RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02344
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20060115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Safety Technician, medically separated for “mood disorder” with a disability rating of 10%.

CI CONTENTION:  The CI contends that his Cat II Tourette's Disorder continues to worsen, and for conditions not identified by either the MEB or PEB.  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 - 20051130	VARD - 20061206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mood Disorder	9435	10%	Mood Disorder	9435	50%	20060929	
Tourette's Disorder	Cat II	Tourette's Syndrome	8199-8103	0%	20060929	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Mood Disorder.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mood disorder condition began in January 2005 brought on by the stresses of a heavy workload, long hours on ship, and his emotional condition created tension in his relationship with his girlfriend.  

The MEB NARSUM examination on 7 October 2005, 3 months prior to separation, noted complaints of persistent depressive symptoms, increased anxiety and obsessing behavior.  The CI admitted to having motor tics described as eye blinking, shoulder shrugging, grimacing and involuntary arm thrusting since age 7.  He also reported vocal grunting.  The CI stated that when he feels pressure the tics “come out” and he is not able to suppress the tics.  Mental status examination showed the CI was alert, pleasant and cooperative, however he displayed scattered variable tics involving his right shoulder, eyes and face.  Psychological testing utilizing the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) characterized that the CI was emotionally withdrawn, socially isolated, suspicious, hostile and lacking insight.  The MMPI-2 also evidenced the CI had general sadness and depressed mood about something and or themselves.  

At the 29 September 2006 VA Compensation and Pension (C&P) evaluation, performed 8 months after separation, the CI reported sleep disturbance, preoccupations with thoughts of his financial problems, decreased social interactions, and depressed mood due to his financial problems.  He reported suicidal thoughts, but no plan or intent.  He also reported significant tics (eyes and facial area) and involuntary movements of his hands.  He reported that he has tics on a daily basis.  The mental status examination showed a dysphoric mood and flat affect.  The examiner noted good eye contact and no inappropriate behavior.  The examiner noted scattered tics primarily in the eyes and face.  There was no evidence of vocal tics.  

The commander’s statement (non-medical assessment letter) dated 14 November 2005 noted that the CI was an above average Sailor. The CI was described as a motivated Sailor who performed and completed all assigned tasks.  The commander noted that the CI’s medical condition limited his potential for continued service.  

The panel directed attention to its rating recommendation based on the above evidence.   The PEB rated the mood disorder condition 10%, coded 9435 (mood order, not otherwise specified).  The VA rated the mood disorder condition 50% coded 9435 (mood order, not otherwise specified), based on the VA C&P examination 8 months after separation, citing moderate occupational and social impairment with symptoms of flattened affect, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships.  

The panel noted that the CI’s mood disorder manifested during a period of duty and relational stress.  There were no psychiatric hospitalizations or emergency department visits.  The commander described as a motivated Sailor who performed and completed all assigned tasks.  The panel also noted that the CI’s worsening symptoms of depression as reported on the VA examination were associated with financial stress.  Panel members agreed that the evidence supports a 10% rating for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the mood disorder condition.  

Tourette’s Syndrome:  The Navy PEB also listed Tourette's Disorder as a related Category II condition (a condition that contributed to the primary unfitting condition but was not separately ratable).  The VA rated the Tourette’s syndrome 0% coded 8199-8103 (tic convulsive) based on the examiner’s noted “some mild eye twitching at the beginning of the exam that became less apparent as you relaxed.” Additionally, the VA stated that the objective evidence showed only mild tics and no medical evidence had been received to show recent treatment for Tourette’s syndrome, therefore a non-compensable evaluation was assigned.  No higher rating was warranted under medical diagnostic code 8103 due to no subjective or objective evidence to substantiate an elevation to a moderate or severe tic convulsive disorder.  

The panel determined that the CI, as was stated during various examinations, experienced the symptomology of Tourette’s during stressful periods or circumstances.  The CI admitted that the tics “come out” when he felt pressured and that they significantly worsened during military service.  The VA examiner noted that the tics were “less apparent” as the CI relaxed.  Panel members agreed that the Tourette’s syndrome was not reasonably justified as separately unfitting, contributed to the mood disorder, and was correctly adjudicated as a Category II condition.  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 Tourette’s syndrome condition.  

BOARD FINDINGS:  In the matter of the Mood Disorder NOS condition and IAW VASRD §4.130 the panel unanimously recommends no change in the PEB adjudication.  In the matter of the Tourette's Disorder condition and IAW VASRD §4.124 the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  

The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150828, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX

		- XXXXXXXXXXXXXXXXXX former USMC
	 	- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

		
	
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	     				  Acting