RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03450
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071022

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty 03, Military Police, medically separated for “major depressive disorder” with a disability rating of 0%.  

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 – 20070802	VARD - NA 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	0%	No VA Examination Proximate to Separation in Evidence	
Panic Disorder without Agoraphobic	Not Unfitting 		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Major Depressive Disorder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI complained of extreme stress, feeling tired, persistent worry, recent depression and feelings of hopelessness on 21 October 2004.  The CI had a history of hypothyroidism, which was treated with levothyroxine.  Paroxetine was prescribed for her depressive symptoms.  The paroxetine dose was increased on 23 November 2004.  In May 2005 her physical and mental status examinations were normal.  She deployed in November 2005.  On 21 June 2007, 7 months after redeployment, the CI’s free thyroxine was 0.57 ng/dL (normal 0.78-2.19) and the thyrotropin sensitive level was 26.5 (normal 0.465-4.68).  She was prescribed hydroxyzine (an antihistamine) at bedtime, as needed, and was referred to endocrinology for hypothyroidism and psychiatry for anxiety.  

During the 29 June 2007 Behavioral Health (BH) evaluation, the CI complained of depression, panic attacks and fatigue.  She sought help due to feelings of exhaustion and ongoing problems with depression.  She had difficulty falling asleep and going back to sleep in the early hours of the morning, which left her fatigued throughout the day.  She also had a low energy level and a depressed mood with frequent crying along with feelings of hopelessness and no pleasure in life that made it difficult to concentrate.  She had no suicidal ideation.  Since the CI’s dose of levothyroxine was increased, her most recent thyroid laboratory studies were within normal limits.  

The 5 July 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of depression and fatigue.  She noted that staying in the service at the end of her obligation in December 2006, rather than getting out, was her sole stressor.  Mental status examination showed a cooperative, neatly dressed and groomed woman.  There was psychomotor restlessness and the CI appeared tense and anxious.  Her speech was within normal limits.  She described her mood as depressed and her affect was restricted as well as tearful at times.  Her thought process was linear and goal-directed, and her thought content was devoid of any suicidal of homicidal ideations.  She denied hallucination, delusions, obsessions or paranoid ideation.  Her insight was fair to good and her judgment was good.  She was alert and oriented in all spheres and there were no gross cognitive deficits.  Psychological testing results revealed moderate personal distress and were consistent with the clinical assessment of a major depressive episode.  The CI was offered a combination of psychotherapy as well as pharmacologic treatment on an outpatient basis; however, the CI declined any type of treatment and opted for her case to be referred to the PEB.  The examiner’s diagnosis was major depressive disorder, recurrent, moderate with a marked degree of impairment for further military service and moderate degree of impairment for both industrial and occupational social adaptability. The General Assessment of Functioning score was 55 (moderate symptoms).

The commander’s statement dated 11 July 2007 indicated the CI was attending a career course as a student and was able to remember locations, work-like procedures and instructions.  She had no unexcused absences, was able to communicate, maintained respect for peers and superiors, and worked well with others.  However, the commander noted the CI frequently complained of tiredness and exhaustion.  

There was no VA examination proximate to separation in evidence.  However, the CI underwent a VA mental health initial evaluation on 28 February 2008 for depressive disorder NOS.  No therapy was felt to be needed at the time of the evaluation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the mental health disorder 0%, coded 9434 (major depressive disorder), citing symptoms that were not severe enough to interfere with occupational functioning and that did not require continuous medication.  

Panel members noted the CI was able to perform her duties despite her complaints of depression.  While she was at a training course, she had no decrease in work efficiency or inability to perform occupational tasks.  Although the CI reported stress in 2004, she did not report any significant stress other than staying on in the service and transferring to another career field when she could have gotten out as her obligation was over in December 2006.  Nevertheless, she was taking prescribed medication, paroxetine initially followed by sertraline, to control her symptoms.  Therefore, in the absence of any decrease in work efficiency, but use of continuous medication to control her symptoms, the CI’s disability warrants a 10% rating, and no higher.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for major depressive disorder, coded 9434.  

Contended PEB Condition:  Panic Disorder without Agoraphobia.  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 profiled, but was not implicated in the commander’s statement or judged to fail retention standards.  The CI had a long-standing history of panic attacks that started around age 18 shortly after her father passed away and prior to induction. The episodes occurred with no known precipitants and typically included a racing heart, sweating, trembling, shortness of breath, lightheadedness and a feeling of losing control.   Cardiac workups were negative, although she was concerned about having additional attacks.  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, the panel recommends a disability rating of 10%, coded 9434 IAW VASRD §4.130.  In the matter of the contended panic disorder, 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, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Major Depressive Disorder	9434	10%	

AR20180015345, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR)
reviewed your application and found that your disability rating should be modified but
not to the degree that would justify changing your separation for disability with
severance pay to a permanent retirement with disability. I have reviewed the Board’s
recommendation and record of proceedings (copy enclosed) and I accept its
recommendation. This will not result in any change to your separation document or the
amount of severance pay. A copy of this decision will be filed with your Physical
Evaluation Board records. I regret that the facts of the case did not provide you with the
outcome you may have desired.
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 also been provided to the Department of Veterans Affairs.