RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX 	CASE:  PD-2017-03601
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080626

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Cadet, Officer Trainee, medically separated for “depressive disorders, not otherwise specified [NOS]” with a disability rating of 10%.  

CI CONTENTION:  “At the time of separation member was diagnosed with major depressive disorder.  Have since been properly diagnosed as bi-polar I.  Bi-polar I is more severe than major depressive disorder.  Warrants larger disability percentage.”  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 - 20080430	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Depressive Disorders, NOS	9435	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Depressive Disorders.  According to the service treatment record and MEB narrative summary (NARSUM), the CI presented to mental health (MH) in November 2007 for long-standing depressed mood, low energy, a decreased ability to sleep through the night, poor concentration and feeling like an outsider at the United States Air Force Academy (USAFA).  She also reported depressive symptoms, including frequent suicidal ideation.  The provider prescribed Prozac (anti-depressant), which she initially did not use.   After agreeing to take the medication, the CI returned to MH on 5 December 2007 with severe suicidal ideation; she denied a specific plan but was unable to contract for safety.  She was admitted for inpatient psychiatric care for 5 days and discharged with the diagnosis of depression NOS, and a prescription for Wellbutrin (anti-depressant).  The CI did not attend follow-up visits, and in January 2008, she stopped taking her medication and her depressive symptoms returned.  She also reported being evaluated at that time by an honor committee for forging a medical notice to be excused from class.  The CI was seen in the emergency room in February 2008 following a suicidal gesture.  Her primary concerns included feeling depressed and trapped at the Air Force Academy.  She was admitted to a local psychiatric hospital the same day and discharged 5 days later with a diagnosis of depression NOS and a prescription for Lamictal (anti-depressant/mood stabilizer).  

The 29 March 2003 commander’s statement noted the CI suffered from depression, which resulted in great difficulty following rules.  She had missed numerous days in class without authorization and 7 days for psychiatric hospitalization, and the “optimal outcome” was noted to be medical retirement and long term mental health care.  A recommendation for disenrollment due to an honor violation was on hold due to the MEB.  

The 10 April 2008 MEB NARSUM examination, 3 months prior to separation, noted complaints of depression associated with being at USAFA, and the inability to perform cadet duties.  Mental status examination (MSE) showed frequent suicidal ideation but without a desire or plan.  A diagnosis of depressive disorders NOS was rendered with a Global Assessment of Functioning score of 40 (major impairment in multiple areas).  The examiner noted mild/transient social and occupational impairment.  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 depressive disorder 10%, coded 9435 (major depressive disorder), citing mild or transient symptoms.  The panel considered the provisions of VASRD §4.129 (mental disorders due to traumatic stress), and agreed there was no evidence of a traumatic event or stressor causing the unfitting mental health condition, and that 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 examination documented a near continuous presence of depression symptoms, decreased by medication but never fully relieved, as indicated by the presence of suicidal ideation documented in the MSE.  The CI had required two hospitalizations within months of initial diagnosis and proximal to discharge, and demonstrated limited insight and poor motivation.  Despite MH interventions, her performance continued to decline and she was unable to perform her duties as a cadet.  Additionally, the commander noted numerous absences and the need for long term psychiatric care.  Panel members agreed the MH symptoms most closely met criteria for 30% disability.  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 depressive disorder, coded 9435.  

BOARD FINDINGS:  In the matter of the depressive disorder, the panel recommends a disability rating of 30%, coded 9435 IAW VASRD §4.130.  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	
Depression Disorder NOS	9435	30%	

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

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Dear XXXXXXXXXX

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03601.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.