RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-03784 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20040426

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve O2, Gynecologic Nurse, 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 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 - 20040114	VARD - 20040504	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Major Depressive Disorder	9434	10%	20040329	
Dysthymic Disorder	Not Unfitting	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Major Depressive Disorder (MDD). According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI began experiencing depressed mood, hypersomnia, low energy, poor concentration and intermittent suicidal ideation in February 2003, and was treated with Celexa and psychotherapy with a good response. Two months later, she was transferred and continued treatment. She became pregnant and decided to change to another anti- depressant, but in the next few weeks, her condition worsened considerably. Concerns were raised in the workplace by June 2003 regarding her behavior, and in July 2003 she was treated in the emergency room for strong suicidal thoughts, but was able to talk to others and avoid admission. Dosing was raised and she enrolled in an impaired provider program. A contributing factor was her daughter moving away to live with her biologic father. By August 2003, her obstetrician was concerned about her failure to gain weight and premature contractions. Her workload was gradually shortened to 4-hour shifts answering phones or doing other simple tasks. Medication dosages were increased but intermittent suicidal ideation remained. The CI was treated in 1996-1997 for dysthymic disorder for about 6 months.

The 2 October 2003 MEB NARSUM examination, 6 months prior to separation, noted the CI was 29 weeks pregnant with ongoing complaints of MDD symptoms and recurrent thoughts of suicide despite medication and psychotherapy. She continued to require weekly visits. The mental status examination (MSE) noted a tearful affect, mood the “same,” endorsement of periodic, but no present, suicidal ideation, plans or intent. The examiner diagnosed MDD and dysthymic disorder, which existed prior to service (onset in 1996), and rendered a Global Assessment of Functioning (GAF) score of 52 (moderate symptoms, impairment.)

At the 29 March 2004 VA Compensation and Pension (C&P) mental health (MH) examination, 1 month before separation, the CI reported working full-time as a nurse and continued weekly visits to the MH clinic. She was able to take care of her family and home, watched television, read novels and used her computer. Current daily medications included Prozac and Synthroid (to raise thyroid levels). The MSE revealed occasional suicidal thoughts without plans, and no homicidal thoughts. She had a slightly depressed mood and affect, got 6 hours of sleep a night while taking medication, was able to carry on her daily life in a generally adequate manner, and could follow simple to moderately complex instructions. She performed serial 7s fairly rapidly with only one mistake. A diagnosis of MDD was rendered with a GAF score of 90. During the VA C&P general medical examination, 2 days later, the CI reported a diagnosis of hypothyroidism, currently active since 2004. She stated that, with the exception of depression and palpitations, she had resolution of the thyroid symptoms with Synthroid. Thyroid studies were normal on current medication but she still required continuous treatment. She had no lost time from work.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the MDD 10%, coded 9434 (MDD), citing “single episode, without psychotic features, requiring psychopharmacological management and psychotherapy, has not required hospitalization,” and noting a mild, “not definite” condition. The VA also rated the MDD 10%, coded 9434, based on the C&P examination, citing a requirement for continuous medication to control depressive symptoms. Panel members first considered the provisions of VASRD §4.129 (mental disorders due to traumatic stress), and agreed they were not that applicable in this case. The NARSUM examination documented continued symptoms of depression and regular treatment that included therapy and medication. The C&P examinations noted the CI still had occasional suicidal ideation but no plans, and was able to care for home and family as well as work full-time with continued Prozac and Synthroid use. After due deliberation, considering all 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: Dysthymic Disorder. 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, implicated in the commander’s statement, and failed retention standards. However, the 18 December 2003 Memorandum to the PEB noted the dysthymic disorder was diagnosed in 1996, as reported in the NARSUM, and included 6 months of psychotherapy. There was no performance-based evidence from the record that the dysthymia 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 dysthymic disorder, 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. Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

                                     

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY
251 18TH STREET SOUTH, SUITE
385
ARLINGTON, VA 22202-3531

AR20200000142, XXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXX
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.

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