habituation.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the MDD condition and IAW VASRD §4.130, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended alcohol substance abuse and tobacco habituation conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the Board’s scope of review for consideration.  The panel, therefore, recommends that 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 20150606, 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-2015-00934.

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.