RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00943
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050301

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Aerospace Maintenance Repair, medically separated for “major depressive disorder,” with a disability rating of 10%.

CI CONTENTION:  His condition continues to worsen and impact his daily life, he also requests a review of all conditions.  The CI’s 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 - 20041206	VARD - 20060623	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder…	9434	10%	Depressive Disorder	9434	10%	20060428	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD) Associated with Dysthymic Disorder (d/o).  According to service treatment records (STR) and the Mental Health (MH) Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s MDD began in September 2004.  The CI was encouraged by his First Sergeant to be evaluated for feelings of being overwhelmed, despair, frustration, and episodes of crying.  The CI was evaluated by MH for depressed mood and anger that the CI related to a recent personal life stressor of divorce.  Additionally, he related he regretted joining the Air Force which he did due to the encouragement of his wife.  The CI was evaluated by a psychiatrist on 27 September 2004 and diagnosed with MDD, single episode, moderate, and an antidepressant medication was started.  
The MEB NARSUM examination on 6 October 2004, 5 months prior to separation, noted complaints of mood swings and irritability, with increasing frequency of angry outbursts, sometimes associated with punching objects such as a wall or mailbox.  He denied suicidal or homicidal ideation.  He reported insomnia with low energy, with no racing thoughts or impulsivity.  He reported decreased concentration and appetite with a 25 pound weight loss in two months.  The CI denied significant anxiety or panic attacks, but did worry a lot.  He had no history of previous MH care and denied any suicide attempts or prior use of psychotropic medications.  The mental status examination (MSE) was incomplete due to a page of the MH NARSUM being missing, but noted no evidence of a thought disorder or psychosis.  The CI was judged to be a good historian.  Insight and judgment were limited.  The Axis I diagnoses were MDD, single, severe and dysthymic d/o.  On Axis II the examiner noted a “probable personality d/o [disorder], NOS [not otherwise specified] evidenced by maladaptive relationships, but current pattern of behavior may be 2° to Axis I.”  The MH MEB NARSUM examiner recommended that after discharge from the “PHP” [partial hospitalization program] the CI should continue with talk therapy and antidepressant medications.  

The commander’s statement dated 8 October 2004, 5 months before separation, indicated the CI’s MH condition significantly limited his ability to perform his assigned duties.  It noted that the CI was a hardworking Airmen, but his inability to cope with stressful situations and tasks common to newly assigned Airmen without constant supervision would restrict his ability to be deployed overseas.  

The final MH note in record dated 27 January 2005, 1 month before separation was a termination case summary. The summary indicated the CI had stopped his antidepressant medication (Celexa) on his own due to sedating side effects and had “mild persistent depression.”   It also documented that the CI’s mood had stabilized after the PHP and that suicidal ideation had been resolved for three months.  The Axis I diagnosis was MDD, single, moderate and the GAF was 68, which is in the mild impairment range on this scale.  He was given another antidepressant medication at that time (Lexapro).  

At the 28 April 2006 VA Compensation and Pension (C&P) Psychiatric examination, performed 13 months after separation, the CI reported being depressed and angering easily.  The CI reported he had improved on Lexapro, but had not taken medication since April 2005 because he did not have insurance and did not think he had any veteran’s benefits to obtain care.  The VA examiner noted the depressive symptoms initially started in May/June 2004 in response to the CI’s distress with the regimentation in the military and going through a divorce.  The CI reported often feeling depressed with crying three to four times per week.  He reported insomnia and difficulty with concentration and memory when anxious.  The examiner noted that the CI reported feeling panicky when he gets angry but did not describe any overt panic attacks.  The CI reported a history of verbal abuse by his father, but got along with his mother and a current girlfriend.  He denied any history of physical or sexual abuse.  He was in a few fights in high school, but had no disciplinary or legal problems.  He denied substance abuse issues or any history of domestic assaults.  Since discharge from the military the CI had two jobs.  He was fired from the first for a “poor attitude” and the second he was terminated due to absences, which he attributed to back pain and depression.  He had not worked in the last 5 months.  The MSE showed a mildly depressed mood with some anxiety and constricted affect and was otherwise unremarkable.  The Axis I diagnosis was depressive disorder, not otherwise specified.  On Axis II the examiner noted “personality traits, but not a personality disorder.”  The GAF assignment was 60, which is in the moderate impairment range on this scale.  The VA MH examiner indicated that the CI had personality traits “but does not appear to have a personality disorder” and he had “mild to moderate” industrial and social impairment and would likely improve with consistent MH treatment and psychotropic medication.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD associated with dysthymic d/o condition 30%, coded 9434 (major depressive disorder) and also adjudicated a personality disorder, NOS as a Category III condition which was not unfitting.  The PEB applied a 20% deduction to the 30% MDD rating for aggravating/contributing factors.  In the remarks section of DA Form 199, the PEB noted that the CI had a personality disorder and opined that “were it not for the non-ratable/non-compensable condition [personality disorder], the CI’s “social and industrial adaptability impairment rating would be described as mild IAW Department of Defense/Veteran’s Administration Schedule for Rating Disabilities Guidelines.”  The VA rated the MDD condition 10% coded 9434, based on the VA C&P examination 13 months after separation.

The panel first 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.  The PEB rated the MH condition 30% but deducted 20% for a significant contribution to impairment due to a non-ratable personality disorder.  IAW DoDI 1332.38, enclosure 5, a personality disorder is a condition that does not constitute a physical disability and is not eligible for disability rating when considered alone.  However, there was no evidence of a definite diagnosis of a personality disorder in the MH records prior to separation.  The MH MEB NARSUM listed a “probable” personality disorder on Axis II, but noted it was also possible the current behavior was secondary to the Axis I diagnosis.  At the post-separation VA examination, the MH examiner’s assessment was that the CI had personality traits (which all people have and do not imply pathology), but did not have a PD.  Moreover, members agreed that it is impossible to clinically dissect the psychiatric impairment in this case into ratable and non-ratable contributing factors and concluded a deduction was not justified on this basis.  Therefore, the panel reviewed to see if a higher rating than the 30% assigned by the PEB (without a deduction) was supported in this case.  However, all members agreed that there was insufficient evidence to support the 50% rating specified as “occupational and social impairment with reduced reliability and productivity”; referencing typical symptoms of flat affect, stereotyped speech, frequent panic attacks, deficits in comprehension and memory, impaired judgment, mood disturbance, and difficulty with establishing relationships.  At the time of separation the CI was improved after the PHP and was noted to have mild residual depression symptoms, despite not being on antidepressant medication.  At the post-separation VA examination, the CI was not under MH care or taking psychotropic medications and he was assessed as having “mild to moderate” impairment that was anticipated to improve with regular MH treatment.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the major depressive disorder associated with dysthymic disorder condition, coded 9434.  

Contended PEB Condition.  The panel’s main charge is to assess the fairness of the PEB’s determination that the personality disorder was a Category III, not unfitting condition.  As noted above the personality disorder is a not a Service ratable condition IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending it as unfitting.  Additionally, the CI’s total MH impairment is given a single rating based upon total social and occupational functioning IAW VASRD 4.130 and any impairment due to non-ratable factors is subsumed in the panel’s rating recommendation for the MDD condition.  After due deliberation in consideration of the preponderance of the evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

PANEL FINDINGS:  In the matter of the major depressive disorder associated with dysthymic disorder condition, the panel unanimously recommends a disability rating of 30%, coded 9432 IAW VASRD §4.130.  In the matter of the contended personality disorder condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the panel’s scope of review for consideration.  

The panel 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 20150607, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXXX	

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00943.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at XXXXXXXXXXXXXXXXXXX to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

Attachment:
Record of Proceedings