RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01201
BRANCH OF SERVICE:  Marine Corps	SEPARATION DATE:  20041115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Hygiene Equipment Operator, medically separated for “major depressive disorder” with a disability rating of 10%.  

CI CONTENTION:  The VA gave her 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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040924	VARD - 20050120	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder (MDD)	9434	10%	Major Depression	9434	30%	20041019	
Anxiety Disorder	Cat II					
Avoidant and Dependent Traits	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

MDD.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s MDD began in January 2004 following the death of her parents.  On 1 January 2003, she was home visiting when her mother committed suicide and she discovered the body.  Subsequently, her father died on 23 December 2003 due to complications from diabetes.  The CI reported symptoms of depression following the death of her mother, but an occupational medical survey dated 18 July 2003 noted no mental or emotional illness.  An STR entry on 15 February 2004 documented that the CI reported cutting herself (superficially) while intoxicated, but denied suicidal intent.  Additionally, the entry also noted that she “works with water purification-does a good job.  No problems with work or command.”  She was evaluated in mental health on 18 February 2004 and reported feeling ashamed and remorseful for her actions after she “sobered up,” but endorsed daily depressed mood and feelings of loss.  She denied symptoms of anxiety, self-injurious behavior or suicide intent or plan, and was future oriented.  The mental status examination (MSE) noted good eye contact, a stressed and depressed mood, congruent affect, intact judgement and fair insight.  

She became intoxicated on 8 April 2004 and reportedly expressed suicidal ideation, but did not remember doing so.  The MSE was remarkable for a sad and pessimistic mood, but suicidal ideation was denied.  In May 2004, the CI was hospitalized for 3 days due to a suicidal gesture in which cut her wrists while intoxicated on leave. She was cleared to drive herself to her new duty station, but again became intoxicated and cut her wrists.  She was hospitalized on 19 May 2004 and then transferred as an inpatient to her new duty station where she was admitted to the local naval hospital.  

At the 1 June 2004 MEB NARSUM examination, 5 months prior to separation, the CI denied current suicidal or homicidal ideation.  The NARSUM was accomplished while she was still admitted and noted she was no longer motivated to continue military service.  The MSE was remarkable for a neutral mood and “somewhat restricted” affect.  Thought content was intact and suicidal ideation denied.  A Global Assessment of Functioning (GAF) of 55-60 (moderate symptoms or impairment) was rendered and she was diagnosed with alcohol dependence for which treatment was initiated.  

On 26 June 2004, the CI made another suicidal gesture while intoxicated (over two and a half times the legal limit for driving) and was voluntarily hospitalized until 6 July 2004.  She received treatment for substance abuse during this time, and at discharge, her eyes were downcast, but speech was normal and mood neutral.  She expressed remorse for her actions at the time of admission and denied active suicidal ideation.  During the hospitalization, her medication dosage was increased and resulted in an improvement in mood and sleep, as well as better insight into the importance of complete abstinence from alcohol.  

The 8 August 2004 non-medical assessment (NMA) noted that the CI had checked into a hospital prior to joining her present unit with the majority of her time been spent in treatment or at medical appointments and her performance observed to be less than average.  During the 29 August 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported a history of MDD and post-traumatic stress disorder (PTSD).  She also endorsed a history of attempted suicide on six occasions (not found in the STR).  The psychiatric examination was checked “normal.”  

At the 19 October 2004 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI drove herself to the interview and was thought to be a reliable historian.  She still grieved the loss of her mother, but was doing better.  She was apparently abstaining from alcohol, which she reported using to “self-medicate,” and socialized with friends, but was not dating.  On MSE, she was neatly groomed and dressed, pleasant and polite, but seemed a little bit passive and dependent.  Speech was normal and cognition was intact, but her self-confidence was low.  She denied suicidal ideation, but was very anxious and still had some depression and psychomotor retardation.  The CI planned to live with her sister after separation and hoped to go to college to become a respiratory therapist.  The examiner diagnosed major depression in partial remission and assigned a GAF of 45 (serious symptoms or impairment).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD 10%, coded 9434 (MDD).  The Category II (contributes or related to the unfitting condition) anxiety disorder and avoidant and dependent traits were appropriately subsumed under the unfitting MDD, and alcohol dependence was determined to be a Category IV (does not constitute a physical disability) condition.  The VA rated the MDD 30%, also coded 9434, based on the C&P examination, citing the use of continuous medications, counseling and anxiousness.  

Upon deliberation, members noted that all of the CI’s suicidal gestures were made while intoxicated, and that proximate to separation, she was maintaining sobriety and responding to treatment.  Additionally, the MSE showed anxiety and some residual depression, but was otherwise fairly normal, and it is not clear what criteria the VA examiner used to assign a GAF of 45.  The threshold for a 30% rating includes the inability to perform occupation tasks.  The CI was admitted several times for suicidal gestures (and unable to perform her job), but these were all in the context of intoxication, and she denied suicidal ideation once sober.  Although her performance was poorer than her peers, the NMA did not state that the CI was unable to perform her job.  The alcohol dependence was not attributed to the mental health disorder, although the VA examiner did note that the CI self-medicated with it (presumably before adequate medical treatment, but this is not specified).  The panel determined that she appeared to be functioning reasonably well at separation with medications and alcohol abstinence, and her condition best fit the criteria for a 10% rating:  “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 there was insufficient cause to recommend a change in the PEB adjudication for the MDD.  

BOARD FINDINGS:  In the matter of the MDD and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20160928, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN

					XXXXXXXXXXXXXXXXXX
	     				Acting