RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00548
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060329

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O2, Infantry Officer, medically separated for “mood disorder due to thyroid disease, with depressive features” with a disability rating of 10%.

CI CONTENTION:  Mood disorder should be changed to 30% in line with how the VA rated the condition.  The CI’s 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 - 20060111	VARD - 20090813	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mood Disorder…	9435	10%	Mood Disorder	9435	30%	20090706	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Mood Disorder Due to Thyroid Disease with Depressive Features.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mood disorder began in August 2005 with treatment of chronic depression secondary to Graves’ disease (hyperthyroidism), which was diagnosed in January 2005.  He continued to experience depressed mood, low energy, insomnia, poor concentration, and hopelessness even after thyroid function tests were normalized in August 2005.  Despite individual counseling and using Wellbutrin (an anti-depressant), the CI had little improvement after 3 months of treatment.  
A 5 October 2005 physical profile restricted assignment to locations with psychiatric care, access to weapons or ammunition, and physical fitness training or testing.  Avoidance of excessively hot environments and strenuous exercise was also required.

During the 14 October 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported being diagnosed with hyperthyroidism and depression.  Physical examination showed exophthalmos (protruding eyes) bilaterally.   Blood pressure was 127/87 and pulse was 68 beats per minute.  

The 18 October 2005 commander’s statement indicated the CI was physically incapable of performing his duties as an infantry officer due to his hyperthyroidism, depression, and Graves’ ophthalmologic changes.  Additionally, his physical and mental conditions created a burden for the unit because he could not deploy and perform his duties in a combat environment.     

At the 11 November 2005 MEB NARSUM examination (signed on 15 December 2005), and NARSUM psychiatry addendum, 4 months before separation, the CI complained of a history of hyperthyroidism and depression. Hyperthyroid symptoms included palpitations and sinus tachycardia, and the condition was confirmed by a thyroid uptake study, ultrasound, laboratory studies including a low thyroid stimulating hormone (0.03 mcIU/ml (normal 0.34-5.6)), and ophthalmologic evaluation.  After initial treatment with beta blockers and propylthiouracil (decreases excess thyroid hormone), the CI’s thyroid studies normalized.  He declined surgery and instead took methimazole to maintain suppression of thyroid hyperactivity; however, the prescription was discontinued when he became hypothyroid.  The examiner opined that the CI required 12-18 months of medical therapy before he could return to normal duties.  

Physical examination showed the CI to be in no acute distress and alert and oriented.  He had a regular heart rate (81 beats per minute) and rhythm without any murmurs and blood pressure was 126/85; the lungs were clear with 12 respirations per minute.  Head, eyes, ears, nose and throat were normal, although the CI had lid lag.  There were no neck masses and the thyroid was not grossly enlarged.  Mental status examination revealed the CI to be cooperative and appropriate, with good eye contact and normal speech.  His mood was primarily depressive or hopeless with a depressed and anxious affect.  He denied any suicidal or homicidal thoughts, and thought processes were logical with no hallucinations or delusions.  Cognition was intact with partial insight; judgment was adequate for legal and financial decision-making.  The CI’s Axis I diagnosis was mood disorder due to thyroid disease with depressive features manifested by a 1-year history of depressed mood, anxiety, insomnia, low energy, impaired concentration, and hopelessness with a predisposition of Graves’ disease.  The examiner noted the CI performed military duties and had adequate job adjustment; however, the CI did require medication and “displayed some symptoms of mental illness on examination.”  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 mood disorder 10%, coded 9435 (unspecified depressive disorder), citing required psychotropic medication and military duty performance with adequate job adjustment.  The panel first considered whether the provisions of VASRD §4.129 (mental disorders due to traumatic stress) were applicable and agreed they were not appropriate in this case since there was no traumatic event causing the unfitting mental health condition.  Members then deliberated whether the VASRD §4.130 threshold for a 10% or 30% rating were met at the time of separation.  The CI did take medication, but according to the PEB, performed military duties with adequate job adjustment.  The panel agreed that a 10% rating, but no higher, were met 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, or; symptoms controlled by continuous medication.” 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 adjudication for the mood disorder.

Contended PEB Condition:  Graves’ Disease (Hyperthyroidism).  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was profiled, was implicated in the commander’s statement, and was judged to fail retention standards, although it was listed as:  “Mood Disorder Due to Thyroid Disease.”  The NARSUM examiner noted that while the condition by itself did not require a MEB, “the Graves’s combined with his psychiatric illness may qualify for a Medical Board . . . in that it is interfering with satisfactory performance of his normal duties.”   Panel members noted there was performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel agreed that a preponderance of evidence with regard to the functional impairment of Graves’ disease (hyperthyroidism) favors its recommendation as an additionally unfitting condition for disability rating.  It is appropriately coded 7900 (hyperthyroidism) and meets the VASRD §4.119 criteria for a 10% rating. The 30% rating requires evidence of tachycardia, tremor, and increased pulse pressure or blood pressure, all of which were not present proximate to separation.  

BOARD FINDINGS:  In the matter of the mood disorder and IAW VASRD §4.130, the panel unanimously recommends no change in the PEB adjudication.   In the matter of the contended Graves’ disease (hyperthyroidism)  condition, the panel unanimously agrees that it was unfitting and recommends a disability rating of 10%, coded 7900 IAW VASRD §4.119.  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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Mood Disorder Due to Thyroid Disease with Depressive Features	9435	10%	
Graves’ Disease (Hyperthyroidism)	7900	10%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160908, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170016252, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

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

Sincerely,	
Enclosure