RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02960
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051030

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

CI CONTENTION:  “I received 0% for migraines which has since worsened and increased.”  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 - 20050826	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder (MDD)	9434	10%	MDD with Anxiety 	9434-9400	30%	STR	
Migraine Headaches	Not Unfitting	Migraine Headaches	8100	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

MDD.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI reported depressed feelings, including mood and neuro vegetative symptoms, for several months in early 2003 after experiencing abuse from her husband.   In April 2004 after returning from Iraq she reported significant difficulties with memory and concentration.  At an October 2004 mental health (MH) visit, the CI reported significant depressive symptoms over the previous month.  She felt sad and empty and had sleep difficulties (unable to fall asleep).  She also reported symptoms of depression, including a loss of appetite resulting in a 15 pound weight loss.  She felt guilt and worthlessness related to her son not doing well in school and admitted occasional passive suicidal ideations.  She reported multiple stressors contributing to her depressive symptoms, including school and a recent promotion to Squad Leader.  She eventually dropped out of school and was removed from her position as Squad Leader due to her significant difficulties.  The CI was counseled while training for sleep problems, irritability and depressive symptoms.  However, she was not treated with psychiatric medication prior to December 2004.  
The CI also reported a history of anxiety, especially in social situations, a chronic history of worrying about multiple things.  Her anxiety had worsened since her feelings of depression began.  She experienced a rapid heart rate when she became anxious and worried.  Anxiety and hypervigilance had increased since her return from Iraq, with feeling “more alert and paranoid.”  She felt fearful with reminders of Iraq, particularly loud noises.  She also had a hyper-startle response to loud noises.  The CI reported feeling overwhelmed and unable to accomplish daily tasks.  She had difficulty performing the duties of her MOS and experienced active suicidal ideation with thoughts of cutting her wrists, briefly in February 2005.  

The 19 April 2005 MEB NARSUM examination, 6 months prior to separation, noted significant difficulty with concentration and memory, continued difficulties functioning, particularly regarding managing basic daily tasks and job requirements.  She continued to experience mild to moderate depressive symptoms, but these had improved.  She was separated, pending divorce and raising her son alone.  Medications included Celexa and Wellbutrin (anti-depression medications) and Ambien (a sleep aide) as needed.  Mental status examination (MSE) showed psychomotor retardation, dysphoria and tearfulness.  Mood was cited as “depressed” and affect was congruent.  Thought content was significant for passive suicidal ideations.  The CI was quiet and withdrawn.  She was diagnosed with MDD (definite social/industrial impairment) and generalized anxiety disorder and anxiety disorder (mild impairment) with a Global Assessment of Functioning (GAF) score of 60 (moderate bordering on mild.)  Her NCOER from October 2004 to June 2005 indicated satisfactory performance.  

During the 8 August 2005 neuropsychological examination, 3 months prior to separation, it was noted that her cognitive difficulties arose in the months following her deployment to Iraq.  The examiner noted no clear etiology of cognitive deficits, but indicated they were often observed in individuals with affective disturbance and/or anxiety disorders.  The examiner noted significant psychological distress with features of both an affective disorder and likely an anxiety disorder.  Diagnoses included cognitive disorder due to depression.  

Although the March 2005 commander’s statement noted the CI could not remember things, make decisions or concentrate, and her performance was below standard, the 25 August 2005 commander’s statement noted her duty hours were from 0630 to 1700 and her duties involved small tasks, such as escorting Soldiers to appointments and limited paper work.  She was unable to work in her MOS due to her memory loss but passed a recent fitness test.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MH disorder 10%, coded 9434 (MDD), citing medication, outpatient treatment, working more than 8 hours per day, satisfactory performance per NCOER and mild impairment.  The VA rated the MH Disorder 30%, based on the STR, citing a GAF score of 60 denoting moderate impairment in social and occupational functioning.  The panel considered if the provisions of VASRD §4.129 (mental disorders due to traumatic stress) applied in this case, and agreed there was no evidence of a traumatic event or stressor causing the unfitting MH disorder.  Therefore, application of VASRD §4.129 was not appropriate in this case.  The panel next considered the §4.130 rating at the time of separation.  

The NARSUM noted improvement in some symptoms with medication but continued significant impairment of memory and concentration, which a pre-separation neuropsychological examination findings attributed to depression.  The NARSUM noted the CI had never been prescribed medication prior to December 2004 and the MSE showed continued depressed mood, passive suicidal ideations and psychomotor retardation.  Panel members concluded symptoms most closely met the criteria for a 30% disability rating.  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 MH disorder, coded 9434.  

Contended PEB Condition:  Migraine Headaches.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The CI reported migraine headaches at the rate of one or two monthly that were not debilitating or prostrating and were well managed with medication.  The contended condition was not profiled, implicated in the commander’s statement 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 MH disorder, the panel recommends a disability rating of 30%, coded 9434, IAW VASRD §4.130.  In the matter of the contended migraine headache condition, 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.  

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%	
COMBINED	30%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170423, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20190008045, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. 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 and will provide information on your retirement benefits.  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.  Inquiry 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.