RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01083
BRANCH OF SERVICE:  Coast Guard 	SEPARATION DATE:  20080506

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Machinery Technician, medically separated for “major depressive disorder” rated 10%.

CI CONTENTION:  “I’m 100% disabled vet and my condition is why I was separated from the military.”  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 - 20071213	VARD - 20140930	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder…	9434	10%	Major Depressive Disorder…	9434	*100%	20140926	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 100%	
*Rating granted effective 20131113, beyond probative timeframe for panel consideration

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM)/addendum, the CI’s MDD condition began in February 2007 with reports of fleeting suicidal ideation (SI), depressed mood, anger,   irritability, and decreased frustration tolerance.   In April 2007, he became upset when he received news from home that his girlfriend gave birth to a stillborn child.  He sought counseling and was prescribed medication which initially improved his symptoms.

On 29 May 2007, after receiving news that his parents were homeless, the CI was admitted to inpatient psychiatric care after he threatened to harm himself by overdose and wrist-cutting.  On the following day, he presented himself as being well and not in need of any help.  The CI reported he was not taking any psychotropic medications and had no desire to receive a prescription for any.  He was released on 7 June 2007 and enrolled in a partial hospitalization program which he attended daily.   On 3 August 2007, the CI reportedly made passive threats to harm himself and others when providers determined he should be transitioned from outpatient treatment.  He was again admitted for psychiatric care until 8 August 2007 and observed to have transient periods of mood instability and suicidal thoughts when faced with perceived stressors.  

The MEB NARSUM examination (undated), noted the CI was “doing well as a day worker assigned to the Master at Arms force on base awaiting discharge.” The mental health NARSUM addendum, dated 16 November 2007, 6 months before separation, noted complaints of depressed and irritable mood, loss of interest in enjoyable activities and feeling overwhelmed.  The CI attributed his mood-related symptoms to major job stress and family problems, felt his chain of command was unsupportive and no longer wanted to continue with military service.  

The mental status examination was unremarkable with the exception of a dysphoric affect and passive SI without plan or intent for self-harm.  The examiner opined that the CI’s condition “will likely abate when the relevant stressors are lessened or he is removed from the stress of the military setting.”  The recorded Axis I diagnoses included:  anxiety disorder, not otherwise specified, with generalized anxiety, obsessive-compulsive features causing psychosocial and occupational dysfunction; and MDD, moderate, in partial remission.  A diagnosis of personality disorder, not otherwise specified, was documented on Axis II.  The examiner assigned a Global Assessment of Functioning (GAF) score of 62 for mild symptoms and impairment.  The CI did not file a VA claim until late November 2013.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the MDD 10%, coded 9434 (MDD), and cited mild or transient symptoms IAW VASRD §4.130.  The VA examination was too remote from separation for the panel’s consideration.  The panel members first agreed that the provision of VASRD§ 4.129 for a “mental disorder that develops in service as a result of a highly stressful event” were not applicable in this case.

The panel next considered the rating recommendation.  Members noted the CI had two inpatient admissions but none in the 9 months prior to separation.  While he continued MH treatment, there were no emergency room visits, no continued suicidal ideations and a mild GAF score recorded in the 6 months leading to separation.  Additionally, the psychiatrist opined that the MDD was in partial remission.  The panel concluded the CI’s condition at separation was most reflective of the 10% level of disability for “occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication.”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the MDD condition.  

BOARD FINDINGS:  In the matter of the MDD condition and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20150604, w/atchs
Exhibit B.  Service Treatment Record

	

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX,

I am the Designated Decision Authority for the Coast Guard on applications submitted to the Department of Defense Physical Disability Board of Review (PDBR).  Under the authority of Title 10, United States Code, section 1554a, I accept the PDBR’s recommendation in your case (Case Number PD-2015-01083) and decline to modify your findings. 

Enclosed for your information are a copy of the PDBR’s recommendation and a copy of the record of proceedings. 

A copy of this decision has also been provided to Coast Guard Enlisted Personnel Management Branch, the PDBR, and the Department of Veterans Affairs. 

If you have any further questions, please contact the Coast Guard Personnel Service Center at XXXXXXXXXXXXXXXXXXX. 

	Sincerely,

	XXXXXXXXXXXXXXXXXXX
Rear Admiral, U. S. Coast Guard
Assistant Commandant for Human Resources

2 Enclosures	

Copy:	CG Personnel Service Center (EPM-1)
DoD Physical Disability Board of Review
Department of Veterans Affairs