RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01595
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20080422

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve W02, Field Artillery Target Technician, medically separated from the Temporary Disability Retired List (TDRL) for “major depression single episode, in partial remission,” with disability rating of 0%.

CI CONTENTION:  “My conditions were not pre-existing.”  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 panel 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 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 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 – 20050912/20080227	VARD – 20060512	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Major Depressive Disorder with Dysthymic Disorder…	9434
	30%	--	Dysthymic Disorder …	9499-9434	NSC	--	
Major Depression, Single Episode, in Partial Remission…		--	0%					
COMBINED RATING:  30% → 0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:

Major Depressive Disorder with Dysthymic Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI reported mood swings in Spring 2003 prior to deploying to Iraq deployment which continued after deployment in March 2004.  He presented to mental health in January 2005 due to worsening and impairing depressive symptoms.  The MEB forwarded “major depressive disorder” and “dysthymic disorder” for PEB adjudication.  

The MEB NARSUM examination on 9 August 2005, 4 months prior to TDRL placement, noted the examiner to have ongoing depressed mood with significant sleep disturbance, significant inability to feel pleasure, appetite disturbance, feelings of guilt and worthlessness, decreased energy, poor concentration, suicidal ideation and marked social/industrial impairment despite treatment with two anti-depressive medications.  Psychiatric examination showed that the CI was very cooperative and polite, but very quiet and subdued as well. He displayed moderate psychomotor retardation.  His speech was quiet and monotone, but otherwise of normal rate, rhythm, and was fluent.  Eye contact was fair.  Mood was "depressed."  Affect was congruent and notably down.  Thought processes were logical, linear, and goal directed.  Thought content was significant for intermittent passive suicidal ideation.  Final diagnoses: major depressive disorder, single episode and dysthymic disorder, manifested by greater than 2-year history feeling depressed more often than not with associated decreased interest, decreased energy, feelings of worthlessness and intermittent suicidal ideation.  

At the 30 March 2006 VA Compensation and Pension (C&P) Mental Disorder evaluation, performed 4 months after TDRL placement, the CI reported he was having “a little difficulty focusing.”  CI was off medications for over 1 month.  Psychiatric examination showed no significant findings.  No suicidal ideation.  Diagnosis was major depressive disorder in partial remission, dysthymic disorder and adjustment disorder with depressed mood.  The TDRL evaluation on 2 December 2007, 5 months prior to TDRL removal, noted complaints of a continued inability to feel pleasure with the only exception of playing with his 3-year-old daughter.  The examiner noted that the CI had stopped all medications and has had no psychiatric treatment since TDRL placement.  The mental status examination showed his mood was mildly depressed and anxious and his affect was congruent with his mood.  He denied suicidal and homicidal ideation and denied hallucinations.  There was no evidence of delusions or of a formal thought disorder.  He was alert and fully oriented and recalled 2-1/2 of 3 test items after 5 minutes.  His intellect was above average and his insight and judgment were good.  The examiner also noted that the CI's condition had improved significantly since being placed on TDRL status and the CI had been successfully and gainfully employed for 2 years without requiring further psychiatric treatment.  The CI’s condition had stabilized without requiring psychiatric treatment but it seemed extremely likely that his depression would recur if he were to return to active duty.  The examiner’s final assessment was major depression, single episode, in partial remission.  There was no VA C&P examination performed 12 months before or after TDRL removal.

The Board considered its rating recommendation at the time of removal from TDRL.  The PEB rated the mental health disorders 0%, coded 9434 (major depressive disorder), citing full-time employment with symptoms not severe enough to interfere with occupational or social functioning.  The VA continued non service connection of the mental health disorder(s), analogously coded 9499-9434 (major depressive disorder).  The Board agreed that a 0% rating, was justified for major depressive disorder with a mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.  There was no evidence of 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 to justify a rating of 10% or higher.  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 major depressive disorder at TDRL removal.  

BOARD FINDINGS:  In the matter of the major depressive disorder with dysthymic disorder and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication at TDRL removal.  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 20150626, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170003531, XXXXXXXXXXXXXXXXXX. 

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,