RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01740
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O1, United States Military Academy officer, medically separated for “major depression, recurrent,” with a disability rating of 10%.

CI CONTENTION: The CI made no specific contention.  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 - 20080819	VARD - 20090106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depression, Recurrent	9434	10%	Major Depression, Recurrent	9434	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  
 
Major Depression, Recurrent.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first seen for symptoms of depression while attending a service academy in January 2008, almost 5 months prior to graduation and 10 months prior to separation.  He was hospitalized for suicidal ideation for 10 days beginning on 25 April 2008 approximately 2 months prior to graduation, in the context of stress over “school, upcoming graduation, being a lieutenant …and upcoming marital plans,” and was treated with a psychotropic medication.  At the time of follow-up 1 month later he was eating and sleeping well, and denied thoughts of harm.  He successfully completed term examinations, and was due to graduate and be married in a few days.  Mental status examination (MSE) showed normal appearance, and anxious mood and affect.  Insight and judgment were fair.  An assigned Global Assessment of Function (GAF) was 75, connoting transient symptoms or no more than slight impairment.

During a 15 July 2008 primary care clinic visit for follow-up of depression at his new duty location, 4 months prior to separation, the CI reported that symptoms were well-controlled with current medication.  There was no sleep disturbance or anxiety, energy was normal, and depression was mild.  The CI reported no thoughts of suicide and no problems with interpersonal relationships, but he requested continued counseling.  Three days later the CI presented to the emergency room after taking 10 antidepressant pills in a suicide attempt, and was subsequently hospitalized for one week.  A note by a psychiatrist on 21 July 2008 indicated that increasing depression occurred over the previous 2 weeks, and that the CI wanted to separate from the service.  The examiner concluded that future episodes of depression and suicidal thoughts were likely to occur if he remained in the military. 

The NARSUM examiner on 25 July 2008, 4 months prior to separation, reported a 2 week history leading up to hospitalization of loss of appetite and low self-esteem.  Sleep disruption was due to his training schedule.  He had thoughts of suicide for 1 week, and an argument with his wife led to the overdose.  He was immediately regretful of the overdose attempt.  The CI felt that he had completely recovered from the previous episode of depression that led to the first hospitalization, and ascribed worsening depression to him and his wife being at different duty stations.  At the conclusion of the hospitalization, he denied any suicidal ideation and was not complaining of depression.  He expressed happiness that his wife was pregnant, and looked forward to joining her at her assignment location.  MSE showed a normal appearance and orientation.  Cognition and speech were intact, and insight and judgment were good.  He was “in good spirits” and affect was variable and appropriate.  Based on “symptoms of loss of interest and motivation, depressed mood most of the day, poor appetite, disrupted sleep…and thoughts of death and suicide,” the examiner rendered a diagnosis of major depression (recurrent, moderate).  The degree of impairment for social and industrial adaptability was deemed to be mild.  At an MEB separation examination on 1 August 2008, one week later the MSE documented normal appearance, orientation, affect, memory and speech, and noted that depression was “present by history.”

The commander’s statement on 15 August 2008 three months prior to separation noted that the CI could remember locations, procedures and instructions, could communicate effectively, and could sustain an ordinary routine without extra supervision.  However, it was also noted that the mental condition prevented him from “completing any of his [MOS] tasks & missions.”  There was no VA Compensation and Pension examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  Regardless of final PEB diagnosis, §4.129 does not specify a diagnosis of PTSD, rather it states “mental disorder due to a highly stressful event,” and its application is not restricted to PTSD.  The panel agreed there was not sufficient evidence to support a conclusion that a highly stressful event severe enough to bring about the veteran’s release from active military service occurred and that the application of §4.129 was not appropriate in this case.  The PEB rated the major depression 10%, coded 9434 (major depressive disorder), citing “mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress with symptoms requiring continuous medication.”  Using the same code, the VA rated the major depression 0% due to lack of evidence of current disability after discharge from the service.  The 10% rating specifies “occupational and social impairment due to mild or transient symptoms which decrease work efficiency … only during periods of significant stress, or; symptoms controlled by continuous medication.”  The §4.130 criteria for the 30% rating are “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks,” and 50% requires occupational and social impairment with reduced reliability and productivity.”  Panel members agreed however that the latter criteria were not approached, and therefore a rating higher than 30% was not supported.  Despite the considerable stress leading to the first hospitalization, the panel noted that occupational performance was relatively intact, as reflected by successful completion of all term examinations and graduation.  The panel noted the NARSUM’s assessment that social and industrial impairment was “mild” and that the commander’s statement depicted no significant limitations in communication, independent work and memory.  The NARSUM and clinical entries on 15 and 21 July 2008 portrayed symptoms that were transient and occurred during periods of significant stress.  It was thus concluded that the 10% rating most accurately described the condition at the time of separation.  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 major depression condition.

BOARD FINDINGS:  In the matter of the major depression 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150702, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008886, XXXXXXXXXXXXXXXXXX 

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,					      
						      					
Enclosure