RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02006
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050509

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Health Care Specialist/Combat Documentation Production Specialist, medically separated for “major depressive disorder and anxiety disorder” 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 - 20050203	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder and Anxiety Disorder	9434	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Major Depressive Disorder and Anxiety Disorder.  According to the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health condition began in childhood and continued through her teen years, including a suicide attempt.  This was not disclosed on the CI’s service entry examinations and there are no mental health service treatment records (STR) in evidence.

The MEB NARSUM documents the CI sought mental health treatment in September 2004 after her symptoms worsened while deployed.  She self-medicated with an anti-depressant which had been prescribed a few years earlier (it is not clear who prescribed the medication).  She presented to mental health as a walk-in patient and was admitted for safety and stabilization.  She reported having a suicide ideation for the previous few weeks.  Psychotropic medications were prescribed and she improved sufficiently although she remained symptomatic after discharge.  Over the next few months, her medication regime was adjusted which resulted in some mental health symptoms improvement, but she continued to have difficulty at work despite being placed on light, administrative duty.  She was also separated from her (second) husband.

The MEB mental health examination on 3 January 2005, 2 months prior to separation, noted that she was shaking during the interview with frequent tears.  She showed decreased volume of speech (normal otherwise), depressed and anxious mood with congruent affect, logical but frequently tangential thinking, intermittent suicidal ideations without active planning, fair to poor insight, and fair judgement.  Concentration, attention and abstract ability were intact.  She was diagnosed with a major depressive disorder without psychotic features; anxiety disorder not otherwise specified (NOS); and alcohol dependence in remission.  She was also noted to have a personality disorder NOS.  It was noted that she could not tolerate mild stressors without “breaking down”.

There was not a VA examination in evidence for the panel to review.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the major depressive disorder and anxiety disorder condition 10%, coded 9434 (major depressive disorder), citing the use of a psychotropic medication and outpatient treatment.

The panel considered the evidence.  Although the CI’s mental health condition had its onset prior to service, a deduction was not taken by the PEB IAW 10 USC 1207a, as the CI had over 8 years of service.  The panel noted that the use of psychotropic medications supports a 10% rating adjudicated by the PEB.  The panel noted that the CI was assigned light duty but could not handle mild stress without breaking down.  The panel agreed this meets a 30% rating.  The panel then considered a 50% rating.  It was noted that the CI had one hospitalization, for 6 days, which occurred shortly after a confrontation with her leadership.  She was prescribed psychotropic medications and she improved sufficiently although she remained symptomatic after discharge.  There was no evidence of further hospital admissions or emergency room encounters.  Improvement on medications was noted.  Her mental status examination noted frequent tangential thinking, but intact concentration, attention and abstract ability.  Speech was normal other than mildly decreased volume.  The panel majority determined that the level of impairment did not support a 50% disability rating.  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 MDD and anxiety disorder condition, coded 9434.

BOARD FINDINGS:  In the matter of the major depressive disorder and anxiety disorder condition, the panel majority recommends a disability rating of 30% coded 9434 IAW VASRD §4.130.  The single voter for dissent recommends re-characterization to 50% and elected not to submit a minority opinion.  There are 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	
Major Depressive Disorder and Anxiety Disorder	9434	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150323, w/atchs
Exhibit B.  Service Treatment Record

AR20170011808, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure