RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-03983
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060622

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Health Care Specialist, medically separated for “major depressive disorder (MDD)” with a disability rating of 10%.  

CI CONTENTION:  “Immediately after separation, VA rated my disability severance condition at 50% effective date of separation.”  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 – 20060227	VARD - 20070316	
Condition	Code	Rating	Condition	Code	Rating	Exam	
MDD	9434	10%	MDD	9434	50%	20060907	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

MDD. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI had a long history of mental health issues beginning as early as 1993.  He was seen in July of 1999 for anxiety and in April 2002 the CI reported onset of panic attacks with increased irritability.  The STR documented one panic attack in January 2005 that required emergency room (ER) care.

The 23 January 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of reported depressed mood, worsening sleep, hypersomnia, anhedonia, feelings of worthlessness and guilt, decreased energy and concentration, psychomotor slowing, and significant anxiety in large crowds; these symptoms were affecting his job performance.  The mental status examination (MSE) was unremarkable with the exception of depressed mood and affect.  The CI did not have a history of suicidal or homicidal attempts, and had not been hospitalized psychiatrically.  The examiner noted the patient continued to work but experienced decreased productivity due to his symptoms.  There were no details documenting work-related impairing symptoms.  There was no documentation of frequency of panic attacks, or chronic sleep impairment.

The examiner recorded the diagnoses of moderate MDD, recurrent, dysthymic generalized anxiety disorder and panic disorder with agoraphobia, and indicated that these diagnoses were assessed in 2005, during the ER visit, as well as during psychological testing. The Global Assessment of Functioning (GAF) score was 55 for moderate symptoms or impairment; however, the examiner concluded that the CI’s impairment was in the mild to moderate range but would be considered marked impairment in military functioning.  

At the 7 September 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI had continued his psychotropic medications and was seeking employment.  He reported being generally depressed and “having the blahs 90% of the time.” He reported panic attacks averaging one per day.  However, panic attacks were described as anxiety attack (tachycardia, shortness of breath, lightheadedness, anxiety) and the circumstances were, “when I can't find things” or upon hearing loud noises, and these lasted 5 to 10 minutes.  The CI also reported chronic sleep disturbance, but was able to average 6 hours per night and took naps 1-2 hours during the day.  The MSE noted a slow gait, slow speech, and depressed and anxious affect and mood.  There was no evidence of a formal thought or psychotic disorder, and suicidal or homicidal thoughts were not present.  The examiner noted the CI had a long history of emotional problems that failed to respond to aggressive treatment and he remained symptomatic.  His GAF score was again 55 with ongoing depression, anxiety, insomnia, and moderate difficulty in social and occupational functioning.  

The PEB rated the MDD 10%, coded 9434 (MDD), citing mild industrial impairment.  The VA rated the MDD condition 50%, coded 9434, based on the C&P examination.  The panel first considered whether the provisions of VASRD §4.129 (mental disorders due to traumatic stress) were applicable.  Members noted there was no traumatic event causing the unfitting mental health condition and therefore concluded that application of VASRD §4.129 was not appropriate in this case.  

The panel next noted that IAW VASRD §4.126, (evaluation of disability from mental disorders), mental health diagnoses are rated together as one condition under the primary diagnosis due to overlapping symptoms and impairments.  In its overall §4.130 rating recommendation for MDD, members considered impairments attributed to the CI’s dysthymic disorder, anxiety disorder, and panic disorder with agoraphobia.  

The panel next considered whether the evidence at the time of separation supported a rating higher than the 10% rating adjudicated by the PEB.  Members noted the PEB rating was for symptoms manifested over several years which required repeated episodes of medication and psychotherapy.  The higher 30% rating requires evidence of “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks” due to  such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events).  

At the time of the MEB NARSUM examination, 5 months prior to separation, the CI reported depressed mood, problems with sleep, anxiety in crowds, and symptoms related to depression.  Although a history of panic attacks was recorded, the frequency of such attacks was not.  The record demonstrated one panic attack requiring ER care more than one year before separation.  There was no history of psychiatric hospitalization, and no indication of panic attacks while performing duty.  The examiner recorded “mild to moderate” for social and industrial impairment.  The commander’s statement did implicate the specific condition of depression but did not note a decrease in work performance, missed work, or poor work relationships, panic attacks, inability to focus or concentrate, or falling asleep during duty.  Yet the commander’s statement concluded that based on the mental health provider’s recommendations the CI would “not be able to function as a Soldier.”  Although the CI reported his employment status as “unemployed” during the C&P examination, the panel noted he was able to secure work post- separation teaching EMT students for the Army.  Socially, he had been married for 12 years, had a “few” friends and various hobbies.  He had no legal issues.  All panel members agreed the CI’s condition at the time of separation best supported the 10% disability rating.  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.  

BOARD FINDINGS:  In the matter of the MDD and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  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.    

AR20180015897, 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.