DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD DC 20374-5023

IN REPLY REFER TO

1850
CORB:003
12 Feb 20

From:	Director, Secretary of the Navy Council of Review Boards To:	PD-2017-00463

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 4 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy of 15 October 2019 for appropriate action.

2.	On 31 January 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-00463
BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20080811

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Postal Clerk, medically separated for “major depressive disorder [MDD], recurrent, severe, without psychotic features,” and anxiety disorder, not otherwise specified [NOS],” rated 10% each, 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 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 - 20080605	VARD - 20080820	
Condition	Code	Rating	Condition	Code	Rating	Exam	
MDD…	9434	10%	
Depression, Anxiety NOS and OCD	
9499-9434	
NSC*	

STR	
Anxiety Disorder, NOS	9413	10%					
Obsessive Compulsive Disorder [OCD]	Cat II					
Borderline Traits	Cat IV					
Migraine Headaches	Cat III	Migraine Headaches	8100	NSC		
Recurrent Kidney Infection	Cat III	Pyelonephritis and Left Kidney Stone	7504	30%		
Scoliosis	Cat III	No VA Placement	
Underweight	Cat III	No VA Placement	
Possible Hip Dysplasia	Cat III	Right Hip Dysplasia	5299-5252	NSC	STR	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 30%	
*VARD 20151229 rated 10% effective 20080908, presumably based on Memorandum of Formal Findings on a Lack of Information Required to Verify Stressors in Connection to PTSD, dated 20150903.

ANALYSIS SUMMARY:

MDD/Anxiety Disorder (D/O), NOS. The PEB assigned two mental health (MH) ratings: MDD and anxiety D/O, NOS. However, IAW VASRD 4.130, only one rating may be assigned for MH impairment based on overall occupational and social functioning. Therefore, the evidence for the MDD, anxiety d/o, NOS and related Category II (contributes to the unfitting condition) OCD are reviewed together.

According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s anxiety and depression symptoms began in approximately December 2006. Scant MH notes in the STR indicated the CI was seen by psychiatry in January 2007 with complaints of difficulty sleeping, crying spells, and feeling overwhelmed. She also reported having presented to the emergency room in December 2006 with dizziness and palpitations, and symptoms “triggered” and “exacerbated” by multiple stressors including having two children in 1 year and a pending divorce making her the primary provider for four children under the age of seven. She reported being obsessed with cleanliness, but denied intrusive or ego-dystonic thoughts (in conflict with her self-image), or suicidal ideation (SI). She had previously been on psychotropic medication for depression, which was stopped when she became pregnant. The mental status examination (MSE) was unremarkable except for the CI being “slightly anxious appearing” with a tearful affect; she was prescribed antidepressant medications for mood and sleep. A primary care note in February 2007 recorded a phobia of driving due to a history of a childhood motor vehicle accident with her mother, and three recently automobile accidents within the year. A psychiatry entry on 26 April 2007 indicated the CI was working around her driving anxieties by using back roads, staying off highways, and moving closer to work. She also reported marital counseling and making a commitment to improve the relationship.

Two limited duty (LIMDUs) periods were granted for MH conditions. The LIMDU dated 22 January 2007 listed anxiety, NOS and the other on 31 January 2008 listed MDD, OCD and anxiety disorder, NOS. Limitations included no sea duty or deployments, no weapons or ordnance handling, and the requirement for stationing within 25 miles of a military treatment facility with a psychiatric ward. The non-medical assessment (NMA) on 10 March 2008 noted the CI performed in garrison in a billet appropriate to her rank and level of training, but that she was unable to work in a deployed or field environment. She missed approximately 3 hours of work per week due to her medical condition, and the commander stated that beyond the medical issues, extensive family problems impaired her ability to function at the level expected by her chain of command. She periodically requested assignment to duties outside her rating and was not amenable to fulfilling sea/shore rotations.

The 17 March 2008 MEB NARSUM examination, 5 months prior to separation, noted CI complaints of depression and anxiety triggered by multiple stressors. Regarding her cleanliness obsession, she endorsed cleaning rituals helped relieve symptoms during times of high anxiety; she denied alcohol or illicit drug use. Medications included two antidepressants and two anti- anxiety agents daily. The MSE showed the CI to be visibly agitated during the interview with a dysphoric (dissatisfied or restless) and anxious mood and congruent affect. Judgment was described as critical, but insight and impulse control were good, and she denied SI. The Axis I diagnoses were MDD, recurrent, severe, without psychotic features, OCD and anxiety d/o, NOS. Borderline traits were listed on Axis II and the global assessment of functioning score was 65 (mild range of impairment). The examiner indicated the CI was compliant with outpatient treatment which included medications and individual counseling.

A 5 May 2008 MEB NARSUM addendum addressed the CI’s underweight condition at the PEB’s request for further information. Medical history indicated she smoked, was underweight all her life, and had recently gained several pounds rather than losing weight. The examiner noted that except for being underweight, there was no evidence of an eating disorder, malabsorption

syndrome, or acute weight loss due to a medical cause. 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) and the anxiety d/o, NOS 10%, coded 9413 (anxiety d/o, NOS) with OCD listed as a related Category II condition. The VA initially did not service connect depression, anxiety and OCD, based on the STR, citing the CI received an MH diagnoses from general health care providers. However, these conditions were subsequently rated 10% effective 8 September 2008, presumably based on a Memorandum of Formal Findings on a Lack of Information Required to Verify Stressors in Connection to PTSD, dated 3 September 2015.

A 10% rating is warranted for 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, as evidenced by the CI’s performance of duties commensurate with her rank and training according to the NMA. There was no evidence in the record of occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks required to support a 30% rating. The PEB provided two separate VASRD §4.130 10% ratings for MDD and anxiety, as noted above, and listed the OCD as a related diagnoses (Category II) contributing to the Category I anxiety D/O, NOS. According to the VASRD, the CI’s overall occupational and social impairment is provided a single rating, despite the presence of multiple MH diagnoses. No change to the PEB adjudication of the OCD as a Category II condition is recommended as all three MH conditions may only be assigned one rating. The panel recommends a 10% rating for the CI’s overall occupational and social impairment due to her MH conditions. However, the panel may not recommend a lower combined rating than the PEB and therefore, no change to the PEB adjudication of two unfitting MH conditions is recommended. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudications for the MDD or anxiety D/O.

Contended PEB Conditions: Migraine Headaches, Recurrent Kidney Infection, Scoliosis, Underweight, and Possible Hip Dysplasia. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended conditions were not noted on limited duty forms or implicated in the non-medical assessment, and did not fail retention standards. There was no performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended conditions, so no additional disability rating is recommended. Borderline Traits is a condition not constituting a physical disability. Therefore, the panel has no basis for recommending it as unfitting.

BOARD FINDINGS: In the matter of the major depressive disorder, recurrent, severe, without psychotic features and anxiety disorder, NOS, and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication. In the matter of the migraine headaches, recurrent kidney infection, scoliosis, underweight, possible hip dysplasia, and borderline traits condition, the panel recommends no change from the PEB determination as not unfitting. 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 20170215, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record