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DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD DC 20374-5023

From:
To:

Subj: Ref:

Director, Secretary of the Navy Council of Review Boards
PD-2017-03893

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(bl PDBR ltr of 18 Jul 19

I   REPLY REFER TO

1850
CORB:003
27 Feb 20

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy for appropriate  action.

2.	On 21 February 2020, the Assistant General Counsel of the Navy (Manpower & Reserve Affairs) took action in your case by   accepting the recommendation of  the PDBR.	Accordingly,  your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEBI from 0% to 10% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, has been forwarded to the Navy Personnel Command for appropriate changes to your personnel records and notification to you upon completion.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2017-03893 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060328

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Auxiliary Equipment Technician, medically separated for “cyclothymic disorder” with a disability rating of 10% and a non-compliance deduction of 10% resulting in a 0% rating.

CI CONTENTION: “I have kidney stones while in the Navy and since getting out, lots of them. I think I was misdiagnosed and I have PTSD [post-traumatic stress disorder].” 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 - 20060123	VARD - 20080821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cyclothymic Disorder	9431	10%
-10%
0%	Cyclothymic Disorder	9431	30%	20060301	
Borderline and Antisocial Personality Traits	Cat II	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	
	
ANALYSIS SUMMARY:

Cyclothymic Disorder. According to the service treatment record and MEB narrative summary (NARSUM), the CI reported a suicidal ideation in 1998 when he held a gun to his head. During his first year in the Navy, he was diagnosed with a “mood disorder” by mental health and

recommended for administrative separation, but the command retained him. During his second year, he received a psychiatric evaluation for “an inability to cope with shipboard life” and diagnosed with an adjustment disorder with depressed mood, occupational problems, and borderline personality traits. He attended an Occupational Crisis Intervention Program in 1999 where he “made limited gains in insight.” In 2002, he was referred for “sleep problems” and diagnosed with parasomnia not otherwise specified (NOS), depression NOS, and rule out cyclothymic disorder. He was treated with hypnosis for the insomnia and referred to psychiatry for medication management. In January 2003, the CI was disqualified from submarine duty, but an administrative separation was not pursued. Medication adjustments were made and the CI was placed on “limited duty” for 6 months. In October 2003, the CI was returned to full duty while on Depakote and paroxetine. In November 2003, the CI complained of depression due to pending PCS and his paroxetine was increased. The CI discontinued his medication from March 2004, in order to meet physical readiness testing (PRT) standards, and restarted on the medication in February 2005. In April 2005, the CI had an “incident at the main gate at which time he reportedly stated, “I quit taking my meds to meet PRT standards, then I lost control at the front gate.” The CI was never hospitalized for psychiatric treatment, nor had treatment in the emergency room (ER).

The 12 July 2005 MEB NARSUM examination, 8 months prior to separation, noted complaints of anger and mood swings. The CI stated that after he stopped taking his medications to meet PRT standards, he experienced feelings of anger and depression alternating with periods of elation and increased energy. He also had periods of pressured speech and decreased sleep. He denied suicidal ideation but said he had thoughts of hurting others but would not act on them. The mental status examination (MSE) documented an irritable attitude and somewhat disheveled uniform. Mood was angry and speech was pressured. There was no disturbance of motor activity, thoughts, or perception, and judgment was fair.

At the 1 March 2006 VA Compensation and Pension (C&P) general examination, one month before separation, the mental portion of the physical examination showed normal behavior, no signs of tension, and appropriate affect. On the same day, the C&P mental examination, noted complaints of rapid cycling and periods of euphoria and depression accompanied by anger outbursts. Due to side effects, the CI was not on medication. He had a job lined up doing maintenance work and felt capable of working full-time. It was noted he was able to establish and maintain effective work/school and social relationships and posed no threat of persistent danger or injury to self or others. The MSE was unremarkable. The Global Assessment of Functioning (GAF) score was 75 for, “If symptoms are present, they are transient and expectable reactions to psychosocial stressors; no more than slight impairment in social, occupational functioning.”

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the cyclothymic disorder 10%, coded 9431 (cyclothymic disorder), but deducted 10% for non-compliance. The PEB listed borderline and antisocial personality traits as related diagnoses (Category II) contributing to the disability in this case. The panel concluded the Category II diagnoses were not separate conditions which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding). The VA rated the cyclothymic disorder 30%, coded 9431, based on the C&P examination, citing occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, functioning satisfactorily, with routine behavior, self-care, and conversation.

Regardless of the diagnosis, VASRD§4.130 rating is based on symptoms independent of diagnosis, therefore, all mental health symptoms are considered in the rating, and reflected in the panel’s recommendation. The panel first acknowledged the PEB’s application of DoDI 1332.39 in this case of medication non-compliance; however, the panel is obliged to comply with DoDI 6040.44

and the VASRD. Therefore, the panel considered its rating recommendation based solely on the impairment and guidelines of the applicable VASRD diagnostic code; hence the panel recommends no less than the 10% rating. The panel members next 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.

The panel then proceeded with the rating recommendation. The panel considered the absence of ER treatment, or hospitalization, and the apparent stability of symptoms during the 8 months prior to separation, and the 2 years after separation. The MEB, 8 months prior to separation, documented an angry mood and affect, but an otherwise unremarkable MSE. The C&P examination, one month before separation recorded an essentially normal MSE. The CI was not on medication, and he had a job lined up doing maintenance work and felt that he was capable of working full-time. The examiner assessed a GAF score of 75. The March 2008 MH visit, 12 months after separation noted an unremarkable MSE and that the CI was not receiving any MH treatment. The. The CI was working as a long distance truck driver. The June 2008 C&P examination, noted the CI was stable and taking antianxiety medication on an as-needed basis. The CI had no in-patient hospitalizations, and no history of suicidal thoughts or behaviors. He had been with his present girlfriend for past 2 years and they lived together with her 14-year old son. It was noted that the CI had been driving trucks since separation from the Navy and liked it.

Panel members agreed, the 10% rating and 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.” After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the cyclothymic condition, coded 9431.

BOARD FINDINGS: In the matter of the cyclothymic disorder, the panel recommends a disability rating of 10%, coded 9431 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, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Cyclothymic Disorder	9431	10%