RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00401
BRANCH OF SERVICE:  navy 	SEPARATION DATE:  20080817

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Aviation Electronic Warfare Operator, medically separated for “major depressive disorder single episode” with a disability rating of 10%.   

CI CONTENTION:  Counsel provided a brief on the CI’s behalf requesting the CI's unfitting condition be changed to PTSD and rated at 50%.  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 - 20080512	VARD - 20090114	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder Single Episode	9434	10%	Post-Traumatic Stress Disorder	9411	30%	20081112	
Post-Traumatic Stress Disorder	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD) Single Episode.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health (MH) condition began following his deployment.  The CI reported the emergence of anger, irritability, hypervigilance, nightmares, and recurring thought and memories of previous combat missions and was diagnosed with acute posttraumatic stress disorder (PTSD).  He also reported decreased energy and concentration, hypersomnia, crying spells and decreased motivation, later diagnosed as depression.  His symptoms did not require medication, hospitalization or treatment in the emergency room (ER).  He participated in individual and group therapy with good response.
During the 8 April 2008 MEB NARSUM examination, 4 months prior to separation, the CI complained, “I was not feeling like myself and shared that with my flight surgeon.”  The examiner noted the CI had continued to have irritability, poor sleep, some recurrent thoughts and images, and depressed symptoms.  It was noted that he had a brief trial of medication but discontinued them due to side effects, and refused other medication trials.  The examiner opined that his depressive symptoms had impacted his “occupational status, being downed, and has contributed to interpersonal relationships as well (marriage).”  The mental status examination (MSE) was unremarkable.  The diagnoses of PTSD and MDD were recorded.

At the November 2008 VA Compensation and Pension (C&P) mental evaluation, 3 months after separation, the CI reported that he had “helped to coordinate the attack that resulted in approximately 180 militants being killed” during his deployment to Afghanistan.  He reported he had PTSD symptoms, and had remained in therapy.  The CI was employed in an information technology job as a systems administrator and was performing well at work and getting along well with co-workers and supervisors.  His relationship with his wife was improving with therapy.  The MSE was unremarkable.  The CI noted he had problems with sleep, and some mild anxiety related to job performance.  He denied panic attacks.  The examiner opined that the CI “experiences mild social/occupational impairment due to anger, impaired concentration and detachment symptoms,” and that his symptoms were improving.  However, the examiner also stated, “There is occasional decrease in work efficiency or there are intermittent periods of inability to perform occupational tasks due to signs and symptoms but generally satisfactory functioning.”  The Global Assessment of Functioning Score assessed by the examiner connoted very mild symptoms.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD condition 10%, coded 9434 (MDD).  The PEB listed the PTSD condition as a related diagnosis (Category II) that contributed to the disability in this case.  The panel agreed that the PTSD was a diagnosis related to the MDD and was not a separate condition which could be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited).  Regardless of diagnosis, VARSD §4.130 rates conditions based on symptoms, and therefore, all symptoms related to mental health are considered in the rating scheme, inclusive of Category II mental health conditions.  The VA rated the PTSD condition 30%, coded 9411 (PTSD), based on the C&P examination 3 months after separation. 

The panel, IAW DoDI 6040.44 and DoD guidance (which applies current VASRD §4.129 to all Board cases as appropriate), must consider if the definition of §4.129 is met for any psychiatric condition resulting in medical separation; i.e., “a mental disorder that develops in service as a result of a highly stressful event”.  If the panel judges that application of §4.129 is appropriate, it will recommend a minimum 50% rating for a retroactive 6-month period on the Temporary Disability Retired List (TDRL).  The panel must then determine the most appropriate fit with VASRD 4.130 criteria at 6 months for its permanent rating recommendation, based on the facts in evidence which are most probative for that interval.  The PEB noted the CI’s condition was not directly related to combat.  The panel was unable to locate any documentation of a highly stressful event.  The NARSUM examiner noted the CI reported his combat experience had affected him “on a fundamental philosophical level whereas his assumptions regarding his purpose, the significance of his actions, the rationale for war, and belief his ability to perform his duties have been shattered…”  The examiner noted he continued to have symptoms of irritability, poor sleep and “some recurrent thoughts/images,” but, there was no mention of the CI having felt his life was threatened or that he experienced intense fear or horror after witnessing a specific traumatic event.  The September 2006 post deployment screen completed by the CI noted he endorsed witnessing wounded, killed or dead enemy combatants or civilians, but had not engaged in direct combat and had not ever felt that his life was in danger.  After prolonged deliberations, the panel concluded in the absence of a documented highly stressful event there is insufficient evidence to support the application of §4.129.  Therefore, panel members agreed it was not appropriate to apply the provisions of §4.129 in this case.  The panel next proceeded with its rating recommendation under VARSD§ 4.130 based on the evidence.

The record demonstrated, the CI had no history of psychiatric hospitalizations or visits to the ER.  Suicidal or homicidal ideation was absent.  He reported substantial benefit from therapy, and although the NARSUM psychologist noted his depression had moderate impairment in military functioning, the commander’s non-medical assessment (NMA) noted that his performance was adequate, in the absence of environmental stress.  No behaviors or symptoms of his illness was recorded by the commander in the commander’s performance statement.  The NMA recorded, “Due to the restriction of ensuring him a stress-free environment, he [CI] is not recommended for continued service.”  There was no evidence of panic attacks, impairment of judgment, or cognitive impairment.  At the time of the VA examination, the CI reported good response to therapy. He was working and reportedly had no issue with job performance.  The examiner noted he had no job performance issues, which was not consistent with the examiner’s opinion that the CI had occasional decrease in work efficiency or intermittent periods of inability to perform occupational tasks.  However, the assigned GAF score was consistent with the 10% rating.  The CI had continued in treatment and reported good response to therapy.  He had good interpersonal relationships with co-workers, and supervisors and he and wife were attending marital counseling.  He had no hospitalizations, and no visits to the ER for MH issues.  Panel members concluded that the evidence at the time of separation, was most reflective of the 10% level of disability for ”Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress.

After due deliberation, and in consideration of all the evidence and VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the MDD condition.

BOARD FINDINGS:  In the matter of the MDD condition and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20160329, 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 USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN