RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxxxx	CASE:  PD-2017-04886
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090824

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Aerospace Medical Service Journeyman, medically separated for “chronic major depression” with a disability rating of 10%.  

CI CONTENTION:  Given a higher rating by the VA.  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 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 - 20090605	VARD – 20100908	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Major Depression	9434	10%	PTSD	9411	50%	20100908	
Obsessive Compulsive Disorder	Cat II 					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  90% 	

ANALYSIS SUMMARY:  

Chronic Major Depression.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI presented to mental health (MH) in January 2009 with a 12-year history of recurrent depression.   She was referred for inpatient psychiatric care for safety and mood stabilization.  The CI reported that in 2004 she was sexually assaulted during a home intrusion and stated she “fought back” and hit the assailant.  She did not receive any counseling following this event and denied any post-traumatic stress disorder (PTSD) symptoms from the incident.  The CI also reported a history of mood symptoms that were present to a lesser degree since her return from her October 2008 deployment.  After returning, she felt more on edge in public places but denied feeling anxious or hyper-vigilant.  She also had problems with sleep, but described her 5-month deployment as “amazing.”  The CI denied any significant mood or anxiety symptoms while deployed, and was able to fulfill her duties and establish new friendships. 

The 20 March 2009 MEB NARSUM examination, 5 months prior to separation, noted that the CI had been admitted to the hospital in January 2009 due to recurrent suicidal ideation framed as “it would be easier to die,” but after hospital discharge, she reported feeling better.  She also reported continued depression and feeling “stressed” by her job.  Medication was beneficial, and the CI was able to return to full duty in the intensive care unit, although she had transient passive suicidal ideation, especially when she felt that she was overwhelmed or treated unfairly at work (given too many duties).  The examiner noted that techniques acquired from therapy had helped her to manage these periods.  The mental status examination (MSE) was unremarkable.  The examiner opined that the CI was able to function in her primary job specialty, but “if exposed to overwhelming situational stressors, either in an occupational or social context, she [was] highly likely to decompensate.” 

At the 9 February 2010 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported “really bad nightmares and a hard time sleeping” due to issues from Iraq.  The CI also reported that she was sexually assaulted off base in a civilian incident, and that she had recurring intrusive memories and images of both the sexual assault and casualties she saw in Iraq.  At the time of the examination, the CI was not receiving any form of MH treatment nor was she taking psychotropic medication.  The CI was enrolled full-time in school and was studying criminal justice to become a private investigator.  She was not working because she wanted to concentrate full-time on her studies.  Although divorced, she was in a relationship and lived with her parents.  The MSE was unremarkable with the exception of anxious affect.  

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), citing “a 12-year history of depressive episodes prior to entering Service.”  The VA rated the MH disorder 50%, coded 9411 (PTSD), based on the C&P examination.  Panel members first considered if the provision of VASRD§ 4.129 were applicable in this case.  Although the CI was exposed to a traumatic incident, the stressor did not cause her release from active duty.  There were no documented treatment notes associated with a traumatic event, and no documented symptoms causing impairment related to trauma.  Members concluded that the requisite link between the Service stressor and the psychiatric condition was not adequately satisfied.

The panel next proceeded with the rating recommendation.  The panel considered the absence of hospitalization, emergency room treatment, and the apparent stability of symptoms, albeit chronic, during the 8 months prior to separation, and 6 months after separation.  There was no report of clinical decompensation that required urgent psychiatric care.  The NARSUM recorded a normal MSE without chronic insomnia, panic attacks, problems with memory, or suicidal or homicidal thoughts.  The CI was stable on psychotropic medication.  The C&P examination, 6 months after separation, noted the CI was not in any form of MH treatment, but had remained stable.  She was a full-time college student, was in a relationship, and living with her parents. The MSE was unremarkable except for anxious affect.  There had been no report of panic attacks requiring treatment in the emergency room, and although the examiner documented panic attacks without agoraphobia, there was no documentation of any panic attacks in the STR.  There was no report of chronic insomnia, memory problems, or suicidal ideation in the 6 months prior to separation.  There was no evidence of significant impairment in social or occupational functioning as a result of the MH disorder.  The NARSUM examiner opined that the condition was stable but that during periods of significant stress, the CI would likely demonstrate impairment in social and occupational functioning.

Panel members agreed, a 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; or symptoms controlled by continuous medication.  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 major depression.  

Contended PEB Condition:  Obsessive Compulsive Disorder (OCD).  The panel notes that IAW DoDI 1332.38, E5.1.3.9.5, impulse control disorders such as OCD do not constitute physical disabilities.  Therefore, the panel has no basis for recommending this condition for additional rating. 

BOARD FINDINGS:  In the matter of the MH disorder and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  In the matter of the contended OCD, the panel agrees it cannot recommend it 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.   

Dear XXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04886.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.

						Sincerely,