RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00816
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20040123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Air Transportation Apprentice, medically separated for “depression” and “right knee bursitis,” each rated at 10%, with a combined disability rating of 20%.   

CI CONTENTION:  “Review all conditions.” 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 - 20031215	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Depression	9434	10%	No VA Examination Proximate to Separation in Evidence 	
Right Knee Bursitis	5257	10%		
Tobacco Abuse	Cat III		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Depression.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health condition began in October 2002 after experiencing chest pain related to anxiety attributed to her grandfather’s death 3 weeks earlier.  She subsequently visited mental health approximately fourteen times from October 2002 to January 2004 and received an Axis I diagnoses of “occupational problems” and a Global Assessment of Functioning of 65 (mild symptoms).

The 3 December 2003 commander’s statement implicated the CI’s physical limitations and motivation as the reasons for her inability to satisfactorily accomplish military duties.  The commander did not report any homicidal or suicidal ideations and noted she had recently become pregnant.  The CI received a temporary P4/L4 profile limiting her from running, jumping, pushing, pulling or prolonged standing; however, it did not prohibit access to firearms.

During the 10 November 2003 MEB NARSUM psychiatric examination, 2 months prior to separation, the CI endorsed significant “work related depressive symptoms” which improved over the weekends and completely resolved while on leave.  She stated, "I was great when I was back home.  It was like back in high school; I had lots of energy."  While the CI acknowledged most symptoms stemmed from work, other stressors included ill family members, being overseas away from family, and participating in a weight management program.  She denied any neurovegetative symptoms (physical, emotional or cognitive changes impacting ability to function in everyday life within society) while on leave, but said that returning to work worsened her depression.  The mental status examination revealed the CI as casually dressed, pleasant, and cooperative with good eye contact.  Mood was euthymic (normal non-depressed, reasonably positive) and congruent to affect.  She was oriented with fair insight and judgement, and denied any current suicidal or homicidal ideation; there was no psychosis.  Speech was unremarkable and thought processes logical, linear and goal directed.  The Axis I diagnoses included “occupational problems and depression not otherwise specified.”  Degree of impairment for civilian, social, and industrial adaptability was rated “mild.”  The examiner specifically documented that the CI should continue to receive medication management.  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 depression condition 10%, coded 9434 (major depressive disorder).  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 Mental Health conditions.  Panel members first agreed that there was no specific, highly stressful service-related event to invoke VASRD §4.129 for a mental disorder due to traumatic stress.  In this case, the documented stressors stemmed across multiple areas of the CI’s life to include self-induced worries/anxiety about returning to work-related duties.  Therefore, the panel only considered a single mental health rating recommendation IAW VASRD §4.130 at the time of separation.

A 30% rating requires “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks…” while a 10% rating requires “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.”  Panel members agreed that the recommendation for medication management coupled with the CI’s transient resolution of depressive symptoms when away from work, as well as an overall description of “mild” impairment, did not support a rating above 10%.  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 depression condition.

Right Knee Bursitis.  According to the STR and MEB NARSUM, the CI’s right knee pain began in September 2002 after falling in a pot hole; radiographic imaging (MRI) revealed a normal right knee.  The knee pain was unresponsive to therapy, and at a 30 July 2003 orthopedic consultation, 6 months before separation, the CI reported continued right anterior knee pain while climbing stairs and with prolonged sitting or standing.  Physical examination revealed patellar tenderness and negative instability and meniscal testing.  Range of motion (ROM) and painful motion were not addressed.

During the 20 August 2003 MEB NARSUM examination, 5 months prior to separation, the examiner noted right patellar tenderness with minimal crepitus.  There was no effusion, joint-line tenderness, and instability and meniscal testing were negative.  ROM was flexion to 135 degrees (normal 140) and extension to 0 degrees (normal); painful motion was not addressed.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee condition 10%, coded 5257 (knee, other impairment).  Members agreed there was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There likewise was no limitation of motion which attained a 10% rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  There was no history of dislocated meniscus or loose body causing frequent locking with recurrent effusions (5258) to support a rating under this code.  There was no fracture, nonunion or malunion of the femur or tibia to support consideration under the respective codes for knee impairment related to long bone conditions (5255, 5262).  There was insufficient evidence of ligament instability proximate to separation to support a dual coding under 5257 and 5003.  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’s adjudication for the right knee condition.

Contended PEB Condition:  Tobacco Abuse.  The panel’s main charge is to assess the fairness of the PEB’s determination that tobacco abuse was not compensable.  Members noted that tobacco abuse is a condition not constituting a physical disability IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending it as unfitting.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the depressive disorder and IAW VASRD §4.130, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the right knee bursitis condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended tobacco abuse condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20160913, w/atchs
Exhibit B.  Service Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00816.

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 appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings