RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03144
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050225

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve WO1, Supply Systems Technician, 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 - 20050225	VARD - 20050902	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Dysthymia	9433	10%	2000713	
Back Pain	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  According to the service treatment record (STR) and mental health (MH) MEB narrative summary (NARSUM), the CI’s MDD began around May 2004 while deployed.  He reported multiple psychosocial stressors to include some conflict within his unit and feeling overwhelmed by his extensive duties.  He experienced depressed mood, insomnia, diminished appetite, feelings of hopelessness, and difficulty concentrating.  The CI was evacuated from theater due to making a suicidal gesture (overdose of his prescription medication), and spent 3 days in the hospital before his transfer to home station.  There were no documented visits to the emergency room (ER), additional hospitalizations for mental health concerns, and no further reports of suicidal gestures or attempts.  

During the 13 December 2004 MEB NARSUM examination, 2 months prior to separation, the CI stated that he was “under a lot of stress in Iraq” having deployed in February 2004 (2 months after being activated) and returned to Puerto Rico in June 2004.  He reported having problems with sleep and had felt hyper, depressed and sad.  An argument with his commander led to a referral for mental health care where he was prescribed anti-depressant medication.  On 2 June 2004, he took an overdose and initially did not tell anyone.  But after 30-45 minutes, he became aware of palpitations and told his leadership.  The examiner noted that the CI continued taking his medication and consistently denied suicidal or homicidal thoughts. The mental status examination (MSE) was unremarkable.

The 13 July 2005 VA Compensation and Pension (C&P) examination, 5 months after separation, noted CI complaints of depressed mood and difficulty sleeping.  He was taking anti-depressant medications, and had returned to a job he held since 1986, where his performance was acceptable with no indication that he had lost time from work due to his condition.  His relationship with his wife and teenage children was slowing improving.  The MSE revealed good memory and concentration, and was otherwise unremarkable with the exception of depressed mood and blunted affect.  The provider diagnosed dysthymia and assigned a Global Assessment of Functioning score of 70 for mild symptoms.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD 10%, coded 9434 (MDD), citing the requirement for psychotropic medication and outpatient treatment.  The VA rated the dysthymia condition 10%, coded 9433 (dysthymia), based on the C&P examination, citing mild and transient symptoms.  Panel members first agreed that the provisions of VASRD§ 4.129 for a “mental disorder that develops in service as a result of a highly stressful event” were not applicable in this case.  Members next considered the rating recommendation, noting the absence of ER treatment or hospitalizations, and the apparent mild and stable symptoms documented by the NARSUM and C&P examinations before and after separation.  There were no reports of chronic sleep impairment, problems with memory, anxiety or panic attacks.  The commander’s statement mentioned the CI had a diagnosis of MDD; however, there was no indication that any MH condition had any impact on his ability to perform in his military specialty, or work with supervisors or peers.  The panel agreed that the 10% rating, but 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 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.  

Contended PEB Condition:  Back Pain.  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 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 major depressive disorder and IAW VASRD §4.130 the panel recommends no change in the PEB adjudication.  In the matter of the contended back 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.  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 20170331, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010798, 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.

	A copy of this decision has been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure