RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02141
BRANCH OF SERVICE:  Air Force 	
DATE PLACED ON TDRL:  20050921	DATE REMOVED FROM TDRL:  20070424

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Medical Administrative Technician, medically separated from the Temporary Disability Retired List (TDRL) for “major depressive disorder [MDD], severe, with mood-incongruent psychotic features…in remission…with panic disorder” with a disability rating of 10%.

CI CONTENTION:  The CI’s condition continues to worsen and negatively impacts daily activities.  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 – 20050809/20070212	VARD - 20060728	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
MDD	9434	50%	10%	Major Depression	9434	10%	10%	
COMBINED RATING:  50% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Major Depressive Disorder.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was admitted on 2 June 2005 for a history of worsening depression, paranoia, and suicidal ideation the previous few months.  She was released on 8 June 2005 on medications and placed into outpatient therapy.  It was subsequently noted that her symptoms began shortly after the birth of her daughter 21 months earlier.  

The PEB rated the MDD condition 50%, coded 9434 (major depressive disorder), severe symptoms.  She was placed on TDRL effective 21 September 2005.  At the 22 June 2006 VA Compensation and Pension (C&P) evaluation, performed 10 months before TDRL removal, the CI reported that she had not been employed since entering TDRL 9 months earlier.  She had not sought work due to her mental health symptoms.  However, she was a single parent and attended college.  She reported that her symptoms of depression and anxiety were improved since separation.  Her condition was thought to be moderate.  

On 13 July 2006 at the mental health examination, the CI reported that her paranoia had resolved.  Her MDD disorder was thought to be in remission.  It was noted that she had also been diagnosed with a panic disorder a few months earlier.  On 5 October 2006, she was seen by the same VA psychiatrist (as in July) and reported irregular compliance with her medications.  She was thought to have symptoms consistent with major depression, but with the psychotic features in remission.  Medication compliance was recommended as was a follow up in 3 months.  

At the 12 December 2006 TDRL NARSUM she reported compliance with her mental health appointments, but irregular use of her medications due to a concern of becoming “dependent” on them.  The medical officer observed that irregular use of or sudden cessation of psychotropic medications (for depression, anxiety, etc.) can actually aggravate the condition and increase symptoms.  She reported a depressed mood several times a months and difficulty sleeping 1-2 times a week due to anxiety over school.  She was making A’s and B’s though.  She endorsed becoming stressed over little things.  She was thought to be in remission, but at risk of relapse if exposed to the stressors of military life.  She was then seen by the treating VA psychiatrist on 5 January 2007, 1 month after the NARSUM and 4 months prior to TDRL removal.  She was thought to be showing depressive symptoms with psychotic features.  Medication compliance was again recommended.  

On 24 April 2007 the CI was removed from TDRL.

On 17 August 2007 at the mental health examination, 4 months after TDRL removal, again with the VA psychiatrist.  She reported that she was not taking her medications, but that her symptoms were resolved and that her mood was good.  It was noted that she had been symptom free for the last several months.  On 16 October 2008 the VA psychiatrist again saw her, 20 months after removal from TDRL, and noted that she was asymptomatic and off of medications.  He saw no mental health limitations in re-entry into the military.  

The panel directed attention to its rating recommendation based on the above evidence. 

The PEB rated the MDD condition 10% at TDRL removal, coded 9434 (MDD), noting that the condition had improved and was stabilized.  The VA conducted a de novo review of the evidence from the initial rating as well as the clinical notes addressed above.  It continued the 10% rating for the major depression disorder condition.  The panel considered the evidence.  The CI was not working after TDRL entry, but was a single mother and attended college, obtaining A’s and B’s.  She was noted to be in remission on several visits with others showing recurrent symptoms.  There were no admissions documented after the second admission 2 months prior to TDRL entry and no evidence of emergency room visits after TDRL entry either.  The panel also noted that medication compliance was an issue and that this can itself aggravate symptoms.  The VA mental health note dated 4 months after TDRL removal documented that she had been off of medications and asymptomatic for the past several months suggesting that she was asymptomatic off of mediations near the time of TDRL removal.  The panel observed that this is actually more consistent with a 0% rating.  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 condition.  

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 are 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 20150807, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-02141.

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 appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted, and I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings