RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02884 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20040311

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

CI CONTENTION:  Review all conditions.  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 - 20031222	VARD - 20040514	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Depression	9434	30%	20040226	
Hypothyroidism	Cat III	Hypothyroidism	7903	10%	20040217	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Major Depressive Disorder (MDD). According to the service treatment record and MEB narrative summary (NARSUM), the CI’s MDD began in late 1997 when the she developed symptoms of  depression. She was treated with fluoxetine (antidepressant) and psychotherapy and had a good response. Because of a recurrence of symptoms she was placed on limited duty (LIMDU) in March 2001 for 8 months. She subsequently had three miscarriages and her depressive symptoms recurred in August 2002 and was again placed on LIMDU for a period of 8 months because she could not function aboard ship. At a clinic visit on 18 July 2003, she complained of depression and stated she had decreased interest and sleep.  In a rebuttal to the LIMDU   Board

on 7 November 2002, the CI wrote: “Environment, shipboard life, excessive stress, and an inability to separate Naval work from my personal time tends to trigger the symptoms. As tearfulness and agitation increase, my ability as an effective leader decreases. The medication being prescribed could be for a lengthy period.” She also stated the MEB evaluation was conducted in a controlled environment away from immediate stressors, which intensified her condition. She believed she should be observed in a shipboard environment for purposes of an MEB.

The 28 July 2003 MEB NARSUM examination, 7 months prior to separation, noted complaints of continued ongoing symptoms of depression despite treatment. Mental status examination (MSE) revealed a well-developed and well-nourished individual who appeared appropriately groomed. There were no speech or psychomotor abnormalities.  Her mood was dysphoric with a full, congruent affect. Her thought process was grossly linear, logical and goal directed. There were no perceptual disturbances, delusions or overt paranoia. Her reality sense and testing were intact. She was alert and oriented to person, place and time. Concentration, memory, retention and recall were grossly intact. Insight and judgment were intact. She denied suicidal or homicidal ideation. The Axis I diagnosis was MDD, recurrent, moderate, and the Global Assessment of Functioning (GAF) was 55 (moderate symptoms). The examiner noted the military impairment was moderate to severe and the social and future industrial impairment was moderate.

The Non-Medical Assessment (NMA) dated 28 August 2003 indicated the CI had difficulty working with other people at times and felt this was a result of her condition. Her supervisor said she became quite emotional with sudden mood swings, which contributed to a stressful working environment and she stated her condition had also caused significant stress at home. The commander also reported the CI felt the condition would worsen if assigned to sea duty.

During a psychiatry clinic visit on 19 February 2004 she described feeling more irritable, anxious, and sad, and in general having more difficulty dealing with stress. The MSE revealed her to be fully alert and oriented with no speech or other psychomotor abnormalities. Mood was neutral- anxious with a full, congruent affect. Thought process was linear, logical and goal directed. There was no evidence of psychosis. Higher cognitive functions were grossly intact. Insight was good and judgment was not impaired. She denied suicidal or homicidal thoughts, plan or intent. The examiner’s diagnosis was MDD-symptoms in partial remission. Bupropion, which was stopped during pregnancy, was restarted.

At the 26 February 2004 VA Compensation and Pension (C&P) examination, 2 weeks before separation, the CI reported symptoms of depression, but was somewhat better on Wellbutrin (bupropion). She reported being married, having two children, and that the marriage was good. The MSE revealed a woman who was dressed casually, but appropriately and was well groomed. There was no psychomotor abnormality. Her speech was normal in rate and tone. Her thoughts were goal-directed. Her mood was better, and her affect was somewhat anxious. She was paranoid and used minimization, rationalization, intellectualization and projective identification as her main defenses. She denied lethality and hallucinations. She was fully alert and oriented. There was no gross impairment in memory or cognition. Her insight and judgment were fair. The Axis I diagnosis was depression, NOS, possibly the postpartum onset as exhibited by hypersomnia, concentration and memory problems, hopelessness, helplessness and tearfulness. Her GAF score was 55.

During a psychiatry visit on 4 March 2004, 1 week prior to separation, the examiner noted the visit was for medication management and supportive therapy. The CI reported restarting the bupropion and felt it had improved her mood. She reported appropriate anxiety about the transition from the military, but felt the medication had been helpful in calming her, and there was no side effect from the medications. The MSE revealed the CI to be fully alert and oriented with  no speech or other psychomotor abnormalities.        Mood was neutral-anxious with a full,

congruent affect. Thought process was linear, logical and goal directed. There was no evidence of psychosis. Higher cognitive functions were grossly intact. Insight was good and judgment was not impaired. She denied suicidal or homicidal thoughts, plan or intent. The psychiatrist’s diagnosis was MDD, recurrent-symptoms in remission.  Bupropion was continued.

Post-separation, the CI underwent regular sessions with a social worker and reported continued increased irritability, anxiety and worrying as well as increased crying episodes. She was also seen by a psychiatrist for psychotherapy and medication management. On 2 December 2004 she reported improvement of her mood and some in sleep. Her depression was “pretty good” and anxiety was 4-5/10. She was finishing her first college semester and had marital stress as both she and her husband were so busy.  Her GAF score was 51.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the MDD 10%, coded 9434 (MDD). The VA rated the MDD 30%, coded 9434, based on the C&P examination, citing the condition did not exhibit symptoms which met the next higher rating level (50%).

The panel noted the PEB assigned a 10% rating for the MDD, which requires evidence of “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.” The panel majority favored a 10% rating, since the CI’s symptoms were attributed to her duties and responsibilities related sea duty by the commander’s and her own reporting, which was interpreted as mild or transient symptoms during periods of significant stress, and she was found to be improved at a psychiatry visit 1 week prior to separation with symptoms controlled by continuous medication. Therefore, the panel majority did not feel the CI had moderate “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events)” proximate to separation. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded there was insufficient cause to recommend a change in the PEB adjudication for the MDD.

Contended PEB Condition: Hypothyroidism. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was not noted on LIMDU forms, implicated in the non-medical assessment, or judged to fail retention standards. There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the MDD and IAW VASRD §4.130, the panel majority recommends no change in the PEB adjudication. The single voter for dissent submitted the appended minority opinion. In the matter of the contended hypothyroidism, the panel recommends no change from the PEB determination as not unfitting. 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 20170330, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

Minority Opinion. The panel noted the PEB assigned a 10% rating for the major depressive disorder, which requires “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.” While the CI was on medication for years, including during pregnancy, as well as receiving psychotherapy, she had more than mild or transient symptoms that persisted even after she was no longer on sea duty. Based on the NARSUM where the examiner noted the military impairment was moderate to severe and the social and future industrial impairment was moderate, while the VA examiner recorded her affect was somewhat anxious and she was paranoid. Furthermore, she used minimization, rationalization, intellectualization and projective identification as her main defenses and her Axis I diagnosis was depression, NOS, possibly the postpartum onset as exhibited by hypersomnia, concentration and memory problems, hopelessness, helplessness, and tearfulness. The panel majority noted that just prior to separation, a psychiatrist indicated the CI’s symptoms were in remission. However, that is not unexpected since she was about to be separated from the service; however, the VA examiner noted the CI had a host of defenses, which included minimization, but not limited solely to it, that could explain the report of symptoms in remission. Additionally, the NMA author indicated the CI had difficulty working with other people at times and felt this was a result of her condition. He added that her supervisor said she became quite emotional with sudden mood swings, which contributed to a stressful working environment and she stated her condition had also caused significant stress at home.  Therefore, based on the findings as documented in the NARSUM, VA examination, NMA, and post-separation reporting of increased irritability, anxiety and worrying as well as increased crying episodes, she had more than a mild condition and had certainly enough findings consistent with a 30% rating proximate to separation that required “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).” The minority voter notes the key phrase “intermittent periods of inability to perform occupational tasks” is what the CI demonstrated whereas the panel majority, relying on the phrase “symptoms in remission” just prior to separation is but a snapshot in time and in no way reflective of the course, treatment, and behaviors exhibited by the CI during service. Even post-service despite the fact that she was finishing her first semester of college, she still was anxious and stressed.
Furthermore, there was no evidence of how many courses she took or how her performance actually was. Therefore, it is speculative to give any significant probative value to the fact the CI was in college. The minority vote recommends the ROP be modified as follows: After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the major depressive disorder, coded 9434. The minority voter additionally recommends the Board Findings be modified as follows:

In the matter of the major depressive disorder condition, the panel recommends a disability rating of 30%, coded 9434 IAW VASRD §4.130. In the matter of the contended luteal phase defect and primary hypothyroidism condition, the panel recommends no change from the PEB determinations as not unfitting. 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Major Depressive Disorder	9434	30%	

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY  REFER  TO:
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL  DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 25 Apr 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate  action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.