RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02504
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Motor Transport Operator, medically separated for “major depressive disorder with anxiety disorder” with disability rating of 10%.   

CI CONTENTION:  No specific contention was made.  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 - 20061129	VARD - 20080206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder [MDD] with Anxiety Disorder	9434	10%	Post Traumatic Stress Disorder [PTSD] and MDD	9434-9411	50%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

MDD with Anxiety Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s mental health (MH) condition began in July 2006 following a training accident, in which he witnessed the death of his best friend.  The CI was seen in the emergency room (ER) on 22 August 2006 secondary to suicidal/homicidal thoughts, and was assessed with anger and depression.  He was transferred via ambulance to inpatient psychiatry at a civilian hospital, where he reported thoughts of killing his platoon sergeant, and crashing his truck to end his pain.  The provider noted that the CI had not been taking his medications.  There was no STR documentation of additional ER visits or psychiatric hospitalizations.
The 28 August 2006 MEB MH examination, 4 months prior to separation, noted CI complaints of irritability with angry outbursts, recurring thoughts and nightmares of the accident and his friend “bleeding out,” insomnia, and feeling anxious, sad and depressed.  He was taking psychotropic medication, and attending anger management and talk therapy, but response to treatment was minimal.  The examiner stated the CI had no prior psychiatric history, and the mental status examination (MSE) was unremarkable except for sad affect and poor judgment and insight.

At the 17 October 2006 MEB NARSUM examination, 3 months before separation, the CI described unpredictable depressive moods with irritability, emotional lability, and excessive rumination about the accident.  He reported no significant improvement in symptoms despite treatment.  The examiner noted the 2006 psychiatric hospitalization and referred to the MEB MH evaluation for findings.  The CI’s current duties included administrative tasks, plus cleaning the barracks, and minimal jobs in the motor pool, and he felt unable to perform in his military since June 2006 because he was fearful of getting into a truck and driving.  The commander’s statement on 4 October 2006 indicated that the CI’s performance and leadership ability was “sufficient” if he stayed “actively engaged in an activity,” but otherwise tended to “become complacent.”

During the 31 May 2007 VA Compensation and Pension (C&P) MH examination, 4 months after separation, the CI reported a history of two psychiatric hospitalizations in the month of September 2006 (second admission not mentioned in the STR).  He reported daily depressed mood, problems with sleep, appetite, concentration, energy and motivation, and that once a week he slept in instead of going to work.  He had held a full-time job in construction since separation, and had dated his girlfriend, whom he lived with, for 10 months.  On weekends, he spent time with his girlfriend and other friends, and he consumed alcohol 3-4 nights per week.  The MSE was unremarkable with the exception of irritable mood and affect.  Judgment was not impaired, and memory was intact.  Although the examiner recorded sleep impairment, the CI reported 5-6 hours a night, with difficulty falling or staying asleep.  There was no endorsement of panic attacks, suicidal or homicidal thoughts, psychotic symptoms, or legal issues, but he stated that MH symptoms negatively impacted his work by causing decreased concentration, increased tardiness and absenteeism, and poor social interactions.  However, there was no report of any disciplinary actions taken by his employer, and he maintained employment.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD with anxiety disorder 10%, coded 9434 (MDD), citing mild industrial impairment.  The VA rated PTSD and MDD 50%, dual coded 9434-9411 (MDD-PTSD), based on the C&P examination, citing occupational and social impairment with reduced reliability and productivity.  The panel considered the provisions of VASRD §4.129 (mental disorders due to traumatic stress), and determined that the MDD was due to a “highly stressful event,” and that application of §4.129 was appropriate in this case.  Therefore, a minimum 50% rating for a retroactive 6‐month period on the Temporary Disability Retired List (TDRL) is recommended.  The panel turned to its rating recommendation at the time of TDRL placement, and noted that the §4.130 criteria for a 70% rating for “occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood” were not met; and, therefore the minimum 50% TDRL rating prescribed by §4.129 is applicable.

The panel then turned to its permanent rating recommendation at the time of TDRL removal.  While there were no treatment records during the constructive TDRL period, the C&P examination documented no ER visits related to MH symptoms, or inpatient psychiatric treatment in the 9 months since initial hospitalization.  Additionally, the CI did not report any panic attacks or memory problems, and the examiner found no cognitive or judgement impairment.  There was no indication that he continued on psychotropic medication or was involved in MH treatment post-separation.   While he had difficulty maintaining sleep, he engaged in social activities and had his girlfriend’s support.  He was employed, and although he reported tardiness and missing work, there was no mention of any disciplinary actions taken by his employer.  

A 50% disability rating requires evidence of “occupational and social impairment with reduced reliability and productivity due to symptoms such as: flat affect, panic attacks more than once a week, difficulty in understanding complex commands, impaired short and long-term memory and impairment in judgment and thinking,” while a 30% rating stipulates “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.”  The panel agreed that that the CI’s MH impairment did not rise to the level of a 30% disability, and concluded that the evidence demonstrated the condition was most reflective of the 10% level for “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.”  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a retroactive 6-month period of TDRL with a rating of 50% (in accordance with §4.129), and a permanent rating of 10% for the MDD, coded 9434. 

BOARD FINDINGS:   In the matter of the major depressive disorder with anxiety disorder, the panel recommends an initial TDRL rating of 50%, coded 9434, in retroactive compliance with VASRD §4.129 as DoD directed; and a 10% permanent rating at 6 months 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, effective the date of medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Major Depressive Disorder With Anxiety Disorder	9434	50%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170313, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190008128, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to constructively place you on the Temporary Disability Retired List (TDRL) at 50% disability for six months effective the date of your original medical separation for disability with severance pay, and then following this six month period no re-characterization of your separation or modification of the permanent disability rating of 10%.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The constructive TDRL period will result in an adjustment to your pay providing you 50% retired pay for six months from the date of your original medical separation and then no re-characterization of your separation or modification of the permanent disability rating of 10% following the constructive six month TDRL period. 

	The accepted DoD PDBR recommendation has been forwarded to the 
Army Physical Disability Agency for required correction of records and then to the 
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.  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.  Inquiries concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

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

Sincerely,					      
Enclosure