RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00909
BRANCH OF SERVICE:  army 	
DATE REMOVED FROM TDRL:  20050110

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Internment/Resettlement Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “dysthymic disorder” with a  disability rating of 0%.

CI CONTENTION:  His condition was rated 70% by the VA and he feels his service rating warrants a higher rating.  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 - 20041208	VARD - 20050127	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Dysthymic Disorder	9433	0%	Depression, Bipolar Disorder	9432-9434	70%	20040823	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70% 	

ANALYSIS SUMMARY:  

Dysthymic Disorder.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was initially seen in mental health in 1998 for marital counseling and was again seen in 2000 for insomnia.  In early 2003, he again had psychological distress associated with marital discord.  Prior to that, he functioned well as evidenced by a performance report dated 20 February 2003 which recommended promotion ahead of his peers.  He was seen in mental health on 6 March 2003 for anxiety symptoms.  It was noted that his wife had bipolar disorder.  He was begun on a psychotropic medication and entered counseling.  He remained symptomatic despite treatment and was admitted for depression on 8 August 2003 reporting suicidal and homicidal ideation with panic attacks.  It was noted he planned on the military “processing me out.”  He improved during the hospitalization and was discharged on 25 August 2003 with the diagnosis of a bipolar mood disorder.  He was then placed on convalescent leave and was entered into the MEB process.  

The 5 September 2003 MEB NARSUM examination, 5 months prior to TDRL placement, noted the CI’s wife had recently been admitted to work on some old abuse issues.  On examination, he was somewhat unkempt and dressed in pajama bottoms and a t-shirt.  Speech was somewhat pressured and loud.  Thought processes and memory were intact.  Hallucinations and delusions were absent.  He described himself as depressed and hopeless, but was noted to be somewhat histrionic and adamant about not continuing military service.  He was subsequently re-hospitalized on 29 September 2003 for recurrent depression and self-mutilation (cutting himself).  A 15 October 2003 addendum to the MEB NARSUM noted he was depressed.  The CI was placed on temporary disability retirement (TDRL) effective 27 January 2004.  

At the 23 August 2004 VA Compensation and Pension (C&P) evaluation, 7 months after TDRL placement and 5 months before TDRL removal, the CI was unkempt and had poor eye contact.  He reported that he had recently been divorced, lost his house, and broken up with his girlfriend.  He stated that the military had been his life.  He reported that he spent too much money and was unfaithful during his manic periods.  Scars from self-mutilation were present.  He worked for the VA, but had used up all of his leave and sick time as he did not like his job.  On examination, his affect was flat and mood depressed and irritable.  Thought processes were linear and goal oriented, but with some loosening of association.  Speech was soft and paucity noted.  Insight and judgement were impaired.  Suicidal ideation was present, but without plan or intent.  He denied homicidal ideation.  He was diagnosed with bipolar II disorder (by history) and noted to have borderline and narcissistic personality traits.  A Global Assessment of Functioning (GAF) score of 38 (consistent with major impairment in multiple areas) was assigned.  

The TDRL removal examination was accomplished 6 weeks later on 8 October 2004, 3 months prior to TDRL exit.  He denied manic symptoms, but endorsed a low level of depression.  He reported multiple stressors including a recent divorce and attendant financial distress as well as separation from his children.  He had moved to a new location (which he had planned with his now ex-wife) and reported some isolation without new friends.  He denied suicidal ideation or self-mutilation.  He was working with the VA.  He enjoyed helping veterans, but was unhappy with his salary.  On examination, he was noted to be a little depressed and occasionally tearful, but otherwise the examination was unremarkable.  The diagnosis was changed to dysthymic disorder.  The GAF was noted to be greater than 65 (some mild symptoms or impairment).  The CI reported improvement with his current treatment which included medications.  At a family practice evaluation on 23 September 2005, 8 months after TDRL removal, the CI was noted to be mildly anxious, but not depressed.  The psychiatric evaluation was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the mental disorder 0%, coded 9433 (dysthymic disorder), citing “symptoms stabilized at a mild level of impairment, and has obtained employment in GS system at the VA.”  The VA rated the mental disorder 70%, coded 9432-9434, (bipolar disorder – major depressive disorder), based on the C&P examination 5 months before TDRL removal, citing “occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships.”  

The PEB NARSUM for TDRL removal was more proximate than the VA examination.  In addition, this was also consistent with the family practice note accomplished 8 months after TDRL removal.  The CI was working and enjoyed his job.  He reported depressive symptoms, but was separated from his children and recently divorced.  The use of medications does support a 10% rating though.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the dysthymic disorder condition, coded 9433.  

BOARD FINDINGS:  In the matter of the dysthymic disorder condition, the panel unanimously recommends a disability rating of 10%, coded 9433 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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	RATING	
Dysthymic Disorder	9433	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170018433, 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