RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00362
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061214

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E7, Human Resource Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “major depressive disorder” with a disability rating of 10%.  

CI CONTENTION:  “The Army PEB's disability rating was inconsistent with the Department of Veteran Affairs' rating of 30% during the same year.” 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 - 20061002	VARD - 20060202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Major Depression Associated with Human Immunodeficiency Virus 	9434	30%	20050721	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s MDD condition began in September 2003 after being diagnosed and treated for human immunodeficiency virus.  In March 2004, he was referred to mental health for worsening depression, irritability, decreased concentration/interest, poor sleep, and pervasive hopelessness that affected his work performance.  He became socially avoidant with frequent suicidal ideation.  At work, his supervisor reassigned duties because the CI could not accomplish his workload.  In April 2004, he was prescribed antidepressant medications.  In May 2004, he was admitted for inpatient treatment for suicidal ideation with agitation, hopelessness, and poor judgement, after having run out of his medications.  The mental status examination (MSE) indicated the CI was initially uncooperative during the interview, but then became cooperative.  He avoided eye contact; displayed retarded speech and motor activity; had a constricted affect; had circumstantial thought processes; admitted suicidal ideation; and denied homicidal ideation, delusions, and hallucinations.  Insight was fair with improved judgment and impulse control.  After 3 days, the CI was discharged to a partial hospitalization program.  He was separated and placed on TDRL on 21 March 2005.  

At the 21 July 2005 VA Compensation and Pension (C&P) evaluation, performed 17 months prior to TDRL removal, the CI reported decreased alcohol consumption (three to four drinks, 3 times per week).  He stated that work was “stressful,” and his attendance and performance were “okay.”  He reported few social interactions, and usually stayed home and slept when not at work.  The MSE showed a depressed mood and affect, however, there was no evidence of thought disorder, delusions, hallucinations, or suicidal ideation.  Attention, memory and concentration were intact.  

At the 17 June 2006 TDRL re-evaluation, 6 months before TDRL removal, the CI was working full- time with reduced responsibility and adequate performance.  He had taken a significant amount of leave but was within the maximum days allowed.  He reported daily depressed mood, guarded hope for the future, low energy, lack of interest, limited appetite, poor concentration, passive suicidal thoughts, interrupted sleep, and had resumed alcohol use in January 2006.  He visited his psychiatrist weekly.  The MSE showed intact memory, concentration, cognition, and thought processes; normal speech, eye contact, motor activity, and impulse control; depressed mood and affect; and passive suicidal thoughts without intent or homicidal thoughts, delusion, or hallucinations.  Insight was fair, and judgement was poor based on persistent alcohol use.  The examiner opined that the CI had improved only mildly from the time of TDRL placement and assigned a global assessment of functioning (GAF) of 60 (moderate symptoms).  

The panel directed attention to its rating recommendation at TDRL removal based on the above evidence. The PEB rated the MDD condition 10%, coded 9434 (MDD), citing full-time employment with adequate work performance, and mild impact on industrial capabilities.  The VA rated the MDD condition 30%, coded 9434, based on the C&P evaluation 17 months prior to separation, citing irritability at work, lack of social or personal relationships, poor sleep and concentration, and depression with an essentially normal MSE and an assigned GAF of 55  (moderate symptoms).   All panel members agreed that at the time of TDRL removal, the §4.130 threshold for a 50% rating (or higher) was not approached.  Therefore the panel discussed whether the impairment more nearly approximated the 10% versus the 30% rating criteria.  A 30% rating requires “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational task.” Symptoms reported at the time of the TDRL re-evaluation included dysphoria, irritability, loss of motivation, decreased concentration, and social isolation.  Panel members agreed that these symptoms most closely reflected the 30% level of impairment.  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 condition, coded 9434, at the time of TDRL removal. 

BOARD FINDINGS:  In the matter of the MDD condition, the panel unanimously recommends a disability rating and permanent disability disposition of 30%, coded 9434 IAW VASRD §4.130 at the time of TDRL removal.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows; and, 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 20160523, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170015429, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure