RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01743
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051101

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Traffic Management Craftsman, medically separated for “depressive disorder, not otherwise specified (NOS)” with a disability rating of 10%.  

CI CONTENTION:  The CI submitted a lengthy contention for PTSD.  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 - 20050831	VARD - 20051206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Depressive Disorder, NOS	9434	30%
    -- 20_*
       10%
	Depression/ Adjustment Disorder	9499-9440	10%	20051005	
Adjustment Disorder, Chronic with Mixed Disturbance of Emotion and Conduct	Cat II					
Narcissistic and Antisocial Traits	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	
*Less Aggravating/contributory Factors

ANALYSIS SUMMARY:

Depressive Disorder, NOS.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s mental health condition began in October 2004 after a near suicide attempt.  In December 2004 he was diagnosed with combat related PTSD and was subsequently seen monthly for medication management.  In June 2005 he was admitted to a psychiatric ward for psychological testing.  At that admission, the focus of care was sorting through multiple “untrue” stories the CI had told his command and his wife.  The CI’s providers then questioned the truthfulness of his traumatic experiences while on deployment leading to his diagnosis of PTSD.  His psychologist stated, “By and large, this evaluation suggested that Sgt. C--- has significant problems with depression and traumatic stress symptoms.  His description of traumatic stressors appeared plausible, but could not be corroborated here.  None of the results from the psychometric tests (i.e., MCMI-III, PAI, SIRS) suggested that Sgt. C--- is feigning problems or misrepresenting his psychiatric condition. These same measures do, however, provide some evidence that he over-reports problems, i.e., he endorses greater symptomatology than is the case which is a pattern commonly seen in individuals diagnosed with PTSD.  Furthermore, Mr.  C---'s report that the vehicular accident was more stressful than his sexual assault, and his being almost entirely amnestic about the most recent trauma in Liberia, show an increasing problem in coping with extreme stressors (less coping and more debilitation with each successive trauma).  This pattern gives further weight to the contention that trauma exposure is an etiological factor in Sgt. C---'s current functioning.”  

The mentioned vehicular accident happened prior to the CI’s enlistment.  At the time of his discharge the diagnosis was depression NOS, rule out PTSD.  The 07 July 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of flashback, intrusive thoughts, sleep problems, difficulty concentrating, but no difficulties at work.  The mental status examination was normal, showing mood congruent affect and intact judgment and insight.  The provider rendered diagnoses of depressive disorder, not otherwise specified, and adjustment disorder, chronic, with mixed disturbance of emotion and conduct.  

At the 10 October 2005 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported symptoms consistent with PTSD and had a normal mental status examination.  The examiner rendered diagnoses of depressive disorder, not otherwise specified; adjustment disorder, with anxiety; and personality disorder, NOS, with antisocial and narcissistic traits.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the mental health condition 10%, coded 9434 (major depressive disorder), citing that the CI met criteria for 30%, but the non-compensable condition, adjustment disorder, contributed significantly to the CI’s disability, reducing the rating to 10%.  The VA also rated the mental health condition 10%, coded 9499-9440, (analogous to chronic adjustment disorder), based on the C&P examination, citing lack of corroborative data regarding in-service stressors to make the diagnosis of post-traumatic stress disorder.  Panel members agreed that the preponderance of evidence did not support the application of §4.129.  In considering its rating recommendation the panel notes that, IAW DoDI 6040.44, provisions in governing instructions not in compliance with the VASRD are not to be taken in account during the PDBR’s deliberations. There is no 20% mental health rating in the VASRD to justify such a deduction.  With regard to a 50% evaluation (“occupational and social impairment with reduced reliability and productivity”), the panel noted the absence of functional impairment due to symptoms that would support a 50% evaluation such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of memory; impaired judgment; or impaired abstract thinking.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the mental health condition, coded 9434.  

BOARD FINDINGS:  In the matter of the mental health condition, the panel recommends a disability rating of 30%, coded 9434 IAW VASRD §4.130.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Depressive Disorder	9434	30%	

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01743.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.