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-2017-02015.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

						Sincerely,

								

Attachment:
Record of Proceedings 

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02015
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20091229

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Tactical Aircraft Maintenance, medically separated for “depressive disorder, not otherwise specified (NOS)” with a disability rating of 10%.  

CI CONTENTION:  “…despite multiple attempts to schedule my follow up V.A. appt.  I was never timely evaluated due to other life issues.”  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 - 20090921	VARD - 20100223	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Depressive Disorder, NOS	9434	10%	Depressive Disorder	9417	0%	STR	
Personality Disorder	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Depressive Disorder, NOS.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s depressive disorder began in April 2008 when he complained of a depressed and irritable mood, decreased energy and appetite, some concern about feeling guilty, being less hopeful about the future, and marked distractibility at work.  He worried about his mother’s health and was sleeping very poorly.  On 23 April 2008 he was seen on an emergency basis for auditory hallucinations and nightmares and subsequently underwent counseling for an adjustment disorder with a depressed mood.  In May 2008 he was prescribed hydroxyzine (an antihistamine) for insomnia.  On 22 September 2008 he was prescribed Wellbutrin (an antidepressant) for the depressed and irritable mood, but the medication was only partially effective.  He was subsequently hospitalized for a day on 11 November 2008 for thoughts of jumping out of a car and then continued treatment on an outpatient basis.  Prozac (an antidepressant) was added to the medication protocol on 17 November 2008.  At a commander- directed evaluation two days later the CI was diagnosed with a depressive disorder, NOS.  The CI then continued regular mental health (MH) sessions and reported some improvement with the combination of Wellbutrin and Prozac, but he would forget the “small stuff.”  The undated commander’s statement indicated the CI was placed on no flight line or critical maintenance duties, which basically removed him from his AFSC; he was only utilized cleaning the building and tasks of that nature.  

The 19 February 2009 MEB NARSUM examination, 10 months prior to separation, noted complaints of depression symptoms.  A mental status examination revealed the CI appeared well, was well-dressed and groomed, and had good eye contact.  His mood was euthymic.  Affect was mid-range, appropriate, congruent with thought, and not labile.  Sensorium was intact.  Thought was coherent, logical, and goal-directed.  He denied suicidal or homicidal ideation, plans, or intent and had no psychotic symptoms.  Insight and judgment were fair.  The Axis I diagnosis was depressive disorder NOS and the Axis II diagnosis was personality disorder, NOS.  His Global Assessment of Functioning score was 55 (moderate symptoms).  He had a marked degree of impairment for military service and a definite degree of impairment for social and industrial adaptability.  

At the 24 November 2009 VA Compensation and Pension (C&P) general medical examination (GME), one month prior to separation, the CI did not report any MH complaints.  However, the psychiatric examination portion of the GME indicated the CI had a normal affect, mood, and judgment.  His behavior was appropriate with no obsessiveness.  There were no hallucinations or delusions, and comprehension of commands was normal.  However, there was no VA C&P MH examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the depressive disorder 10%, coded 9434 (major depressive disorder), citing the VA Schedule for Rating Disabilities (VASRD), and IAW NDAA 2008.  The VA rated the depressive disorder 0%, coded 9417 (depersonalization disorder), based on the STR, citing no symptoms that were severe enough to interfere with occupational and social functioning or to require continuous medication.  

The panel first noted that there was no traumatic event causing the unfitting MH condition, and therefore concluded that application of VASRD §4.129 was not appropriate in this case.  The panel noted the PEB assigned a 10% rating, which requires “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.”  However, the CI was removed from the flight line and was performing building custodian duties.  The higher rating of 30% requires evidence of “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks” due to  such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events.  

The CI, once removed from the flight line, worked as a building custodian, and although he wanted to return to the flight line, he did his assigned tasks, but still had anger issues.  While the CI’s symptoms related to depression persisted to some extent, they were somewhat improved with medication.  Nevertheless, he still had job-related anxiety, but no significant sleep impairment once on adequate medication or panic attacks prior to receiving the results of the MEB.  Although he was concerned about forgetting details, he still forgot the “small stuff,” but cognition was intact.  Therefore, panel members determined that based on the CI’s MH status proximate to separation, a 30% rating is not warranted.  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 depressive disorder, NOS.  

Personality Disorder.  The contended condition is not a condition that constitutes a physical disability.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the depressive disorder, NOS and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  In the matter of the contended personality disorder 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 20170222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record