RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX		CASE: PD-2017-05648 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20050430

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve O3, Aviator, medically separated for “major depressive disorder [MDD]” with a disability rating of 10%.

CI CONTENTION: “Review all conditions.” 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 - 20050325	VARD - 20060321	
Condition	Code	Rating	Condition	Code	Rating	Exam	
MDD	9434	10%	MDD	9434	30%	20051219	
[Right] Shoulder Impingement Syndrome	Cat III	Right Shoulder Bursitis	5024	10%	20060217	
Chronic Pelvic Pain	Cat III	Endometriosis	7629	10%	20060217	
Acute Thyroiditis	Cat III	Thyroidism	7900	NSC	20060217	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

MDD. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI had history of intermittent depressed mood, stress and anxiety and reported a suicide attempt prior to joining the Navy. She had been followed in the mental health (MH) clinic since 2004 for significant chronic occupational stressors (helicopter pilot and partner relational problems), and was treated with medications and psychotherapy. Current symptoms included dysphoria, agitated mood, low self-esteem, chronic worrying, crying spells, over-eating, self- inflicted lacerations and suicidal ideation (SI).

The 25 January 2005 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of depressive symptoms that interfered with limited duty assignments and required leaving work early because she was functioning so poorly. Although she had a history of acute thyroiditis, she continued to have significant depressive symptoms despite normal thyroid

function tests. The mental status examination (MSE) showed mildly decreased psychomotor activity and mild anxiety. She revealed self-inflicted superficial lacerations to her left arm and right leg, and mood was depressed as evidenced by facial expressions, spontaneous comments and expressed feelings. Affect was of decreased range but normal intensity without lability. Thought processes were intact and thought content showed low self-esteem and “self-loathing.” She denied SI or homicidal ideations. A diagnosis of MDD was rendered with a Global Assessment of Functioning (GAF) score of 55-65 (mild to moderate impairment).

The February 2005 non-medical assessment (NMA) noted that the CI’s ability to perform duties “did not seem degraded by her condition [but on] two occasions she left work without any explanation and later stated she was sick [and] frequently demonstrated an inability to report to work on time.” The CI claimed that she needed to separate herself from the work environment about 4 times a week to perform relaxation exercises to reduce depressive symptoms. “For the most part, she was observed to be well-adjusted, happy and sociable. Her performance in a short period had been commendable but at times she complained of depression and of an inability to concentrate.”

At the 19 December 2005 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported poor sleep, weekly nightmares, depression (improved to some extent with antidepressants) with a sense of failure, some hopelessness, poor psychosocial function, irregular sleep (from 4-12 hours), and a history of monthly panic attacks while in the Navy. She was seeing a private psychologist and taking an anti-depressant, which improved the depressive symptoms and sleep issues, but not the nightmares. She was unemployed, but enjoyed watching television, remodeling projects, and gardening, and she reported good relationships with her husband and others. The MSE showed a blunted affect, and an anxious, good and depressed mood. She reported feeling hopeless and helpless, but denied SI. Personal hygiene and memory were good. A diagnosis of MDD was rendered with a GAF score of 50 (moderate impairment).

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the MDD 10%, coded 9434 (MDD). The PEB also listed anxiety as a related Category II condition, but any disability from this condition was properly subsumed under the overall rating for the MDD to avoid pyramiding (VASRD §4.14). The VA rated the MDD 30%, coded 9434, based on the C&P examination, citing “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily).” Panel members first considered whether the provisions of VASRD §4.129 (mental disorders due to traumatic stress) applied in this case, and agreed there was no evidence of a traumatic event or stressor causing the unfitting MH condition. The NARSUM indicated only mild depression and anxiety, and the NMA indicated good performance and no obvious signs of depression, although the CI occasionally reported depression and showed tardiness. Although the C&P noted she was unemployed, she had good relationships, and engaged in several leisure activities. Medication therapy was beneficial for depression and sleep difficulties, and she had no history of psychiatric hospitalizations, emergency room visits, violent behavior or legal involvement. The panel agreed that her MH condition most closely met the criteria for a 10% disability. 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: Right Shoulder Impingement Syndrome, Pelvic Pain and Thyroiditis. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. None of the conditions were noted on limited duty forms or implicated in the non-medical assessment, and did not fail retention standards. There was no performance-based evidence from the record that any of the 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 any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the major depressive disorder and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication. In the matter of the contended right shoulder impingement syndrome, pelvic pain and thyroiditis, the panel recommends no change from the PEB determination as not unfitting. 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.

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
10 Sep 20

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

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.