RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02283
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040526

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Fitness Specialist, medically for “mood disorder, not otherwise specified (NOS)” with a disability rating of 10%.

CI CONTENTION:  The CI requests consideration of all conditions.  The 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 - 20040413	VARD - 20041223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mood Disorder, NOS	9435	30%
  -20%
  10%	Mood Disorder	9435	30%	20041119	
Attention Deficit Disorder	CAT III	No VA Rating	
Alcohol Abuse	CAT III	NSC/Compensable	
Attention Deficit Hyperactivity Disorder	CAT III	No VA Rating	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Mood Disorder, NOS.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) Mental Health (MH) narrative summary (NARSUM), the CI’s depression began in approximately October 2001.  On the Report of Medical History at enlistment, dated 22 February 2001, the CI denied any history of MH treatment.  He reported he was in good health and on no medications.  He had entered active duty in March 2001 and had just arrived on base when his depression symptoms began.  
He reported his depression symptoms waxed and waned but never fully resolved, but he attributed some worsening of his symptoms to a head trauma with loss of consciousness for 1 to 3 minutes in October 2002.  The CI was hospitalized for depression for 5 days in September 2003.  Brain magnetic resonance imaging/ angiogram (MRI/MRA) was negative on 12 August 2003.  There was no history of learning disorders, attention deficit hyperactivity disorder (ADHD), delirium, dementia, psychosis or impulse control disorders.  Neuropsychological testing in October 2003 showed the CI to have severe depression, but the examiner noted “his cognitive profile was not consistent with organic brain damage” and also indicated the profile was consistent with ADHD.  The CI was evaluated by psychiatry and diagnosed with major depressive disorder (MDD) and alcohol abuse and he participated in an alcohol abuse program (ADAPT) in August 2003.  

The 3 February 2004 commander’s statement dated referenced the CI’s medical board, noted to be for chief complaint of depression, and indicated the CI had missed many days of work due to his condition and “simply cannot satisfy any duty requirements for this or any job in the Air Force.” 

At the 21 January 2004 MEB MH NARSUM examination, 4 months prior to separation, the CI reported low motivation, easily fatigability, being easily confused, greater difficulty understanding concepts, unpredictable moods, and angry outbursts with a history of several motor vehicle accidents, including a motorcycle accident (with helmet), after which the CI was described as “more controlling and irritable.”  The CI had been abstinent from alcohol for several months.  He was on an antidepressant medication and a mood stabilizing medication had been started a week earlier.  The mental status examination (MSE) showed a “mildly” dysphoric mood and the CI’s affect was “often inappropriate” and was otherwise unremarkable.  The Axis I diagnosis was mood disorder, NOS and the global assessment of functioning (GAF) assignment was 50, which is on the cusp of moderate to serious impairment on this scale.  

The psychiatrist wrote a letter 31 March 2004 after the Informal PEB to clarify the CI’s MEB MH NARSUM (presumably for the Formal PEB).  The psychiatrist made three major points:  

1.	There was no evidence the CI suffered from depression prior to active duty and the first episode of depression was dated at approximately February 2002.  
2.	The examiner provided the opinion that a series of head injuries was related to the CI’s present mood instability.  
3.	The CI would need continued mental health treatment indefinitely to manage his depression and mood instability and the CI’s condition was only in partial remission” on his current medication regimen.

At the 1 September 2004 VA Compensation and Pension (C&P) Mental Disorders examination, 3 months after separation, the CI reported use of mood stabilizing medications prescribed in the military following separation until he ran out of medications, which were then renewed by VA primary care providers.  The VA C&P examiner noted the CI had never been seen by VA psychiatry as an outpatient.  The MSE examination noted a normal mood and slightly constricted affect attributed to the CI’s discomfort with the interview process.  The CI reported anxiety graded 3/10, but the examiner noted that no anxiety was evident.  The remainder of the MSE was normal, except that the examiner noted “mild flight of ideas.”  The CI reported “flights of ideas” at times during the year that coincided with disrupted sleep patterns.  The Axis I diagnosis was mood disorder, NOS, rule out bipolar II disorder, rule out mood disorder due to head injury and alcohol dependence currently in remission.  The GAF assignment was 70, which is on the cusp of minimal or no impairment and mild impairment on this scale.  

The panel directed attention to its rating recommendation based on the above evidence. 
 
The PEB provided a 30% rating, coded 9435 and applied a 20% deduction without further explanation, for a combined 10% rating.  The VA also rated the MH condition 30% coded 9435, based on the VA C&P examination 3 months after separation, citing “occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.”
  
As noted above, the PEB provided a 30% rating for the MH condition and deducted 20% for contributing/aggravating factors.  The panel must base it’s rating recommendation for the unfitting condition upon the VASRD §4.130 rating rules in effect at the time of separation and the VASRD does not provide for deductions unless specified in individual rating criteria and the panel did not find that the evidence in record supported a 20% rating for the CI’s MH condition at the time of enlistment.  Therefore, the panel considered whether the evidence at the time of separation supported a rating higher than the 30% rating adjudicated by the PEB.  The panel did not find evidence for a higher rating without evidence of symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships that are supportive of the 50% rating or other symptoms which caused this level of impairment.  Therefore, the panel concluded a 30% rating was appropriate.  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 mood disorder, NOS condition, coded 9435.  

Contended PEB Conditions:  History of Alcohol Abuse, Tobacco Abuse, and History of Attention Deficit Hyperactivity Disorder (ADHD).  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were implicated by the profile or the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  Additionally, alcohol abuse, tobacco abuse, and ADHD are conditions not constituting a physical disability IAW DoDI 1332.38 and are not eligible for service disability rating.  Lastly, any mental health impairment due to alcohol abuse or ADHD is subsumed in the panel’s rating recommendation for the unfitting MH condition since rating under §4.130 is based on overall occupational and social impairment due to MH symptoms and not based on any specific MH diagnosis.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the mood disorder, NOS condition, the panel unanimously recommends a disability rating of 30%, coded 9435 IAW VASRD §4.130.  In the matter of the contended history of alcohol abuse, tobacco abuse, history of ADHD conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  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	
Mood Disorder, NOS	9435	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150825, with attachments
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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-02283.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  The Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at XXXXXXXXXXXXXXXXXX to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings