RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00356
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061102

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Dental Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “asthma” and “major depressive disorder [MDD]” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  “They reduced my rating from retirement to 0%.  I am currently receiving care from the VA for depression.”  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 – 20061017	VARD - 20060518	
Condition	Code	Rating	Condition	Code	Rating	
Asthma	6602	10%	Asthma	6602	0%	
MDD	9434	0%	Dysthymic Disorder	9433	0%	
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Asthma.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the asthma condition began in 2002 during basic training.  

Primary care notes in December 2004 (7 months prior to TDRL placement) and March 2005 (4 months prior to TDRL placement), in addition to a March 2005 medication profile, listed prescriptions for inhaled anti-inflammatory medication (Advair) obtained in December 2004, January 2005, and March 2005.  
The 29 March 2005 MEB NARSUM examination, 3 months prior to TDRL placement, noted that since the most recent change of duty station, her symptoms were significantly improved with less shortness of breath, that she was only using her bronchodilator once per day, and that home monitoring of her asthma showed peak flow rates in the 400’s.   Physical examination showed a normal respiratory rate, and bilaterally clear lungs without wheezing.  The examiner concluded by stating that the CI continued to have episodes of shortness of breath that limited her from fitness testing, and wearing the gas mask.  The CI was separated and placed on TDRL.  

Pulmonary function testing (PFTs) on 22 August 2006, 3 months prior to TDRL removal/ separation, documented normal results: forced expiratory volume in 1 second (FEV-1) of 100%, and FEV-1/ forced vital capacity (FVC) of 105%.  An undated medication profile documented a repeat prescription for the same anti-inflammatory medication in August 2006.  

The 23 August 2006 TDRL examination, 2 months prior to TDRL removal/ separation, noted that the CI had not used bronchodilators in “quite a while,” and that she had run out of her medications with no recent flare ups.  Physical examination showed a normal respiratory rate, and bilaterally clear lungs without wheezing.  There were no PFTs in evidence dated after the August 2006 studies.  

In a 17 September 2006 statement signed by the CI, 2 months prior to TDRL removal/ separation, she attested that she “did not take any medication after December 2005 other than periodic doses of albuterol [an inhaled bronchodilator] when I was short of breath.”  

The panel directed attention to the rating recommendation based on the above evidence.  
The PEB rated the asthma condition 10%, coded 6602.  The VA rated the asthma condition 0%, coded 6602, based on the STR, citing a lack of evidence of current disability.  

The panel considered the recommendation for permanent disability rating at the time of removal from TDRL.  There was STR evidence of intermittent bronchodilator medication usage that would support a 10% rating, coded 6602.  There was no STR evidence during the TDRL period of FEV-1 or FEV-1/FVC of 56-70%; daily bronchodilator therapy; or intermittent anti-inflammatory medication usage that would support a higher 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 adjudications for the asthma condition at TDRL removal.  

MDD  According to the STR and the MEB NARSUM, the MDD was first evaluated after a referral to the emergency room in February 2003 for suicidal ideation expressed during attendance at a substance abuse program.  

At a psychiatry consultation on 24 August 2004, the CI reported loneliness, increased sleep, fatigue, and panic symptoms while taking an anti-depressant medication.  She also reported alcohol use with black outs, financial issues, and suicidal ideation with self-injury.  The mental status examination (MSE) showed a constricted affect with fair eye contact, with clear, logical and goal directed though processes, with good judgement, concentration, and attention.  The examiner decided to change anti-depressant medications.  At a 25 August 2004 substance abuse intake evaluation, the MSE was normal.  

At a September 2004 psychiatry visit, the CI reported a new relationship and less irritability on this anti-depressant.  However, she wanted to restart the previous medication due to increased fatigue and other side effects.  The MSE showed a “calm” mood and “constricted” affect and was otherwise normal.  Her medications were changed.  

At an October 2004 psychiatry visit, the CI reported being in a relationship, “doing well” and feeling much better, with no medication side effects.  The MSE showed a “good” mood and was otherwise normal.  

At a November 2004 psychiatry visit, the CI denied any symptoms of depression, that she was doing great and work was going well, and that she was getting married the next month.  The MSE was normal and she was in a “good” mood.  

At a January 2005 psychiatry visit, the CI reported doing “OK,” but in a “good” mood, was frustrated with her command, and had postponed the wedding (fiancée in Iraq).  The MSE showed a “good” mood, a “constricted” affect, but was otherwise normal.  

At a February 2005 psychiatry visit, the CI reported worsening symptoms of depression with worry about relapsing, hopelessness, decreased concentration, inability to function independently, and that work was a “struggle emotionally.”  The MSE showed psychomotor retardation, with a depressed mood and constricted affect.  She denied suicidal ideation and use of alcohol.  

In the April 2005 psychiatry MEB addendum, the MSE showed mild psychomotor retardation, depressed mood, and an affect that was congruent with her mood, regulated and constricted.  She displayed good concentration and insight, with fair judgement, and denied suicidal ideation.  The examiner concluded “definite” impairment for military duty, and for social and industrial adaptability; and assigned a GAF of 65 (mild symptoms).  

During a 6 May 2005 telephone consultation and at the follow up psychiatry visit on 26 May 2005, the CI reported worsening symptoms of depression, which included increased irritability, anxiety, and inability to concentrate.  The MSE showed an “OK” mood, with fair judgement and insight, and good impulse control, as she had denied suicidal thought, intent or plan.  Her medication was increased.  

The 22 August 2006 TDRL examination on, 2 months prior to TDRL removal, noted no medications or treatment for depression in the past year.  She reported “mild to moderate” symptoms, which included feelings of discouragement, hopelessness, irritability and anxiousness, but denied panic attacks, and suicidal ideation.  She participated in social activities, was living with her mother, and was still in a relationship.  She was a full time college student and was not working at the time, but had worked in 3 different jobs which lasted about 2 months each.  She denied alcohol abuse but admitted to having 3 drinks per week.  The MSE showed a mildly anxious and irritable mood, with “adequate” judgement, and “partial “insight (in that she realized that her depression may still require treatment in the future).  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 0% for the MDD, coded 9434 (major depressive disorder), citing “no medication or other treatment in the past year.”  The VA also rated 0% for “dysthymia disorder” but used the 9433 code (dysthymic disorder), based on STRs, and citing a lack of medical evidence showing a current disability.  

All panel members agreed that §4.129 did not apply in this case.  At the time of the TDRL reevaluation, symptoms of mild to moderate depression were present however, the symptoms were not severe enough to interfere with social functioning or require continuous medication.  In accordance with VASRD §4.126, the panel considered all of the evidence of record that related to occupational and social impairment rather than solely on a single examiner’s assessment of the level of disability at the moment of the examination.  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 adjudications for the MDD condition at TDRL removal.  

BOARD FINDINGS:  In the matter of the asthma condition and IAW VASRD §4.100, the panel unanimously recommends no change in the PEB adjudication at TDRL removal.  In the matter of the MDD condition and IAW VASRD §4.130, the panel unanimously determined that VASRD §4.129 was not applicable and 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 modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170015424, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX
Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
						      					
Enclosure