RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05037
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051009

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Armament Repairer, medically separated for “major depressive disorder” with a disability rating of 10%.   

CI CONTENTION:  “I suffer from PTSD and vertigo due to my left ear ringing from the tinnitus and Meniere’s disease.”  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 - 20050808	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder	9434	10%	No VA Examination Proximate to Separation in Evidence	
PTSD	Not Unfitting		
Tinnitus	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s major depressive disorder (MDD) condition began in 2002 after he broke his ankle and developed problems with weight and performance.  He noted difficulty with mood, irritability and work performance due to worries about his weight and retention in the Army.  He was scared to eat around people, was having more difficulty with peers and began to isolate socially.  His wife was diagnosed with HIV and he developed sadness, guilt and fear, with arguments and blaming between him and his wife.  He became HIV positive in March 2003.  A domestic altercation and several separations ensued.  He first visited mental health (MH) in 2004, and was hospitalized in September 2004 for 4 days due to acute suicidal ideation associated with having occupational and marital difficulties.  He had multiple anti-depression medication trials with some improvement.  He had a history of depression, sleep, appetite and concentration problems with suicidal and homicidal thoughts after his first wife left him.  

The MEB NARSUM examination, noted complaints of difficulty with sleep, irritability and concentration, especially if he did not use his continuous positive airway pressure (CPAP) machine.  At times, he pulled the CPAP off during the night.  He felt angry and irritable and had difficulty controlling his emotions.  He reported headaches, back pain and knee pain.  He was often tearful and had frequent nightmares, social isolation and suicidal ideation.  Medications included Seroquel at night, Zoloft (anti-depression) at night and Ativan (anti-anxiety) as needed for acute agitation.  He continued to require CPAP, medications, weekly psychotherapy, family intervention and supervision and a restrictive profile.  He was intermittently explosive and suicidal.  He was described as a pleasant soldier who missed too much work for medical appointments.  Mental status examination (MSE) showed slow and halting speech and diminished eye contact to about 30-40%.  Affect was restricted and tearful when appropriate.  Thought content revealed chronic hopelessness and suicidal ideation without current intent or plan and frustration with his irritability.  He felt better when using his CPAP.  He reported regular nightmares (violent in nature and frightening and gang violence related) when not using his CPAP.  He denied hallucinations, flashbacks, avoidance or startle behavior.  Judgment was good and insight fair.  The examiner diagnosed MDD, moderate and recurrent and PTSD, due to exposure at age eight to traumatic events and to seeing violence at age 16, with a Global Assessment of Functioning (GAF) of 45 (serious symptoms, impairment),  There was no VA examination proximate to separation in evidence. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD 10%, coded 9434 (MDD), citing partial improvement with medication.  Disability associated with any psychiatric disorder, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 (general rating formula for MH disorders).  Therefore, any disability from the contended PTSD is appropriately subsumed in the rating for the primary MH diagnosis of MDD.  The panel considered applicability of VASRD §4.129 and agreed that the ‘highly stressful event’ requisite for application of §4.129 was not satisfied in this case.  

The panel then considered if there was evidence for a §4.130 rating higher than the 10% assigned by the PEB.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” and for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  During the NARSUM examination, the CI reported anger, irritability and difficulty with controlling his emotions.  He reported frequent tearfulness, isolation, explosiveness and suicidal ideation.  He required multi-modal treatment including daily medications, and weekly psychotherapy.  Symptoms interfered with work and marriage and were exacerbated by sleep apnea and possibly by HIV.  Symptoms improved with use of CPAP.  MSE showed several symptoms of depression (e.g. tearfulness, slowed speech, restricted affect, chronic hopelessness and suicidal ideation).  Nightmares were associated with childhood violence.  Stressors were occupational and marital and his GAF score reflected serious symptoms.  After a careful review of the evidence, panel members agreed the CI’s symptoms were not mild or transient, and were not controlled by medication, therefore, the 30% disability level better reflected the condition at separation.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the MDD, coded 9434. 

Contended PEB Condition:  Tinnitus.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  Tinnitus was profiled, but not implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the MDD, the panel recommends a disability rating of 30%, coded 9434 IAW VASRD §4.130.  In the matter of the contended tinnitus condition, the panel recommends no change from the PEB determinations as not unfitting.  

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Major Depressive Disorder 	9434	30%	

XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure