RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02101
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060310

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

CI CONTENTION:  He requested review of several other conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20060125	VARD - 20060706	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Episode…	9434	10%	Generalized Anxiety Disorder	9413	10%	20060427	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Major Depressive Episode.  According to the service treatment record and MEB narrative summary (NARSUM), the CI sought medical attention for occupational stressors on 2 March 2005.  On 12 January 2006, his commander noted that the CI’s duty performance declined.  The CI had expressed dissatisfaction with his job and requested separation.  His performance further declined after the request for separation was denied.  The CI appeared withdrawn and depressed, had multiple counseling sessions for poor duty performance and required another person to verify his work.  At a 12 May 2005 mental health encounter, the CI was issued an S-2 profile and remained world-wide qualified.  On 18 July 2005, it was noted the CI was off medications with a return of his sleep disturbance.  He was placed back on medications and continued counseling.  The 2 November 2005 mental health visit noted the addition of relationship problems.  On 13 December 2005, his symptoms worsened. 

The 27 December 2005 MEB NARSUM examination, 2 months prior to separation, noted ongoing complaints of depression, poor sleep and fatigue.  It noted that the CI had been admitted to a partial hospitalization on 6 September 2005 and 13 December 2005 for severe depressed symptoms related to work and relationship issues.  It was thought that there had been minimal to no improvement.  The mental status examination (MSE) showed a depressed mood, appropriate affect, but with slightly flat affect at times.  Thought content was normal but with some ruminative worry and mild paranoia (about his job).  Insight was fair and the MSE was otherwise normal.  It was noted that the CI attributed his symptoms primarily to his job and it was thought that he was unlikely to improve while he remained in the military.  Cross training was not advised.  A diagnosis of major depressive episode, single episode, severe was rendered with a Global Assessment of Function (GAF) score of 55, consistent with moderate symptoms or impairment.  The examiner stated the CI’s symptoms remained problematic to his ability to function and the CI was unlikely to improve in a military environment.  The CI required psychotherapy and medication management and his social and occupation impairment was mild.

During the mental health visit on 24 January 2006, 6 weeks prior to separation, the CI reported his marital conflict was resolving.  He was noted to be mildly depressed with a controlled affect.  Speech was mildly slowed and low in volume.  He was mildly anergic (lack of energy).  He displayed no psychotic signs or paranoia.  The CI was diagnosed with major depressive disorder, single episode, “moderate” with a GAF score of 61 (mild symptoms or impairment), improved since the MEB NARSUM evaluation.  The CI was continued on psychotropic medications.

At the 27 April 2006 VA Compensation and Pension (C&P) Mental Disorder examination, 2 months after separation, the CI reported symptom improvement since his discharge.  His wife was pregnant and he was looking for work which was a source of stress and worry.  He reported a good relationship with his wife.  He reported his typical day was fairly nice and the only stressful part was not having a job yet.  He had discontinued use of his psychotropic medications.  The MSE noted “a little irritated” mood and worry about finding a job and supporting his family.  The examination was otherwise unremarkable.  The need for psychiatric counseling or therapy was not addressed.  He was thought to have a generalized anxiety disorder and given a GAF score of 70, indicative of some mild symptoms or impairment, but at the upper end of the range (61-70).  His depression was thought to have cleared and the examiner opined that the CI might have had an adjustment disorder.  Overall his general functioning appeared to be “fairly well.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the mental health disorder 10%, coded 9434 (major depressive disorder).  The VA rated the CI’s mental health disorder 10%, coded 9413 (anxiety disorder, not otherwise specified), based on the C&P examination, citing the VASRD 10% rating criteria.

The panel observed that the CI’s martial relationship problems appeared to have resolved by the time of separation and his mental health state also improved once removed from his military work environment.  The CI reported his typical day was fairly nice and the only stressful part was not having a job yet.  His GAF score progressively improved in the months proximate to separation, increasing from 55 to 61 to 70 (mild impairment).  The panel also noted the CI discontinued his use of psychotropic medications by the time of the VA evaluation.  His VA MSE was otherwise unremarkable.  He was performing odd jobs while seeking meaningful employment.  After due deliberation, considering all of 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 major depressive episode.

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170216, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02101.

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,

								XXXXXXXXXXXXXXXXXX								                           Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings