RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02685
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080830

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Human Resources Specialist, medically separated for “major depressive disorder” with a disability rating of 10%.   

CI CONTENTION:  In addition to the mental health (MH) disorder, the CI requested review of additional 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 - 20080519  	VARD - 20090421	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Cognitive Disorder, Not Otherwise Specified (NOS) with Anxiety Disorder, NOS 	9434	50%	20081027	
Anxiety Disorder, NOS	Not Unfitting					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s MDD began in September 2007 after having concerns about the academic and behavioral functioning of her children.  She felt depressed, hopeless, anxious and panicked, resulting in loss of sleep and reduced appetite.  She was evaluated and diagnosed with MDD and treated with psychotherapy medications and therapy.  The CI was seen in emergency on 1 November 2007 and admitted for inpatient psychiatric treatment due to increasing depression with passive suicidal ideation, crying, tearfulness, anxiety, panic and feeling overwhelmed and out of control.  She was discharged from the hospital on 5 November 2007 and her therapist initiated a permanent S3 profile on the day the CI was notified she would deploy with her unit. 

During the 3 March 2008 MEB consultation, the CI reported symptoms of depression and anxiety.  She was in the early stages of treatment and was unable to attend group treatment due to work demands of her unit; but was taking anti-depression, anti-anxiety, mood-stabilizing anti-psychosis medication and a sleep aide.  Mental status examination (MSE) revealed an anxious and depressed mood and she was frequently tearful.  She reported continued problems with attention and concentration, although she reported mild improvement.  She denied suicidal and homicidal ideation.  Diagnoses of MDD and anxiety disorder, NOS, were rendered with a Global Assessment of Functioning (GAF) score of 50 (severe bordering on moderate impairment).  

The 14 March 2008 MEB NARSUM examination, 6 months prior to separation, noted some complaints of depressive symptoms but anxiety symptoms had been somewhat ameliorated.  She was pregnant and her anti-depression/anti-anxiety medication, though helpful, had been reduced.  She had been transferred from her unit to the Warrior Transition Unit (WTU) and was working in the veterinarian clinic performing administrative duties.  She reported it was hard to be motivated and to function at work, which triggered anxiety due to the high stress environment.  The above consultation was referenced and the diagnosis of MDD was noted for considerable impairment for social and industrial adaptability.  The psychological assessment recorded a score suggesting moderate depression.  Results were consistent with significant anxiety, over focus on somatic concerns, moderate level of depression and features of a dependent personality disorder.  

At the 27 October 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported depression in the mild range of dysfunction with low energy and motivation at times, sadness, and loss of interest.  The anti-depression medication helped.  She also reported anxiety and a panic attack several months previously after a disagreement with her boyfriend.  She had developed nightmares after a fall on the inpatient unit that resulted in a concussion and had nightmares every few months, awoke anxious and had dreams about being late.  The CI reported the office work in the WTU was extremely difficult due to problems with focusing.  She missed work due to symptoms of anxiety and depression.  The CI reported she had a baby in September 2008 with her boyfriend and was in touch with her sister and family.  She was able to maintain activities of daily living with continuous symptoms.  She had no inappropriate behavior, had been in treatment and her medication helped reduce depression.  Social functioning was not impaired.  The MSE showed her mood was in the moderately depressed range of function.  Diagnoses of cognitive disorder, NOS, anxiety disorder, NOS, and depressive disorder, NOS, were rendered with a GAF score of 52 (moderate impairment.)   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD 10%, coded 9434 (MDD), citing symptoms that decrease work efficiency and ability to perform occupational tasks only during times of significant stress.  The VA rated the MDD 50%, coded 9434, based on the C&P examination, citing occupational and social impairment with reduced reliability and productivity.  

Application of VASRD §4.129 was considered by the panel; but, all members agreed that the ‘highly stressful event’ requisite for §4.129 was not satisfied in this case.  The panel then considered if there was evidence for a §4.130 rating higher than the 10% assigned by the PEB.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  The NARSUM examination noted the anxiety symptoms were largely ameliorated and the depression symptoms were improved with the help of anti-depression medication.  The CI was able to work without incident in the WTU performing administrative duties, had a boyfriend and was pregnant.  Her medications were adjusted due to the pregnancy.  The commander noted the CI was proactive in improving herself and planned to continue to develop and expand knowledge of veterinary sciences upon her release.  The C&P examination noted some continuing symptoms of depression with the onset of symptoms of a cognitive disorder; however, she was able to maintain activities of daily living, have a baby and remain in touch with family members.  She had no inappropriate behavior, social function was not impaired and she had no further emergency room visits or hospitalizations.  Panel members agreed the CI’s MH symptoms most closely approximated the criteria for a 10% disability rating.  In regards to the comorbid not-unfitting anxiety disorder, NOS, the panel notes that any disability associated with a MH disorder, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for MH disorders.  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 MDD.  

BOARD FINDINGS:  In the matter of the MH disorder 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 20170310, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190008404, XXXXXXXXXXXXXXXXXX 

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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.