RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01588
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Satellite Communications Systems Operator/Maintainer, medically separated for “major depressive disorder (MDD)” with a disability rating of 10%.  

CI CONTENTION:  “Major Depressive Disorder has had a lasting effect on my life.”  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 - 20051101	VARD - 20060314	
Condition	Code	Rating	Condition	Code	Rating	Exam	
MDD, Single Episode	9434	10%	MDD	9434	30%	20060123	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

MDD. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s MDD began in the middle of 2004 with his wife’s immigration issues.  His symptoms included feelings of depression, sadness, hopelessness, helplessness, anger, and guilt.  He also had problems with sleep that caused residual fatigue, loss of energy, and some impairment in concentration.  Although the CI experienced symptoms, mental health (MH) care was not sought prior to 19 July 2005 which was 4 months prior to separation.  The CI’s condition never required inpatient hospitalization or care in the emergency room.

The 19 July 2005 primary care encounter recorded the complaint of a sleep problem.  The CI reportedly indicated multiple stressors including problems with his wife.  He denied suicidal or homicidal ideation, was assessed with insomnia, and prescribed Ambien for sleep.  The CI was advised to go to MH.  At the 10 August 2005 primary care visit, the CI reported symptoms of erratic eating, sadness, social isolation and insomnia.  He was evaluated by a psychologist at MH and was referred to primary care for medication to treat depression.  The CI noted ongoing problems with his wife.

The 29 September 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of depression, poor sleep, and daytime residual fatigue.  The CI also noted feelings of anger directed towards people in his chain of command for not helping him resolve his problems of anxiety.  He noted problems with concentration at work due to the sleep problem.  He “zoned out “while driving his car” because of poor sleep.  The CI noted he felt stressed over not being able to see his wife for about 2 years due to her inability to obtain a travel visa to the U.S. from the Philippines.  The CI blamed “the geographic system” for some of his marital issues.  In addition to the depression, the CI was also binge drinking alcohol, and had been referred to a substance abuse program.  The CI was prescribed antidepressant medication one month prior to the NARSUM, and took sleep medication on an ‘as needed’ basis.  His medication was noted to have slightly improved his condition.  The mental status examination (MSE) was unremarkable with the exception of depressed mood, restricted affect, and psychomotor slowing.

At the 23 January 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported his depression started in the middle of 2004.  He lost track of his wife and had not seen her since December 2003, and last spoke with her in June 2005 when she told him she no longer wanted to be married to him.  His wife had wanted the CI to bring her to his location, but he had difficulty with the immigration service, and his wife “stopped believing in their marriage.”  She accused him of abandoning her.  This caused him to be very depressed, and he felt his duty as a soldier prevented him from being with his wife.  The CI reportedly stated, I lost my wife because of the Army.”  The CI reported he first saw a MH professional in August 2005 at the suggestion of his company commander and sergeant.  Current symptoms were difficulty sleeping at night, weight gain, and anger, loss of sex drive, decreased concentration, and excessive daytime sleeping.  The CI engaged friends with weekly games of billiards that he enjoyed very much.  He was looking for employment, and stayed busy by working on his truck, checking email, doing household chores, reading at the bookstore, or watching movies.  The MSE was unremarkable with the exception of depressed mood and constricted affect.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and the VA rated the MDD 10% and 30%, respectively, both coded 9434 (MDD). The PEB cited some improvement with medication, and rated as mild industrial impairment. The VA based the rating on the C&P examination, citing the VARSD 4.130 criteria for 30% rating.

The panel members first agreed that the provisions of VASRD§ 4.129 for a “mental disorder that develops in service as a result of a highly stressful event” were not applicable in this case.  The panel then proceeded with the rating recommendation.  The panel considered the absence of emergency room treatment, or hospitalization, minimal MH treatment, and the apparent stability of symptoms during the 12 months prior to separation.  The panel noted MH treatment was not sought prior to 2 months before separation.  The panel also noted the temporal relationship of his seeking MH care and his wife’s pronouncement of not wanting to remain married. The NARSUM and C&P examinations suggested his condition was due to multiple stressors related to his marital situation.  There were no reports of problems with memory, anxiety, or panic attacks.  The commander’s statement one month prior to separation did not mention any MH symptoms having a negative impact on duty performance.  The commander stated the CI completed all his assigned tasks with diligence and that “he has always demonstrated the finest qualities in military bearing and retains a Soldierly demeanor.”  The former first sergeant reportedly related that the CI was an “exceptionally hard worker who slowly began to shut down after prolonged estrangement from his wife, who still resides overseas.”  The commander expressed belief that the longer the CI was alienated from his wife “the more he will slip into despair.” There was no mention of difficulties with supervisors or co-workers. 

Panel members agreed the 10% rating and no higher was justified 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.”  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 adjudication for the MDD.  

BOARD FINDINGS:  In the matter of the major depressive disorder 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. 

AR20190004095, XXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.