RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01816
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Vehicle Operations Craftsman, medically separated for “major depressive disorder” with a disability rating of 10%.

CI CONTENTION: The VA rated the condition higher.  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 - 20050524	VARD - 20060522	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Major Depressive Disorder	9434	50%	20060318	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Major Depressive Disorder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had a history of depressive symptoms for which he was treated in 2002.  In February 2005, he was seen in the emergency room for self-mutilatory behavior marked by superficial cuts and abrasions from the wrists to the forearms.  At a life skills clinic visit on 28 February 2005, the CI reported a history of depression and increased alcohol usage with symptoms of hallucinations and paranoia and was admitted to the hospital.  He was subsequently aero-evacuated to CONUS and hospitalized from 12-29 March 2005.  

The 29 March 2005 MEB NARSUM examination, 2 months prior to separation, noted complaints of suicidal ideation and self-mutilatory behavior.  The CI endorsed suicidal ideations for the preceding 5 years without ever contemplating a plan.  In the prior 8 months he felt significantly more stress with a greater workload and a sense of urgency on the job.  He had less time to relax and had concerns about how his family was doing at home.  Physical examination was unremarkable and a mental status examination noted no suicidality.  Initially the CI was guarded and angry.  There was no evidence of internal stimuli.  The Axis I diagnoses were major depressive disorder (moderate and recurrent), dysthymic disorder and alcohol abuse.  The Axis II diagnosis was personality disorder NOS (narcissistic, avoidant, and paranoid traits).  The Global Assessment of Functioning (GAF) score was 55 (moderate symptoms) on admission and 65-70 (mild symptoms) on discharge.  The social and industrial impairment was definite and military impairment was moderate.  Medication use on an outpatient basis as of 10 May 2005 consisted of Effexor (venlafaxine, an antidepressant), Risperidone (an antipsychotic medication) and Ativan (lorazepam to treat an anxiety disorder).  

At the 18 March 2006 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported depression, suicidal ideation, upsetting thoughts, paranoid ideas,  hopelessness and feelings of impending doom.  He denied any self-mutilating behaviors, considered himself a chronic procrastinator without motivation or drive, derived little pleasure from things and had low energy.  Mental status examination showed a guarded and deliberate manner.  The CI was slightly hostile, definitely evasive and was annoyed at many of the examiner’s questions.  He appeared to be somewhat paranoid without a formal thought disorder on closer examination.  He was quite depressed and reported suicidal ideation, but denied any active plan to injure or kill himself or someone else.  His intelligence was judged to be above average with questionable insight and poor judgment.  His GAF score was 53 (moderate symptoms).  The examiner noted the CI appeared to suffer from clinically significant depression in the context of personality problems.  The examiner opined that the CI’s depression as well as his personality problems created functional problems in their own right with the depression contributing to his maladaptive social isolation, low energy and drive as well as irritability with his personality problems influencing the way he viewed his situation as well as his ability to manage stress and anger more generally.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the major depressive disorder 30%, but decreased the rating to 10% for  aggravating/contributory factors, coded 9434 (major depressive disorder), citing an aggravating personality disorder (a non-ratable/non-compensable condition under disability law/policy), and opining that it significantly affected the severity of the CI’s major depression, which would have been only be mild at best.  The VA rated the major depressive disorder 50%, coded 9434, based on the C&P examination, citing moderate social and occupational impairment due to depressed mood and social isolation.  

Panel members noted the PEB rated the CI’s condition 30%, which requires evidence of “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.”  The VA, on the other hand, rated the condition 50%, which requires “occupational and social impairment with reduced reliability and productivity.”  While the CI clearly had symptoms of a 30% rating at the time of separation, he was avoidant in responding to the examiner’s questions at the C&P examination and had impaired judgment while on active duty marked by cutting himself.  He also had some difficulty in establishing and maintaining effective work and social relationships.  Panel members assigned higher probative value to the 2-month pre-separation NARSUM than the 8-month post-separation VA C&P examination because it was more reflective of the CI’s mental status at the time of separation.  Therefore, panel members were in accord with the PEB’s rating of 30%.  

Panel members then examined the PEB’s 20% rating subtraction based on the personality disorder.  The PEB opined the CI’s personality disorder significantly affected the severity of the major depression.  The panel discussed whether the rating subtraction was appropriate and supported by facts in the record.  The CI’s commander indicated he was not working in his primary AFSC, but opined the CI would be able to effectively resume the duties of his previous position if give a “return to duty” recommendation.  The CI was more than motivated to overcome his condition.  While the CI’s behavior associated with a personality disorder may have played a role in the CI’s depressive symptomatology, his hospital admissions were related to his cutting himself.  Panel members discussed DoDI 1332.38 E4.A1.1.3.7.4. (every effort must be made to distinguish symptoms and impairment resulting from personality disorder or mal-adaptive traits from impairments based on other psychiatric conditions) and concluded the depressive disorder symptoms played the major role in the CI’s overall condition and the final rating was determined based on those symptoms.  Therefore, panel members determined that no subtraction was warranted.  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 depressive disorder, coded 9434.  

BOARD FINDINGS:  In the matter of the major depressive disorder, 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 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	9434	30%	

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

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01816.

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.