RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02458
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20020530

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Aircraft Armament Systems Craftsman, medically separated for “dysthymia disorder associated with major depression” with a disability rating of 10%.

CI CONTENTION:  “Review all Conditions.”  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 - 20020325	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Dysthymia Disorder Associated with Major Depression	9433	10%	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Dysthymia Disorder Associated with Major Depression.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s dysthymia disorder began in June 2000 after a permanent change of duty station.  The CI was seen on 24 August 2000 at the Behavioral Analysis Service (BAS) for Military Training Instructor (MTI) evaluation and had an Axis I diagnosis of adjustment disorder with depressed mood, which by a follow-up visit on 5 October 2000 was changed to no Axis I diagnosis and remained the same until 29 November 2000.  He was seen for emergency care and treatment on 21 February 2001 for depression for 1 week marked by decreased mood and decreased concentration based on stressors that included his service commitment, potential for deployment, and associated family stress.  His symptoms were assessed as either a reactive or major depressive episode.  He was seen in follow-up by a clinical social worker who noted the CI continued to have a depressed mood.  

On 23 March 2001 the CI was referred for medication since he had progressively increasing dysphoria (unease), lack of interest and motivation.  However, the CI admitted that it was really a chronic problem.  Mental status examination revealed the CI to be alert, oriented, attentive, and cooperative.  His mood was mildly dysphoric and his affect was appropriate.  Thought processes were logical and goal directed and centered on his situation.  There was no evidence of any psychotic processes.  Judgment and insight were intact.  The Axis I diagnosis was probable dysthymic disorder and rule out major depression or adjustment disorder.  A trial of Zoloft (sertraline, an antidepressant) was prescribed.  Although he felt better with the medication, his mood was still dysphoric, but he doubted whether treatment would work because he was so unhappy in the service that he would really like to be forced out.  The Zoloft dose was increased and the CI was encouraged to consider group therapy.  

The 25 June 2001 commander’s statement indicated the CI stated on more than one occasion that he felt “that [it was] in his best interest if he was released from the Air Force” and he showed “little desire to cross-train.”  

The 14 August 2001 command-directed mental health evaluation concluded that the CI was functioning well and did not appear to be experiencing any significant symptoms of depression that would cause occupation or social impairment.  The improvement in his psychological functioning was due to a change in his job responsibilities and his undergoing psychotherapy.  It was determined he was suitable for continued military service; however, it was believed that if he was returned to his duties, his symptoms of depression would return and again severely impact his occupational functioning.  Therefore, it was recommended that cross training be considered.  Individual psychotherapy sessions were continued for mood and marital issues.  

At the 29 January 2002 psychiatric examination the CI was noted to have stopped the Zoloft and declined further treatment trials.  On examination, his mood was mildly dysphoric and his affect was subdued.  Thought content was notable for absence of suicidal or homicidal ideation, intent or plan.  The examiner noted the CI would likely benefit significantly from psychotherapy services and from medication treatment as well.  His risk of recurrent major depressive episodes was significant due to his underlying dysthymic disorder, continued depressive symptoms, and the stress of ongoing family issues.   His Global Assessment of Functioning (GAF) score was 70 (some mild symptoms or some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships) and his social/industrial impairment was minimal.  The examiner opined it was unlikely the CI would perform at an acceptable level in his primary AFSC in the foreseeable future.    

The 4 March 2002 MEB NARSUM examination, 2 months prior to separation, noted complaints of depressive symptomatology.  Mental status examination revealed the CI was alert and oriented and was well dressed and well groomed.  His speech was fluent; eye contact was moderate; and kinetics were normal.  His mood was mildly dysphoric and his affect was subdued.  Thought content was notable for absence of suicidal or homicidal ideation, intent or plan.  There was no evidence of psychosis.  Thought processes were logical, linear and goal-directed.  There was no loosening of associations or flight of ideas.  Insight and judgment were fair.  Cognition was grossly intact.  The examiner’s diagnosis was dysthymic disorder, major depressive disorder, single episode, moderate, resolved.  His GAF score was 70.  Military impairment was marked and social/industrial impairment was minimal.  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 dysthymia disorder 10%, coded 9433 (dysthymia disorder), citing “mild social and industrial adaptability impairment.”   The panel noted that there was no traumatic event causing the unfitting mental health condition and concluded that application of VASRD §4.129 was not appropriate in this case.  A higher rating of 30% requires evidence of “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal),  due to  such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).”  Although the CI had a depressed mood, there were no other symptoms for a 30% rating.  The panel notes that the CI’s mood improved with medication, but he discontinued taking it.  Nevertheless, when performing duties other than his AFSC, his job performance was satisfactory.  At the time of the NARSUM examination, 2 months before separation, the psychiatrist indicated occupational and social impairment as mild, which best supports a 10% 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 dysthymia disorder.  

BOARD FINDINGS:  In the matter of the dysthymia disorder and IAW VASRD §4.130, the panel unanimously recommends no change in the PEB adjudication.  There were 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 20151016, w/atchs
Exhibit B.  Service 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-2015-02458.

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.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings