RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04732
BRANCH OF SERVICE:  army	SEPARATION DATE:  20060215

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

CI CONTENTION:  Review the ratings for major depression disorder, PTSD and  back strain.  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 - 20051006	VARD - 20070326	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	PTSD	9411	50%	20060621	
Post-Traumatic Stress Disorder (PTSD)	Not Unfitting					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Major Depressive Disorder (MDD).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s MDD began in 1991 after completing a psychiatric examination due to stress from feeling harassed by his platoon sergeant.  He left the military in 1992 and reenlisted in 1999.  The CI successfully completed an Iraq deployment from December 2003 through April 2004.  The February 2004 Post-Deployment Health Assessment showed responses that were unclear.  The CI reported seeing wounded, killed or dead bodies, and had engaged in direct combat where he discharged his weapon.  He also checked never feeling in great danger of being killed.  He documented no loss of interest or pleasure in doing things, not feeling down, not depressed or hopeless, no nightmares, and did not try to avoid any thoughts.  However, he felt on guard, watchful, numb or detached from others.  He reported close inspection of destroyed military vehicles.  The CI was not interested in help for stress, emotional, alcohol or family problems.

In December 2004, the CI was hospitalized for homicidal thoughts towards his drill sergeant.  The mental status examination revealed slight psychomotor slowing (cognitive functions and physical movement) during the interview with some slowness in responding to questions.  Mood was depressed and affect moderately restricted.  Thought content was of memories of deployment and guilty.  He had a homicidal wish towards his drill sergeant but stated he would never act on it.  During the hospitalization he reported verbal command hallucinations and visual hallucinations of Iraqis trying to attack him.  Mental health staff regarded these symptoms as consistent with PTSD flashbacks rather than with a thought disorder.  Upon discharge he was referred for alcohol treatment and a follow-up with the Adult Psychiatric Partial Hospitalization Program.  During the psychiatric follow-up he maintained a restricted affect and was difficult to interview.  He missed several appointments; reportedly due to nightmares that interfered with sleep.  Because of the staff’s inability to assess him, the CI was re-hospitalized in January 2005 for a more thorough evaluation where he became more cooperative.

The 3 February 2005 MEB NARSUM examination, 12 months prior to separation, noted the CI was not suicidal, was participating, and compliant with psychiatric therapy except for alcohol treatment.  Current medications included Celexa (anti-depression) and Trazodone (sleep aide).  The CI was diagnosed with PTSD which was treated and improved with mild social/industrial impairment.  He was also diagnosed with MDD in partial remission and alcohol abuse.  A Global Assessment of Functioning (GAF) score of 55 (moderate symptoms, impairment) was rendered.  The 18 March 2005 commander’s statement noted the CI participated in numerous combat convoys through Baghdad and surrounding areas during his 4-month deployment.  These convoys were never attacked nor did his unit receive mortar fire at their forward operating base.  The CI made an immediate and positive impact, and was selected for promotion due to his outstanding performance.  The DD Form 214 did not show award of the Combat Action Badge.

The 26 August 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of social withdrawal, hypervigilance, nightmares and avoidance.  He could not talk about his traumatic experience without tearing up and remained mute.  He avoided wearing his uniform because it triggered memories of his traumatic experiences.  He reported poor tolerance and anger to the behavior of others.  He was assigned to the Walter Reed Veterans Administration Office for psychiatric therapy.  The CI reported he “liked being there.”  Current medications included Celexa, Seroquel (mood stabilizer) and Trazadone.  The psychiatrist examiner diagnosed PTSD with marked military and mild social impairments, alcohol abuse was in remission and depression had mild military and social impairments.  

On 15 Feb 2016, the day of separation, a psychiatric evaluation revealed the CI’s mental status examination was essentially normal with a good mood, no homicidal or suicidal ideations, delusions or hallucinations.  On that same day, a psychiatric staff nurse reported the CI had a job all lined up with a social worker’s help.

At the 21 June 2006 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported several combat traumas while in Iraq.  He reported depression, anger, isolation and anxiety.  He had sleep impairment without his medication and denied homicidal ideation.  He reported flashbacks but no nightmares.  Physical examination showed psychomotor retardation.  He worked as a data entry employee for 6 weeks and missed 4 days of work due to medication induced drowsiness or lack of sleep.  He initially enrolled in three college courses after discharge, but was currently enrolled in one course to keep up.  He reported being separated from his wife due to his depression and PTSD, and lived with a roommate.  A diagnosis of PTSD was rendered with a GAF score of 52 (moderate impairment.)

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD 10%, coded 9434 (major depressive disorder).  The PEB found the comorbid PTSD not unfitting.  The VA rated the PTSD 50%, coded 9411 (PTSD), based on the C&P examination, citing occupational and social impairment with reduced reliability and productivity.

The panel noted a psychiatric disability regardless of the number of mental health diagnoses (in this case MDD and PTSD), is subsumed under a single rating using the same criteria IAW VASRD §4.130 General Rating Formula for Mental Health Conditions.  Application of VASRD §4.129 is considered for all psychiatric conditions resulting in discharge from military service.  Members agreed that the ‘highly stressful event’ requisite for §4.129 was not satisfied in this case.  The commander’s statement indicated the CI’s convoys were not exposed to attack and the battalion was not exposed to mortar file during his Iraq deployment.  The panel determined there was no objective evidence of a highly stress event (combat or non-combat trauma) to support application of §4.129.

The panel then considered if there was evidence for a §4.130 rating higher than the 10% adjudicated by the PEB.  A 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  A 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  The 10% rating requires “symptoms controlled by continuous medication.”

The STR revealed the CI displayed post-deployment depressive symptoms after facing a potential marital separation.  The August 2005 MEB NARSUM examination, 4 months before separation, noted the CI continued to suffer from residual symptoms of depression and PTSD but symptoms were significantly reduced when he was away from the military environment (the CI liked working at Walter Reed’s VA office and took numerous vacations and emergency leave secondary to death in family then returned without significant decompensation).  The CI was taking Celexa, Seroquel and Trazadone medications.  The CI was diagnosed with PTSD with marked military and mild social impairments, alcohol abuse was in remission and depression had mild military and social impairments.  On the day of separation a psychiatric evaluation revealed the CI’s mental status examination was essentially normal with a good mood, no homicidal or suicidal ideations, delusions or hallucinations.  The VA examination, 4 months after separation, documented the CI was employed as a data entry employee and missed 4 days of work due to drowsiness.  He was currently enrolled in one college course.  He reported being separated from his wife due to his depression and PTSD, and lived with a roommate.  After due deliberation, considering all of 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 condition.

BOARD FINDINGS:  In the matter of the MDD and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  In the matter of the contended PTSD condition, the panel agrees that it cannot recommend it for additional disability rating as it is subsumed under the rating for the comorbid MDD.  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:

Exhibit A.  DD Form 294, dated 20170516, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006727, 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.

Sincerely,					      
Enclosure