RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01448
BRANCH OF SERVICE:  NAVY	SEPARATION DATE:  20050321

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aviation Administrative Assistant, medically separated for “major depressive disorder with severe psychotic features” with a disability rating of 10%.  

CI CONTENTION:  The rating should be changed.  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 - 20041124	VARD - 20050427	
Condition	Code	Rating	Condition	Code	Rating	Exam	
MDD with Severe Psychotic Features	9434	10%	MDD	9434	70%	20050203	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD) with Severe Psychotic Features.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s MDD began in January 2003 after finishing in the bottom of her aviation warfare systems operator class.  On 9 February 2004, the CI was hospitalized for an attempted suicide after an argument with her ex-partner.    

The 14 September 2004 non-medical assessment (NMA), 18 months prior to separation, indicated the CI was unable “to perform her duties in her rate in that it might compromise aviation safety.”  The CI was serving in the position of an administrative assistant and did a good job; however she was not able to work alone or be “relied upon for any complex or technical tasks due to her frequent episodes of confusion and inability to formulate thoughts correctly.”  
The 20 September 2004 MEB NARSUM examination, 6 months prior to separation, noted feelings of worthlessness.  She did not want to eat and would toss and turn most of the night.  She had difficulty with focus and keeping track of things.  She wanted to serve her country and said after returning to active duty she thought she could be a “suicide bomber (for the US), they could cut off my arm and put a bomb in it then send me over there to bomb whomever.”  The CI also reported she “found herself checking over and over if she locked the door or turned off the stove at home.”  She always had a hard time trusting people.  She felt her co-workers were talking about and plotting against her.  Her medications included Celexa, Trazodone and Wellbutrin.  The mental status examination showed depressed mood and affect.  She was tearful at times.  She denied suicidal or homicidal ideations and auditory or visual hallucinations.  Her judgment, insight, and impulse control was fair.  A conference of staff psychiatrists agreed that the CI had severe MDD with psychotic features.  The CI’s military impairment was marked and her impairment for social and industrial adaptability was considerable.  The Global Assessment of Functioning (GAF) score was 55.  

At the 3 February 2005 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported continued depression and anxiety.  She felt that there were some days during the week when she would like to die and had experienced suicidal ideation.  She reportedly thought about suicide once a week.  The CI reported continued sleep impairment, which interfered with her daytime activities.  The examiner noted the CI was a full-time student at the University of Southern Maine studying Biology, but there was no mention of how well she was performing in her studies.  The mental status examination revealed some tearfulness concerning a past relationship due to “hurting” someone.  There was no suicidal ideation at the time of examination.  Her “judgment was intact.”  Her affect was depressed.  The examiner’s diagnosis included recurrent MDD and relationship problems.  Her GAF score was 50.  The examiner opined that the CI’s prognosis was “quite good” as she was “feeling somewhat better.”

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD with severe psychotic features 10%, coded 9434 (major depressive disorder).  The VA rated the MDD 70%, coded 9434 (MDD), citing occupational and social impairment with deficiencies in most areas.  Panel members agreed that VASRD §4.129 was not applicable in this case.  The panel then considered its rating recommendation.  The panel noted the CI had been psychiatrically hospitalized and was unable to perform her duties due to deficiencies in thought formulation.  The panel placed more probative value on the C&P examination based on its proximity to separation.  The panel noted the CI was a full time student but continued to have severe symptoms and difficulty with social relationships.  The panel consensus was that the CI’s MDD more closely approximated the criteria for a 50% rating for occupational and social impairment with reduced reliability and productivity.  After due deliberation and mindful of VASRD §4.3 (reasonable doubt) along with consideration of VASRD 4.7 (the higher of two evaluations) the panel recommends a disability rating of 50% for the MDD.

BOARD FINDINGS:  In the matter of the MDD, the panel unanimously recommends a disability rating of 50%, coded 9434 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	PERMANENT RATING	
Major Depressive Disorder with Severe Psychotic Features	9434	50%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20161014, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs 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 11 Mar 18 ICO XXXXXXXXXXXXXXXXXX 
	 (c) PDBR ltr dtd 11 Mar 18 ICO XXXXXXXXXXXXXXXXXX 
	 (d) PDBR ltr dtd 12 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	 (e) PDBR ltr dtd 11 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	 (f) PDBR ltr dtd 12 Mar 18 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: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.       

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

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

     d. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 50 percent 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.