RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00206
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050429

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Security Forces Apprentice, medically separated for “major depressive disorder associated with social phobia,” rated 30% minus a 20% deduction for aggregating factors, for a final 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.  

In addition, the Secretary of Defense Mental Health Review Terms of Reference directed a comprehensive review of Service members with certain mental health (MH) conditions referred to a disability evaluation process between 11 September 2001 and 30 April 2012 that were changed or eliminated during that process.  The MH condition was reviewed regarding diagnosis change, fitness determination and rating in accordance with VASRD §4.129 and §4.130.  

RATING COMPARISON:  

SERVICE PEB - 20050216	VARD - 20060210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder associated with Social Phobia	9434	(30% - 20%) 10%	Major- Depressive Disorder associated with Social Phobia and Psychotic Features	9434	0%	STR	
Personality Disorder, Not Otherwise Specified	Category III	No VA placement		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Major Depressive Disorder with Social Phobia.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s major depressive disorder (MDD) was first evaluated on 20 September 2004 when she was admitted to the hospital for an overdose of six Tylenol 3s with Benadryl.  She stated that she had been feeling like she could read other people’s minds and that her thoughts were being broadcast to others since in technical school in early 2004.  By September 2004 she had been having difficulty sleeping, reduced interest and poor concentration.  She felt agitated and restless at times and was complaining of continuously racing thoughts that were becoming intrusive and she was having increasing difficulty controlling them.  She related that she had intrusive thoughts of hurting other people and that she was becoming increasingly concerned that she would act upon those thoughts.  Although there was some improvement with therapy and medication, the CI’s condition was still found to be not compatible with continued service.  

The 20 September 2004 MEB NARSUM examination, 7 months prior to separation, noted complaints of poor sleep, poor concentration, decreased motivation, lack of interest, thoughts of wanting to hurt others by choking or hitting them and intrusive thoughts of her own voice telling her that others were thinking about her negatively.  She denied thoughts of homicide or suicide at the time of the MEB NARSUM.  Mental status examination showed labile affect ranging from happy to tearful that changed quickly depending on the subject she was discussing.  Her affect was sometimes blunted and restricted with poor eye contact and poverty of speech.  Mood was reported as irritable.  Insight and judgement was noted to be poor.  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 major depressive disorder 30% minus a 20% deduction for aggregating factors, for a final disability rating of 10%, coded 9434 (Major depressive disorder (MDD)), citing the CI’s unsworn testimony to the PEB that the depressive disorder was a result of self-isolation due to a facial skin condition and that the personality disorder significantly impacted her condition.  The VA rated the major depressive disorder 0% coded 9434, based on the STR 10 months after separation, citing there was no medical evidence of a current condition.  

Panel members agreed that there was occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to such symptoms as depressed mood, anxiety, suspiciousness and chronic sleep impairment to satisfy the criteria for a 30% rating under the general rating formula for mental disorders VASRD §4.130.  Though there was occasional flattened affect with disturbances of motivation and mood with impaired judgement, there was no evidence of circumstantial, circumlocutory, or stereotyped speech, panic attacks more than once a week, difficulty in understanding complex commands, impairment of short and long-term memory and impaired abstract thinking to justify the next higher 50% rating.  

The CI’s entry physical examination had no evidence of any mental health diagnosis or impairment, and there was therefore not a preponderance of objective medical evidence supporting a rating percentage at the time of entry into service.  Although DoDI 1332.39, para 6.1.8. (rescinded) had provisions for reducing disability ratings, there was no VASRD-compliant path for any reduction in rating percentage for the CI’s mental disorder rating, regardless of the non-compensable personality disorder.  The panel unanimously agreed that no deduction from the PEB’s 30% rating was supported.  

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 MDD, coded 9434.  

Contended PEB Condition:  Personality Disorder, Not Otherwise Specified.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended Air Force category III condition was not unfitting.  Category III conditions are conditions that are not separately unfitting and not compensable or ratable.  The panel noted that IAW VASRD §4.130 all mental health conditions are rated on the General Formula for Mental diseases and rating a second disorder using that same formula to rate a second disorder would constitute pyramiding which is prohibited by VASRD §4.14.  Therefore, no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the major depressive disorder, the panel unanimously recommends a disability rating of 30%, coded 9434 IAW VASRD §4.130.  In the matter of the contended personality disorder, not otherwise specified, the panel unanimously 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 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	
Major Depressive Disorder	9434	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160411, 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-2016-00206.

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 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