RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-04794
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Unit Supply Specialist, medically separated for “major depressive disorder” with a disability rating of 10%.  

CI CONTENTION:  In addition to reviewing all of her unfitting conditions, the CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20040191	VARD -20050525	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	Major Depressive Disorder	9434	30%	20050203	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  According to the service treatment record and MEB narrative summary (NARSUM), the CI presented to mental health (MH) in early 2004 after a several month history of worsening depressive symptoms, which resulted in significant occupational and social impairment.  She was sent home on two weeks of convalescent leave, but her symptoms did not dissipate.  The CI denied a psychiatric history prior to the service.  The 30 July 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of depressed mood most days.  Her command indicated she reported to work most days and was extremely tearful.  Medications included Prozac (depression), klonopin (anxiety) and trazadone (sleep).  Mental status examination (MSE) showed an affect that was repeatedly dysphoric with periods of tearfulness.  A diagnosis of MDD was rendered with a Global Assessment of Functioning (GAF) score of 55 (moderate impairment).  The examiner opined that routine military duty was the precipitant.  

At the 3 February 2005 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported no panic attacks for months, but did have some daytime fatigue, sleep difficulties, anxiety and uneasiness around people.  She felt depressed almost daily and periodically would cry.  The CI had reduced sexual interest and occasional memory difficulties.  Concentration had improved with treatment and there was no suicidal thinking.  She was able to enjoy things and planned to attend school full time for an advanced degree.  The MSE showed an individual with a depressed affect with some anxiety.  A diagnosis of MDD was rendered with a GAF score of 65 (mild impairment.)  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MH disorder 10%, coded 9434 (major depressive disorder).  The VA rated the MH disorder 30%, coded 9434, based on the C&P examination.  Panel members considered if VASRD §4.129 was applicable in this case and agreed that the requisite ‘highly stressful event’ was not satisfied in this case.  The panel then considered if there was evidence for a §4.130 rating higher than the 10% rating adjudicated by the PEB at separation.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” for a 30% rating there must be evidence of “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while the criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  The NARSUM noted the CI had significant symptoms of depression with a moderate level of impairment.  She did accept treatment and the C&P examination, more proximal to separation, reported improvement of symptoms and good treatment compliance.  The CI had some lingering symptoms but reported she was able to enjoy things and had future plans.  There was no history of hospitalizations, legal problems or emergency room visits.  Panel members concluded that her symptoms most closely approximated the criteria for 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 MH disorder.  

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.  

The following documentary evidence was considered:

[AR NUMBER],  

Dear XXXXXXXXXXXX:

	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.

Enclosure