RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00744
BRANCH OF SERVICE:  navy 	SEPARATION DATE:  20070411

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O4, Flight Instructor, medically separated for “major depressive disorder” with a disability rating of 10%.  

CI CONTENTION:  He has had difficulty obtaining (affording) medical care for himself and his dependent and has had ongoing physical and mental issues due to his condition.  He needs Tricare benefits for proper treatment.  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 - 20061122	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	No VA Examination in Evidence	
Posttraumatic Stress Disorder (PTSD)	Cat II		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health condition began in May 2006 after presenting for psychiatric evaluation for symptoms resulting from the April 2002 crash of a helicopter he was piloting.  All passengers, including the CI, escaped and it was determined the mishap was caused by engine failure and not by pilot error.  He began to experience mood changes, nightmares of the event and rumination over the crash.  He also began to isolate from others.  He felt guilty, became more irritable, started second-guessing himself, and developed feelings of paranoia.  Mood swings went from “totally depressed” to “totally enraged.”  The depression deepened over the next 4 years and he finally admitted having thoughts of dying for some time.  He had thoughts of suicide with a plan.  His squadron medical officer arranged for him to be seen on an emergency basis.  There was no previous psychiatric history.  A May 2006 Limited Duty (LIMDU) Medical Board for resulted in a diagnosis of PTSD.

The 21 August 2006 MEB NARSUM examination, 8 months prior to separation, noted complaints of passive suicidal ideation, but he was able to contract for safety.  He had been seen weekly since June and his condition had stabilized, but he was not restored to duty status.  Mental status examination (MSE) showed mood was severely depressed with congruent affect.  He admitted passive suicidal thoughts that he had not implemented.  However, he was not sure he would attend to his own safety if it were challenged.  Diagnoses of PTSD and MDD were rendered with a Global Assessment of Functioning score of 31-40 (major impairment in several areas.)  The examiner noted his condition had stabilized.

During the 18 October 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported difficulty with short-term memory, frequent trouble sleeping, depression, and that he was undergoing psychiatric treatment.  The November 2006 non-medical assessment noted the CI was away from current duties an average of 8 hours per week.  The November 2006 medication refill prescription noted the CI was being treated for PTSD by the staff psychologist and remained on LIMDU.  He had a normal brief MSE and depression and mood were controlled on anti-depression medication.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD, 10%, coded 9434 (MDD).  The PEB’s Category II diagnosis of PTSD is intrinsic to the rated condition and a separate rating cannot be supported without pyramiding (VASRD §4.14); thus, it is appropriately subsumed in the same rating.

The panel first considered if application of VASRD §4.129 with a 6-month (50% minimum) period on the temporary disability retired list (TDRL) was indicated in this case.  Panel members agreed the provisions of VASRD §4.129 were applicable due to the helicopter crash.  The PEB noted the disability was the direct result of a combat-related injury as defined by Title 26 US Code.  Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for MH conditions.  The panel then considered if there was evidence for a §4.130 rating higher than the §4.129 minimum 50% mandated at time of TDRL placement.  The panel agreed the §4.130 criteria for a rating higher than 50% were not met near the time of separation, and therefore the minimum 50% initial TDRL rating is applicable.

The most proximate source of comprehensive evidence on which to base the permanent rating is the August and October NARSUM examinations.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication”; for a 30% rating criteria is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.” A 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  The CI reported passive suicidal ideation.  MSE showed him to have a severely depressed mood with congruent affect.  He was receiving medication and weekly therapy, but it was not possible to restore him to duty status.  During the October NARSUM examination, he reported mild memory loss, depression and trouble with sleep; panel members agreed these symptoms met the threshold for 30% disability.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 50% for 6 months of constructive TDRL and a 30% permanent rating at the time of TDRL removal for MDD. 

BOARD FINDINGS:  In the matter of the major depressive disorder, the panel unanimously recommends a disability rating of 50%, coded 9411 IAW VASRD §4.129 for 6 months from the time of discharge consistent with a constructive period of TDRL and then a permanent separation rating of 30% IAW VASRD §4.130.  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, that 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	RATING	
		TDRL	PERMANENT	
Major Depressive Disorder	9434	50%	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160803, w/atchs
Exhibit B.  Service Treatment Record

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs)
		   COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 01 Mar 18 ICO XXXXXXXXXXXXXXXXXX 
	(c) PDBR ltr dtd 20 Feb 18 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 27 Feb 18 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 13 Feb 18 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 02 Oct 17 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (f) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge. 

     b. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Temporary Disability Retired List at time of discharge for six months with a disability rating of 50 percent followed by transfer to the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent).

     c. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 50 percent rating (increased from 0 percent) effective date of discharge. 

     d. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.      

     e. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.   
     
2.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.