RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01666
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20021126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Heavy Wheeled Vehicle Mechanic, medically separated from the Temporary Disability Retired List (TDRL) for “major depressive disorder,” with a disability rating of 10%.  

CI CONTENTION:  “I still have real issues w/depression treated w/daily medications.  I struggle every day to be a productive member of society.”  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 - 20021018	VARD - 20011114	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Major Depression	9434	10%	20010926	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI became depressed following completion of chemotherapy for testicular cancer.  He was referred to mental health and initially evaluated on 19 December 2000.  Additional stressors included financial difficulties, a divorce (his wife initiated this shortly before he was diagnosed with testicular cancer), and poor health in his father (recent heart surgery).  He was begun on an anti-depressant and reported significant improvement at follow up on 12 March 2001.  These records are not in evidence, but are referenced in a mental health note dated 15 March 2001.  It was noted that he was doing well on medications and no further treatment in mental health was needed at that time.  On 29 March 2001, the commander noted that the CI was working in a purely administrative capacity and that his performance had been excellent.  The MEB mental health addendum to the NARSUM was dated 4 April 2001, 6 months prior to placement on TDRL.  His symptoms were noted to be improved on medications.  He was no longer as depressed and was more optimistic.  The mental status examination was normal.  It was noted that he was in partial remission, but did not meet retention standards and should stay on the anti-depressant.  The CI was given an S3 profile on 21 May 2001.  The MEB forwarded major depression single episode, moderate, in partial remission with treatment for PEB adjudication.  

At the 26 September 2001 VA Compensation and Pension (C&P) mental health evaluation, 3 days before placement on TDRL, the CI reported that he wanted to train as a social worker.  He had begun dating and had reconciled with family members from whom he had been estranged.  He was working out to regain muscle mass loss during his treatment.  He did report some sleep disturbance which was attributed to the underlying depression.  His mental status examination was relatively normal other than some sadness when discussing emotionally difficult issues.  These were not specified.  Minimal occupational impairment was present.  MDD in partial remission was diagnosed.  

There were no mental health records in evidence after TDRL entry until the examination done on 11 September 2002 for the TDRL PEB re-evaluation.  The CI reported a spike in his symptoms and suicidal ideation a few months earlier after he had run out of medications a few months previously.  He reported ongoing mood swings and initial insomnia (difficulty falling asleep).  He thought the former affected his relationships with his family and friends.  He was working as a truck driver and had a roommate.  His family was located in the local area and he saw them on a fairly regular basis.  He denied hospitalizations for a mental health condition.  Current medication included Paxil.  On examination, a mild amount of psychomotor retardation was present, but speech and thought content were normal.  He was thought to remain in partial remission, but not fit to return to duty.  Recommendations included the addition of Ambien to use on an as needed basis for his sleep issues.    

The panel directed attention to its permanent disability rating recommendation at the time of removal from the TDRL based on the above evidence.  The PEB rated the MDD condition 10%, coded 9434 (major depressive disorder), citing improvement, considered to be in partial remission, and moderately symptomatic.  No additional VA examination was in evidence.  A 10% rating is warranted whenever there is occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational task only during periods of significant stress; or symptoms controlled by continuous medications.  The higher 30% requires evidence of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to such symptoms as: depressed mood, anxiety, suspiciousness panic attacks (weekly or less often), chronic sleep impairment and mild memory loss.  The panel did not find evidence to support a higher rating of 30%.  Therefore, the panel concluded a 10% rating was appropriate.  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 at TDRL removal.  

BOARD FINDINGS:  In the matter of the MDD condition and IAW VASRD §4.130, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’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 20150626, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170006653, XXXXXXXXXXXXXXXXXX 

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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,					       
						      					
Enclosure