RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01910
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20080829

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Tracked Vehicle Mechanic, medically separated for “depressive disorder” with a disability rating of 10%.  

CI CONTENTION:  The condition continues to worsen.  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 - 20080612	VARD - 20081030	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Depressive Disorder	9499-9435	10%	Anxiety Disorder, Not Otherwise Specified	9400	10%	20081003	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Depressive Disorder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s mental health condition began in early 2005 during his first deployment.  He was treated with psychotropic medications, stabilized and completed the deployment.  The CI’s treatment continued after redeployment.  His symptoms included depressed mood, difficulty concentrating, lack of energy, feelings of worthlessness/hopelessness and difficulty sleeping.  He was again stabilized on psychotropic medications and deployed again in September 2006.  During his second deployment, he again suffered from depressive symptoms, and had his bolt removed from his personal weapon as a safety precaution.  On returning from this second deployment he was placed on a permanent profile and referred to a medical board.  There was no evidence that the CI’s symptoms resulted from a traumatic experience.  
The 16 May 2008 MEB NARSUM examination, 3 months prior to separation, noted continued depressive symptoms, but the CI’s illness had only a minor to moderate impact on his unit.  He denied homicidal and suicidal ideations.  His mental status exam showed a depressed mood, but a normal full ranging affect.  Thought process was linear, logical and goal directed.  Judgement was intact and impulse control unimpaired. Insight was limited.  

The 4 June 2008 commander’s statement indicated the 8-hour workday was causing the CI to get mentally frustrated and disorientated.  The commander also noted that the CI’s ability to focus on a single task was compromised, he became easily distracted and unable to complete most tasks in a timely manner.  

At the 3 October 2008 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported that his in-service “stress was caused by his separation from his wife and two children during several deployments.”  He reported that he was “distant from everyone.”  He reported a good relationship with his kids, but was down due to his lack of energy.  The CI reported a general withdrawal from people and situations he perceived to be overstimulating. He also reported participating in a very narrow range of recreation/leisure activities due to these factors.  The CI reported a psychiatric hospitalization in 2007 for a suicide attempt (not in record).  The mental status examination showed a blunted affect and an anxious and depressed mood.  Psychomotor activity was noted as lethargic and tense. Speech was impoverished, soft or whispered, but clear and coherent.  Insight and judgement were intact.  The CI was unemployed.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the mental health condition 10%, coded 9499-9435 (analogous to mood disorder, not otherwise specified), citing mild and transient symptoms of decreased work efficiency during periods of significant stress but otherwise controlled by medication.  The VA also rated the mental health condition 10%, coded 9400, (generalized anxiety disorder), based on the C&P examination 1 month after separation, citing mild or transient symptoms which decrease work efficiency.  Panel members noted that from August 2005 to June 2006 the CI underwent multiple medication adjustments for control of his depressive symptoms.  The CI was deployed again in September 2006 and 1 month into his deployment experienced worsening of his depression symptoms.  The CI underwent an intensive outpatient program, but continued to have worsening of his depressive symptoms which culminated in unit watch from late December 2006 to January 2007.  The CI completed his deployment through August 2007.  The panel noted that the commander’s comments indicated significant and constant occupational impairment with reduced reliability and productivity.  The symptoms rose above the level of mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods or stress.  The panel noted the impact of concurrent deployments on the CI’s occupation and social functioning.  The NARSUM and C&P examinations documented marital, occupational, and social impairments as a result of depressive symptoms associated with deployment proximate to the time of separation.  Panel members agreed that the CI’s condition more closely approximated occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to depressive symptoms.  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 9435.  

BOARD FINDINGS:  In the matter of the mental health condition, the panel recommends a disability rating of 30%, coded 9435 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	
Depressive Disorder	9499-9435	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170309, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005905, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXX

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure