RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01272
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050802

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Munitions Systems Journeyman, medically separated for “depression associated with anxiety and suicidal thoughts,” with a disability rating of 10%.

CI CONTENTION:  The CI makes no specific contentions.  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 - 20050510	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Depression Associated with Anxiety and Suicidal Thought	9434	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Depression Associated with Anxiety and Suicidal Thoughts.  According to the service treatment record (STR) and the mental health (MH) Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s MH condition began in November 2003 when the CI sought medical care for his anxiety symptoms and was started on psychotropic medication.  In early February 2004, the MH notes indicated diagnoses of major depressive disorder (MDD) and generalized anxiety disorder (GAD).  The CI was admitted to an inpatient psychiatric facility on 23 February 2004 for attempted suicide and he reported recent depression and addiction to playing internet games.  The psychiatrist noted that the CI’s increasing addiction to the games had led him to suicidal ideation (SI) when something goes wrong in the game.  He was diagnosed with chronic major depression and addictive disorder, not otherwise specified (NOS).  In the summer of 2004, the CI discontinued his medication on his own and did not attend MH appointments from August 2004 to the end of November 2004.  The CI was admitted to an inpatient psychiatric unit in December 2004 due to suicidal thoughts.  A MH note the same day as the admission noted that repeatedly making suicidal statements/exhibiting suicidal behaviors “even if not serious, are signs of immaturity and impulsivity” not compatible with continued military service.  The CI was reportedly diagnosed with adjustment reaction with depressed mood and personality disorder, NOS with narcissistic traits.  The CI refused psychotropic medications, but desired to continue counseling.  However, records from this hospitalization are not available to the panel.  On two Enlisted Performance Reports from March 2003 to February 2004 and March 2004 to February 2005, the CI was rated excellent to exceptional in all categories and recommended for “immediate promotion.”  This was prior to the CI’s hospitalization for S/I.  The commander’s statement dated 29 March 2005 indicated that the CI was only able to be successful and work full shifts due to the commander’s accommodations regarding the CI’s work shift and work duties.  Additionally, the commander noted that the CI had missed work days due to his psychiatric hospitalizations.  

The 4 February 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of depression and anxiety.  The mental status examination showed a normal mood (euthymic) and a constricted affect.  The CI denied SI in the past month.  There were no delusions, hallucinations or other symptoms suggestive of psychosis, speech disturbance, objective cognitive impairment, or other abnormality.  The Axis I diagnoses were MDD, recurrent, moderate, “on no medication by patient’s choice;” generalized anxiety disorder and Axis II noted “no diagnosis, but with avoidant personality traits.” The global assessment of functioning assignment was 50, which reflects serious impairment on this scale (41-51).  An 11 April 2005 addendum to the MH MEB NARSUM, 4 months before separation, noted the CI continued “to struggle with symptoms of anxiety and depression.”  The MH examiner indicated the CI continued to be non-compliant with treatment, was not currently on any psychotropic medications and had made “little progress” in treatment.  Between the MEB NARSUM addendum and separation, the CI was restarted on a different psychotropic medication for his MH symptoms with significant benefit.  At a family practice visit on 11 July 2005, 1 month before separation, the CI reported he felt “50% better” on his current medications and he requested refills.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the depression and anxiety condition 30%, coded 9434 (major depression disorder), and deducted 20% due to non-compliance, citing that the CI’s impairment was “solely” the result of non-compliant behavior.  Under the remarks section, the PEB stated that the IPEB “opines that…Social and Industrial Adaptability Impairment rating is best described as no more than Mild with the recommended medications and psychotherapy.”  The panel noted that there was no traumatic event causing the unfitting MH condition and therefore concluded that application of VASRD §4.129 was not appropriate in this case.  Although the CI was diagnosed with MDD and anxiety, as well as GAD, a single VASRD §4.130 rating is applied based on the overall occupational and social impairment due to the symptoms from both conditions.  While non-compliance with generally acceptable medical standards of care can affect the severity of a ratable condition, once a condition is determined to be unfitting, the panel must rate the condition IAW VASRD guidelines.  The VASRD §4.130 rating criteria for the CI’s MH condition does not incorporate non-compliance as a deduction for rating and the panel may not recommend a lower combined rating than that of the PEB.  The PEB assigned a 30% rating without regard to a deduction.  Therefore, the panel reviewed to see if a higher rating than 30% was supported.  In the 2 years before separation the CI’s received two excellent EPRs and the commander’s statement confirmed that the CI was able to work productively and effectively, but only with significant accommodations, and in the 12 months before separation there had been one inpatient psychiatric hospitalization that caused the CI to miss work days, thus “intermittent inability to perform occupational tasks.”  All members agreed that the 30% rating specified as “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily …)” was appropriate and that the 50% rating threshold which requires evidence of “reduced reliability and productivity” was not met based on the evidence in record.  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 depression associated with anxiety and suicidal thoughts condition, coded 9434.  

BOARD FINDINGS:  In the matter of the depression associated with anxiety and suicidal thoughts condition, the panel unanimously recommends a disability rating of 30%, coded 9434 IAW VASRD §4.130.  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	
Depression associated with Anxiety and Suicidal Thoughts	9434	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150612, w/atchs
Exhibit B.  Service 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-2015-01272.

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