RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02164
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070507

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Postal Specialist, medically separated for “major depressive disorder” rated 10%.

CI CONTENTION:   The CI did not submit a contention with the application.  The CI’s complete submission is 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 - 20070320	VARD - 20120516	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder…	9434	10%	Depression	9434	NSC	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s depressive symptoms began in mid to late 2006 after the premature (32 week) delivery of her first child and worsened after the spontaneous loss of a pregnancy in December 2006.  She received initial treatment and follow-up care through Life skills and Mental Health by way of medications and counsel.  There was no history of psychiatric hospitalizations.  On 22 September 2006, 5 months prior to separation, the CI’s diagnosis was listed as major depression; single episode and the provider noted the following under the heading of current status:  “The [CI] with depressive symptoms of postpartum onset. It is difficult to say whether stressors surrounding childcare and premature infant were the main contributors to this depression, or if there is more of a biological component.”  Further psychiatric treatment did not result in symptom improvement sufficient to allow unrestricted military duty.  The MEB forwarded an AXIS I diagnosis of “MDD, single episode, moderate” and placed it under the following comment on the MEB submission; “Multiple medical issues requiring high utilization, resulting in significant absenteeism and questionable military retainability” for PEB adjudication.  

The 31 January 2007 MEB NARSUM examination, 3 months prior to separation, the CI endorsed poor sleep, low energy, fluctuating concentration, low appetite, and some anhedonia (loss of pleasure).  Her mental status examination (MSE) was detailed and normal excepting a mood described as, “Horrible, I have a migraine.”  Specific documentation included “good” judgment and insight as well as a “logical, coherent, goal-directed” thought process.  Her diagnosis remained unchanged and the provider additionally noted, “Her depression is heavily influenced dissatisfaction with having to go to work and guilt over her premature infant and subsequent miscarriage.”  The case file contained two psychology clinical encounters dated February 2007 that noted the CI’s depressive diagnosis was ‘moderate, with post-partum onset’.  During March 2007, various clinical encounters were inconsistent in revealing depressive symptoms; the CI denied depression on 2 March 2007 and then endorsed having such symptoms on 8 and 27 March 2007.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD condition 10%, coded 9434 (major depressive disorder), citing mild social and industrial adaptability impairment.  The VA determined the MDD condition was not service-connected.  The panel first considered if the definition of VASRD §4.129 was met for any psychiatric condition resulting in medical separation; i.e., “a mental disorder that develops in service as a result of a highly stressful event”.  Panel members agreed that although some minor contribution of military-related stressors to the psychiatric condition may have been present by her dissatisfaction with having to go to work, but rather it predominantly was a combination of her premature child as well as her history of losing a pregnancy; therefore, all members agreed that the requisite §4.129 link that the condition occurred “as a result of a highly stressful event” was not adequately satisfied.  The panel therefore will consider only the VASRD §4.130 general rating formula for MH conditions impairment present near separation for a single rating recommendation.  Members then considered if there was evidence for a §4.130 rating higher than PEB’s 10% at time of Service separation.  

All panel members agreed that although the CI endorsed subjective complaints of depression, the MSE near the time of separation did not overwhelmingly correlate with VASRD criteria above the PEB’s current 10% IAW VASRD §4.130.  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’s adjudication for the major depressive disorder condition.

BOARD FINDINGS:  In the matter of the major depressive disorder 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 modification or 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-2015-02164.

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 have 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.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings