RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02524
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20081014

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Aircrew Flight Equipment Craftsman, medically separated for “major depressive disorder” with a disability rating of 10%.  

CI CONTENTION:  No specific contention 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 - 20080624	VARD - 20100414	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Obsessive Compulsive Disorder	9434-9404	50%	20091125	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s mental health (MH) condition began in 1997 shortly after initial training.  She was able to function well with medications and counseling as evidenced by her performance assessment, which closed out on 18 November 2006 and recommended immediate promotion.  In 2007, the CI suffered an increase in her symptoms precipitated by divorce and work stress.  She voiced suicidal ideation and was hospitalized from 6-13 August 2007.  Her medications were adjusted and she was discharged in stable condition with resolved suicidal ideation.  Over the course of the next few months, her symptoms improved, but she was thought to be at risk of a relapse in a deployed environment or if tasked with supervisory responsibilities appropriate for her rank.  

The MEB NARSUM examination, on or about 28 February 2008 (undated, but inferred from the context), 8 months prior to separation, noted the CI was essentially in remission, but she was concerned of recurrent symptoms if returned to her duty station in a supervisory role, an assessment shared by her commander.  The mental status examination (MSE) showed a mildly depressed mood, but a broad and appropriate affect.  Cognition was intact and suicidal ideation denied.  In addition to her MDD, she was thought to have passive and avoidant personality traits which pre-existed accession.  

At the 19 March 2008 psychiatric evaluation, the CI was thought to be in full remission for the MDD and her obsessive compulsive disorder (OCD) was improving.  In MH on 2 September 2008, 1 month prior to separation, the MDD was recorded as in remission.  The separation examination recorded some fatigue (the CI was also under treatment for a sleep disorder as well as a thyroid condition), but was silent for MH symptoms.  The CI was separated on 14 October 2008.  On 19 November 2008, in a social worker encounter, the MSE was normal.  In psychiatry on 3 December 2008 and 28 January 2009, the CI was also noted to have normal MSEs.  She again reported sleep issues at the December appointment, but noted that she was sleeping well after a medication adjustment.  The 8 April 2009 MH examination noted that the CI was in full remission for both MDD and OCD.  

At the 25 November 2009 VA Compensation and Pension (C&P) evaluation, 13 months after separation, the CI reported running an on-line bookstore and working 6 hours a day while spending another hour searching for a different occupation.  She was the caretaker for her daughter and in a romantic relationship.  She endorsed occasional intrusive thoughts related to preservice sexual abuse as well as some OCD behavior.  She reported some depressive symptoms, but a 75% improvement (it is not clear from what baseline though).  The MSE showed a mildly dysphoric mood and constricted affect.  It was otherwise unremarkable.  Screening tests for depression, anxiety and PTSD were all positive.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MH disorder 10%, coded 9434 (MDD), citing occupational and social impairment due to mild or transient symptoms.  The VA rated the MH disorder 50%, dual coded 9433-9434 (dysthymic disorder-MDD), based on the C&P examination.  The panel observed that numerous MH evaluation proximate to separation, both before and after, noted that the CI had a normal MSE and/or was in remission.  However, the continued use of medications supported the 10% rating adjudication by the PEB.  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 MDD.  

BOARD FINDINGS:  In the matter of the MDD 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 20170325, 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-2017-02524.

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