RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-04829 BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20080609

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Information Systems administrator, medically separated for “major depressive disorder [MDD], recurrent” with a disability rating of 10%.

CI CONTENTION: In addition to depression she 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 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 - 20080331	VARD - 20080827	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent MDD	9434	10%	Major Depression	9434	30%	20080611	
Borderline and Narcissistic Personality Traits	Cat IV	Borderline Narcissistic Histrionic	9499-9435	NSC	20080611	
Alcohol Dependence	Cat IV	Alcohol Dependence	9326	NSC	20080611	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Recurrent MDD. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s recurrent MDD symptoms first began at the age of 14 years. Treatment was with medication for several months. In 2001 she experienced another period of depression while stationed overseas when a family member passed away. In 2003 she had another depressive period after being raped while deployed. Her condition was complicated due to heavy drinking over a 3-month period. She then completed a 28-day residential alcohol treatment program along with after case therapy. On 15 May 2007 she reported decreased sleep and energy, was tearful, and felt “sort of numb.” She noted “I just can’t keep going like this” and found it “extremely difficult” to continue her daily activities. Treatment consisted of sertraline (an antidepressant). At a psychology visit on 22 May 2007, the CI indicated she was stressed from

both a class she took and pending sea duty. She was found fit for duty. Treatment was switched to Wellbutrin (an antidepressant) on 25 June 2007 and therapy was instituted on 10 July 2007. Citalopram (an antidepressant) was added to the treatment, which was then switched to Prozac (an antidepressant). In December 2007 she was taking Prozac, Wellbutrin, Buspar (an anti- anxiety medication), Klonopin (an anti-anxiety medication and for panic attacks), and Trazadone (an antidepressant and sedative). Medication, along with individual and group therapy continued on a regular basis thereafter.

The 22 February 2008 MEB NARSUM examination, 4 months prior to separation, noted the complaints of continued depressive symptoms including a depressed mood, anxiety, insomnia, low motivation, concentration, and low energy despite treatment with Prozac, Buspar, and Wellbutrin. Routine laboratory studies including thyroid and chemistry panels, a complete blood count, and urinalysis were unremarkable. Mental status examination (MSE) revealed she was alert and oriented in all spheres and was cooperative. Her eye contact was good, and her speech was of a normal rate and rhythm. She denied racing thoughts, but displayed mild motor retardation. Her mood was described as depressed with a congruent tearful affect. Thought processes were linear, logical, and goal directed and thought content was negative for suicidal or homicidal ideation. She had no thoughts consistent with delusions and denied any current auditory or visual hallucinations. Cognitive testing demonstrated no problems with recall and memory. Her insight appeared fair and her judgment, and impulse control appeared to be intact. A Personality Assessment Inventory suggested both a strong history of depression and some personality disorder pathology (borderline and narcissistic).

The examiner indicated the CI’s depressive symptoms had improved around 50% over the course of treatment and she would require long- term use of medication and follow-up care. She was functioning adequately at her current shore duty station, but due to potential worsening of poor concentration, low motivation, and mood instability she had a potential for occupational impairment. The CI’s condition manifested with moderate to mild interference with social and civilian adaptability. The Axis I diagnosis was recurrent MDD manifested by depressive periods (depressed mood, anxiety, low motivation, poor concentration, insomnia, and suicidal thoughts). The Global Assessment of Functioning (GAF) score was 50 (moderate problems in occupational functioning). By 13 March 2008 she had around 70% control of her symptoms. Medication, personal therapy, and group therapy continued.

At the 11 June 2008 VA Compensation and Pension (C&P) examination, at separation, the CI reported a depressed mood, anhedonia, crying spells, little motivation for doing activities, fleeting suicidal thoughts, and some mild anxiety. However, she was noted to be in the process of finishing a college degree. MSE showed she was clean, neatly groomed, and appropriately dressed. Psychomotor activity and speech were unremarkable. She was cooperative and attentive. Her mood was dysphoric and affect was appropriate. Attention was intact and she was oriented to person, time, and place. Thought process and content were unremarkable. She had no delusions or hallucinations. Judgment and insight were intact. Intelligence was above average. She had no inappropriate behavior, but did have occasional panic attacks. She had no homicidal thoughts, but had fleeting suicidal thoughts, intent, or plan. Memory was normal. Her Axis I diagnosis was major depression, single episode, and her GAF score was 65 (some mild symptoms).

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the recurrent MDD 10%, 9434 (MDD). Using the same code, the VA rated 30%, based on the C&P examination, citing the mental status findings and the examiner’s conclusion of reduced reliability and productivity due to the mental disorder.

The panel first noted there was no traumatic event causing the unfitting mental health condition, although the CI did have a history of a traumatic event. Therefore, the panel concluded that

application of VASRD §4.129 was not appropriate in this case. Proximate to separation, she was still taking medication and was undergoing frequent therapy sessions. However, she still had depressive symptoms, although they were reported to be 50% to 70% improved. She was functioning adequately at her current shore duty station, but it was felt she had a potential for occupational impairment. Although the GAF score is not used for rating purposes, the panel noted improvement from 50 at the NARSUM to 65 at the VA examination. Furthermore, while at the VA examination, it was noted she was in process of finishing of a college degree and she was functioning adequately on her shore duty assignment, which is more akin to a future civilian occupation than sea duty. 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 Conditions: Borderline and Narcissistic Personality Traits and Alcohol Dependence. In accordance with DoDI 1332.38, E4.13.1.4 and E5, none of the contended conditions constitute a physical disability, and are therefore not compensable. Therefore, the panel has no basis for recommending the contended conditions as unfitting.

BOARD FINDINGS: In the matter of the recurrent major depressive disorder and IAW VASRD
§4.130 the panel recommends no change in the PEB adjudication. In the matter of the contended borderline and narcissistic personality traits and alcohol dependence conditions, the panel agrees it cannot recommend them for additional disability rating. 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:

DEPARTI1ENT OF THE NAVY
SECRETARY OF TIIE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO:
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:	XXXXXXXXXXXXXXXXX

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.