RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00637
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20041123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aerospace Maintenance Craftsman, medically separated for “major depressive disorder [MDD] associated with dysthymia disorder” with an initial disability rating of 30%; however, the PEB deducted 20% for aggravating/contributory factors for a final 10% disability rating.

CI CONTENTION:  The CI made no specific contention.  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 - 20040916	VARD - 20050921	
Condition	Code	Rating	Condition	Code	Rating	Exam	
MDD with Dysthymia Disorder	9434	10%*	MDD with Anxiety	9434	30%	20050611	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	
*Deducted 20% aggravating/contributing factors

ANALYSIS SUMMARY:

Major Depressive Disorder (MDD) with Dysthymia Disorder.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI experienced a lifelong history of chronic depressive symptoms that were worsened with interpersonal difficulties with his military supervisor.  The CI had been in counseling prior to enlistment.  This was disclosed on the accession history and the CI was cleared by mental health for accession.  The CI did well in his career and was recommended for immediate promotion with all “5s” on his final 2 performance reports which closed out on 4 March 2003 and 2004.

On 17 July 2004, the CI was admitted for suicidal ideation and depression secondary to conflicts with his work supervisor although he enjoyed his job.  He reported a long history of depressive episodes which lasted several weeks and occurred every few months.  He recently had increased conflict with his supervisor and considered self-harm.  This was disclosed to his supervisor who then had the CI evaluated by mental health with the resultant hospital admission.  He did report a past history of cutting himself under stress.  He was in a supportive marriage and had a daughter.  He reported some financial stressors.  He planned to separate at the end of his enlistment and start a business (not specified) with his wife.  He was diagnosed with an Axis I:  MDD with an initial Global Assessment of Functioning (GAF) of 35 (some reality testing impairment), but a GAF of 70 (mild symptoms) at discharge.  An Axis II diagnosis was deferred.  He was treated with an anti-depressant and his suicidal ideation resolved completely over the 4 day admission.  He was noted to be somewhat manipulative and entitled during treatment which he initially resisted.  Following discharge from the hospital, the CI began intense outpatient therapy which was directed by a psychiatrist.  On 4 August 2004, the CI had formal psychological testing.  He was thought to have a schizotypal personality disorder, one which is characterized by difficulties with relationships and disturbances in thought patterns and behavior.  He reported social lifelong difficulties.  Symptoms of anxiety and depression were also reported.

The 6 August 2004 MEB NARSUM examination, 4 months prior to separation, noted the above history.  The mental status examination was remarkable for poor eye contact and fidgeting.  The mood was depressed and anxious.  His affect was restricted and depressed.  His thought content was focused on perceived abuses by his supervisor, but otherwise the thought processes were unremarkable.  Insight was fair.  He endorsed suicidal ideation, but denied intent or plan.  He was diagnosed with MDD without psychotic features and a GAF of 50 serious symptoms and an Axis II personality disorder not otherwise specified (NOS).  It was noted that the personality disorder increased the resistance to treatment of the depression.

The commander’s statement was dated 23 August 2004, 3 months prior to separation.  It was noted that the CI was working fulltime, but outside the normal duty section on the advice of medical authorities which was to separate him from other members of his flight.  The commander noted that the CI appeared to be dedicated to overcoming his (mental health) condition, but that he also had expressed a strong desire to separate from the military and had previously applied for early separation (which was denied).  On 3 September 2004, the CI reported that he had recently returned from leave and had been happy on leave.  He also noted improved mood, anxiety, and outlook on medications.

The CI reported a recurrence of symptoms when seen on 5 October 2004; this was in the context of a recently passed kidney stone.  His medications were then adjusted.  He continued to report symptoms when seen 10 days later.  His medications were tapered to determine what was from the underlying MH conditions and what was secondary to the medications.  His medications were adjusted over the next few mental health appointments.  The final clinical note in evidence was for a separation physical, 8 days prior to separation, which was accomplished in primary care.  He was noted to have a normal affect with good eye contact.  He was conversant and cooperative on examination.

At the 11 June 2005 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported that he had worked full time (in a different city than his last assignment) installing software and had not lost any time from work in the past 12 months (he had been hospitalized for 4 days in July 2004).  He reported verbal abuse from his officers and poor job performance due to the increased stress.  The panel noted that the CI actually had stellar EPRs and that he was rated as high as possible on the final two, the last of which closed out 4 months prior to his admission.  He endorsed a stable marriage.  He noted a history of panic attacks, but none for the past month.  The mental status examination noted speech low in volume and tone.  The mood was depressed and affect anxious.  It was otherwise unremarkable.  He was diagnosed with Axis I MDD with anxiety and a GAF of 60 moderate symptoms.  Continued mental health treatment was recommended.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD condition 30%, minus a 20% deduction for aggregating factors for an overall 10% rating, coded 9434 (MDD).  The PEB opined that the CI’s impairment was only slightly higher than mild (10% rating).  The CI was given a 30% rating; to the CI’s advantage.  The PEB also opined that without the contribution from the non-ratable personality disorder the impairment would be mild which supported a 10% rating.  The VA rated the MDD condition 30%, coded 9434, based on the C&P examination 7 months after separation, citing occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  An Axis II disorder was not diagnosed at the time of the hospitalization, although the CI was noted to be manipulative.  The CI reported an antagonistic relationship with his supervisor.  His performance report was stellar though.  The CI was diagnosed with a personality disorder by the treating psychiatrist and this was supported by formal psychological testing.  The CI carried an Axis II diagnosis through separation.  The C&P examiner deferred the diagnosis of an Axis II condition.  The commander noted that the CI was very motivated to separate and that he was working in a different section to remove him from some of his co-workers.  Following separation, he worked installing software, an occupation similar to that he held on active duty.  

A 30% rating includes “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks…,” while a 10% rating includes “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.”

The panel observed that the CI had one episode in which he was unable to perform occupational tasks and that this lead to the sole hospital admission.  His performance was apparently satisfactory once separated from the supervisor with whom he had a conflict.  He did report some symptoms in the final mental health visits, but did not at the time of the separation physical.  The panel opined that the level of function at the time of separation was closer to that for a 10% impairment rating than 30%.  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 MDD condition.

BOARD FINDINGS:  In the matter of the major depressive disorder with dysthymia disorder condition and IAW VASRD §4.130, the panel unanimously 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 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 20160915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAF/MRB

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00637.

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.  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 at XXXXXXXXXXXXXXXXXX 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,

Attachment:
Record of Proceedings