RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02561
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050603

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E4, Motor Transport Operator, medically separated from the Temporary Disability Retired List (TDRL) for “major depressive disorder [MDD]” with a 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 - 20050517	VARD - 20060313	
Condition	Code	Rating	Condition	Code	Rating	Exam	
MDD	9434	10%	MDD with Panic Disorder	9434	70%	20060224	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

MDD.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the onset of the CI’s mental health (MH) disorder began in November 2002 with depression and panic symptoms.  The CI was separated and placed on TDRL on 1 February 2004.  The 29 October 2004 VA Compensation and Pension (C&P) examination, 7 months prior to TDRL removal, noted complaints of sleep problems, panic attacks and depressed mood.  The CI reported stopping his antidepressant/anti-anxiety medication due to the side effect of decreased sex drive.  He reported 90 panic attacks per month, each lasting about 20 minutes.  Although he indicated he required “continuous treatment to control” the condition, he had not sought care in the emergency room (ER) nor did he require inpatient care.  The CI had been working full-time since February 2003 as a truck operator and his relationships with co-workers and supervisor were fair.  He reported a history of problems at work of being easily agitated, but had not lost his temper, and there was no indication of any workplace violence.  The CI had not lost any time from work and there was no evidence of legal trouble.  The mental status examination (MSE) recorded depressed mood but no other abnormality.  Memory was intact and judgment was not impaired.  The CI denied suicidal ideations since Iraq but had homicidal thoughts “running through his mind a few days ago.”  No target for his homicidal ideation was identified.

At the 30 March 2005 TDRL examination, 2 months prior to TDRL removal, the CI reported difficulty with sleep, excessive fear, angry outbursts, panic attacks and depression.  He reportedly took psychotropic medication for anxiety and depression.  The CI also reported decreased appetite, short-term memory loss, suicidal ideations, panic attacks occurring two or three times per day (not affecting his ability to work) and marital problems (without discussion of separation or divorce).  The MSE was unremarkable with the exception of anxious affect.  Current suicidal ideation was not recorded.  The examiner noted that despite his symptoms, the CI was able to maintain a job and sustain a marriage.

During the 24 February 2006 C&P examination, 9 months after TDRL removal, the CI reported daily depressed mood, three or four panic attack per day and problems with sleep.  The CI was still married to his wife of 15 years, and the couple had four children.  The CI stated he was not taking medications because he could not afford them.  He had not taken medications since the previous year and had discontinued counseling.  He remained employed, had a good relationship with his employer and had not required inpatient treatment or visits to the ER.  However, he reported having poor relations with co-workers.  Although he reported problems with his temper, he had never assaulted anyone but had made threats.  The MSE noted the CI seemed anxious, looked depressed and had a flat affect, but there was no evidence of psychosis and memory and judgment was intact.  There was no suicidal or homicidal ideation present.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MH disorder 10%, coded 9434 (MDD), citing mild social and industrial impairment.  The VA rated the MH disorder 70%, coded 9434, based on the C&P examination.  Panel members considered whether the provisions of VASRD §4.129 (mental disorders due to traumatic stress) were applicable.  All members agreed that the evidence of record did not support a traumatic stressor as the cause of the MH disorder for which application of VASRD §4.129 would be appropriate.  

The panel considered the absence of ER treatment or hospitalization, and the apparent stability of symptoms during the 13 months prior to separation and the 9 months after separation.  Panel members noted the recording of chronic suicidal ideation throughout the STR, but also noted there was no report of intent or gestures while on the TDRL or after removal.  Reports of active suicidal ideation were absent during the TDRL examination and both C&P examinations.  The TDRL examination noted that the CI’s responses on personality testing were inconsistent with the usual pattern of responses and that it was possible that symptoms were exaggerated.  The panel also noted that despite the report of on and off suicidal ideations, sleep problems and panic attacks, the CI was able to maintain employment without any reported threats of dismissal, and without consistent MH treatment.  There was no report of the CI missing work or leaving work due to his MH disorder.  The CI reported difficulty with his temper, but was able to demonstrate good impulse control given he had never assaulted anyone who he had reportedly threatened in the past.  There was no indication of occupational impairment due to symptoms and no report of lack of concentration, workplace violence, panic attacks, expression of suicidal thoughts or falling asleep on the job.  The CI continued to work the same job he had since before TDRL placement and had stable relationship with his wife of 15 years.  

Panel members agreed, the 10% rating and no higher was justified 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the MH disorder.  

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 20170314, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190006078, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.