RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05479
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20091207

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

CI CONTENTION: Given a higher rating by the VA for the mental health condition. 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 - 20091109	VARD - 20100714	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Depressive Disorder	9434	10%	Major Depressive Disorder	9434	100%	20100630	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 100%	

ANALYSIS SUMMARY:

Depressive Disorder. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI began experiencing depressed mood, tearfulness, fatigue, anhedonia, impaired attention and concentration, and headaches after giving birth to her second child. She managed these symptoms by seeing a chaplain, but after her third pregnancy, and in the context of occupation stressors, her condition worsened in late 2008 and early 2009. She was referred to mental health (MH) for evaluation and placed on limited duty and work hours consisting of routine administrative tasks for 4 hours a day. The CI was initially treated with anti- depression medication, but developed suicidal ideation after a brief argument with her husband. She also had thoughts of killing her husband and drowning her children and was admitted as a psychiatric inpatient on 19 September 2009. Two days later she was puling at the ends of a pillow case she had wrapped around her neck. While hospitalized, she made multiple phone calls to various individuals/entities involved in her care. After treatment with various modalities, including two anti-depressants and one anti-psychosis medication, she was transferred to outpatient care on 29 September 2009 and seen on a daily basis.

The September 2009 non-medical assessment (NMA) noted the CI was doing administrative work due to her condition, and was away from current duties an average of 20-25 hours per week. The 5 October 2009 MEB NARSUM examination, 2 months prior to separation, noted increased depression during the day and “breakdowns at work.” She reported recent occurrences of short- temper, moodiness, operating in isolation, and notable sadness and fatigue. She had limited improvement from various psychotropic medications, and essentially no improvement from psychotherapy. The mental status examination (MSE) showed a healthy and well-groomed female, dressed in well-kept clothes, a generally serious affect, and mood described as “depressed,” but no suicidal or homicidal ideation. An Axis I diagnosis of depressive disorder, not otherwise specified (NOS), and Axis II cluster B narcissistic and histrionic traits with a Global Assessment of Functioning (GAF) score of 45 (serious symptoms, impairment) were rendered. The examiner opined the depression was only moderately improved with both psychotherapy and psychotropic medications and that the total degree of civilian performance impairment from all sources was moderate.

At a follow-up MH visit on 1 December 2009, the CI described frustration and continued mood issues that would resolve when she was with her family. She reported discriminatory treatment and verbal bullying by supervisors due to her pregnancies and MH problems. She was treated with an anti-depression medication as well as a sleep aid as needed. She ate Thanksgiving dinner with a family from her church and engaged in some socialization. The MSE showed she was casually dressed with no signs of a thought disorder and making plans for Christmas. She described her mood as depressed and affect was blunted with occasional bursts of anger. She denied suicidal/homicidal ideation. Diagnoses included: Axis I depression and Axis II personality disorder NOS, with cluster B borderline and narcissistic traits.

At the 30 June 2010 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported she was a stay-at-home mother and 10 weeks pregnant with her fourth child. She stated she was seeking employment and that she previously had been verbally bullied by supervisors because of her pregnancies and MH issues and was given desk work. She felt the discriminatory treatment led to many of her symptoms. She also described difficulty with parenting and feeling overwhelmed mostly due to mood symptoms. She said her marriage was satisfying, but there were problems with communication, and her husband was becoming frustrated with her inability to perform tasks, parent and control her mood. There was also a decrease in sexual relations. Her mother lived nearby and helped clean and cook for the children. She had positive relationships with both stepparents and saw her nieces and nephews frequently. She reported one hospitalization in November 2009 after overdosing on psychotropic medication. She had decreased and fluctuating appetite, and difficulty with sleep as well as some activities of daily living to include showering, putting on appropriate clothing, and cleaning the house. She admitted to symptoms of major depressive disorder (MDD), but took no medications and she was not in counseling. The MSE showed fair hygiene, inappropriate clothing, diminished concentration, and fleeting suicidal ideation in the last 2 days, but without a plan. She was cooperative but somewhat detached, with slow motor activity, depressed mood and flat, congruent affect. She reported a suicide attempt by drowning in August 2009, by strangulation while hospitalized in September 2009, and by overdose in the Novembers 2009. She was weepy at times, especially when asked to do mental tasks. She admitted to having weekly panic attacks, which started in March 2009, and described them as feeling overwhelmed and claustrophobic with difficulty concentrating and chronic worry. She reported visual and auditory hallucinations 2-3 times per week, mostly at night, but none were evident during the evaluation. Immediate memory was impaired and she began weeping as she attempted serial 7 subtractions, stating she felt overwhelmed and could not finish. A diagnosis of MDD was rendered, with a GAF score of 25 (impairments in all areas).

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the depressive disorder 10%, coded 9434 (MDD). The VA rated the depressive disorder

100%, coded 9434, based on the C&P examination, citing total occupational and social impairment due to intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), with a GAF score of 25. Panel members considered the provisions of VASRD §4.129 (mental disorders due to traumatic stress), and agreed there was no evidence of a traumatic event or stressor causing the unfitting MH condition, and that application of VASRD §4.129 was not appropriate in this case. The panel next considered the
§4.130 rating at the time of separation, noting that the NARSUM documented poor work performance, limited response to medication, and none to therapy. However, the CI was able to perform administrative tasks 4 hours a day. The STR recorded two hospitalizations with assessments of moderate impairment, and the C&P examination noted continued symptoms of depression as well as reported panic attacks, although the description of these attacks did not meet DSM-IV-TR criteria. She appeared poorly groomed and reported hallucinations, both symptoms incongruous with previous presentations, but she was pregnant and able to care for three small children with daily help from her mother, and was not receiving psychiatric treatment or taking psychotropic medication. The preponderance of evidence indicated the CI suffered from symptoms of depression that were exacerbated in the post-partum period. Within a short period, she reportedly attempted suicide three times and was psychiatrically hospitalized twice. However, she was compliant with treatment, able to socialize some, and care for her children with assistance. There was evidence that her mood deteriorated with the stressors of pregnancy and work, but no record of violent behavior or legal involvement. Thus, panel members agreed that the CI’s level of impairment most closely met criteria for a 30% rating. 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 depressive disorder, coded 9434.

BOARD FINDINGS: In the matter of the depressive disorder, the panel recommends a disability rating of 30%, coded 9434 IAW VASRD §4.130. There are no other conditions within the panel’s scope of review for consideration.

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	
Depressive Disorder	9434	30%	

The following documentary evidence was considered:

DEPARTMENT 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 12 Oct 20

From: To:
Subj:

Ref:

Director, Secretary of the Navy Council of Review Boards 

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
(a) DoDI 6040.44
(b)	PDBR ltr of 9 Jan 20
(b)	

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy for appropriate action.

2.	On 7 October 2020, the Assistant Secretary of the Navy took action in your case by accepting the correct recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Physical Evaluation Board from 10 to 30 percent with assignment to the Permanent Disability Retired List.

3.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the Navy Personnel Command, for correction of your records as stated above.	You will be notified once those changes are complete.