RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00005
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20070115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Antitank Assaultman, medically separated for “Mood Disorder, NOS,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends his rating was not high enough and requests all conditions be considered.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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.  Any conditions outside the Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations 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 at the time of separation.  The Board 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 Board 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 – 20061113	VARD - 20120730	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mood Disorder NOS	9435	10%	PTSD/Mood Disorder	9435-9411	0%	STR	
PTSD	CAT II					
Borderline Personality Disorder	CAT IV	No VA Entry	
Alcohol Dependence, with Physiologic Dependence			
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Mood Disorder NOS.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) mental health (MH) narrative summary (NARSUM), the CI’s mood disorder condition began in August 2006.  In June of 2006 he took an overdose of pills after being upset over a work related issue.  He was seen in the emergency room and admitted overnight to the medical unit.  Psychiatry consultation on the following day noted that the CI denied his overdose as a suicide attempt, but he reported depressive symptoms.  He was not diagnosed with a mood disorder at the time.  In July 2006, the CI failed to return from leave at expected time and had pending military action for unauthorized absences.  He reportedly wrote a suicide note 1 week after receiving notice of intended disciplinary action and counseling, and he made calls to numerous people including his estranged wife, drank alcohol, and ingested several medications.  He was admitted to the hospital for 3 days (from 3 August – 5 August), and was diagnosed with a mood disorder.  Post hospitalization, the CI was prescribed psychotropic medication and alcohol abuse treatment.  

The 18 August 2006 MEB Mental Health NARSUM examination, 3 months prior to separation, the CI made the complaint of “depression.”  His depressive symptoms included hypersomnolence, fatigue, amotivation, social isolation, hopelessness, poor concentration/memory, guilt feelings, excessive worry, and substance abuse.  The CI also reported occasional brief episodes of racing thoughts, impulsivity, and decreased need for sleep, and elevated mood, symptoms suggestive of hypomania.  The CI reported that he had experienced some anxiety symptoms since 2 previous deployments to Iraq (2004 and 2005).  His anxiety symptoms had included weekly nightmares which increase in frequency and intensity when he consumed alcohol.  He had some increased startle response, and a desire to avoid conversations about the war, “because I get very angry.”  He denied any daytime symptoms or significant occupational or social impairment secondary to his anxiety symptoms.  

The mental status examination (MSE) was unremarkable with the exception of a dysphoric affect.  Judgment was noted as “good.”  The diagnoses of mood disorder NOS and alcohol dependence were recorded on Axis I and borderline personality disorder was noted on Axis II.  The psychiatrist noted the CI’s mood disorder was “in reaction to: moderate precipitating stress.”  The examiner recommended continued medication use.  

The CI did not file a VA claim until 5 years after separation.  

The panel directed attention to its rating recommendation based on the above evidence. 
The PEB rated the mood disorder condition at 10%, coded 9435 (mood disorder NOS).  The VA did not service connect any mental health condition.  In a July 2012 VA decision, it was noted that the CI had not sought help for any condition since November 2009, and had not supplied any of the requested evidence for his MH condition from the service to the time of the 2012 decision.

The PEB adjudicated the PTSD condition as a CAT II condition (Not separately unfitting but contributes to the unfitting condition).  However, MH disability rating is based on total social and occupational functioning, regardless of diagnosis, and thus, all symptoms are considered.  

The PEB also adjudicated the personality disorder and alcohol condition as a CAT IV conditions (conditions which do not constitute a physical disability).  

The panel first noted there was no traumatic event causing the unfitting mental health condition and therefore concluded that application of VASRD §4.129 was not appropriate in this case.  

The panel next noted that IAW DoDI 1332.38, enclosure 5, the personality disorder and alcohol dependence conditions are not conditions that constitute physical disability and therefore are not eligible for service disability ratings.  

The panel next proceeded with the rating recommendation.  The 30% rating is for “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks”.  The panel considered the Non-Medical Assessment (NMA) dated 2 months prior to separation that stated the CI was fully capable of performing any and all duties expected of his rank and experience, but noted that the CI was not performing duties in his primary MOS due to the commander’s “loss of confidence in his [CI] ability to effectively do his job.”  His MOS duties required “great trust, confidence, and organizational ability and lately [CI] has not recently displayed these qualities.”  The NMA noted that he had performed any and all duties expected of him as recent as May 2006, 6 months prior to separation.  There was no mention of any mood or anxiety symptoms interfering with duty performance.  

Treatment records after the second hospital admission, demonstrated he was stable in the 3 months prior to separation.  The CI had no additional hospitalizations, and he had no visits to the emergency room.  The CI was participating in alcohol treatment and was making improvement.   There was no evidence of chronic sleep problems (no report of falling asleep on the job), panic attacks, impaired judgment (judgment altered due to altered mental status), or memory loss interfering with satisfactory duty performance.  The NMA indicated there were no MH symptoms that significantly impaired the CI’s occupational functioning.  Social impairments were not documented.  There was insufficient evidence that any MH symptom significantly interfered with social or occupational functioning to warrant the higher rating of 30%.  

After careful deliberations, the panel agreed, the overall totality of the CI’s disability more accurately reflects the 10% description, “occupational and social impairment due to mild or transient symptoms which decrease work efficiency only during periods of significant stress, or; symptoms controlled by continuous medication” at separation.  The panel opined that the PTSD condition was an integral component of the mood disorder pathology and could not be recommended for additional rating IAW VASRD 4.14 (avoidance of pyramiding).  

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 NOS condition.  

Contended PEB Conditions: Borderline Personality Disorder, Alcohol Dependence.  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 profiled, implicated in the commander’s statement nor 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.  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 and IAW VASRD §4.130 the panel recommends no change in the PEB adjudication.  In the matter of the contended borderline personality disorder and the alcohol dependence condition, the panel agrees that it cannot recommend it for additional disability rating.  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 20151227, 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:

		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

		
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	     				  Acting