RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05658
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20071030

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Imagery Analysis Craftsman, medically separated for “major depressive disorder in partial remission” with a disability rating of 10%, less 10% for personality disorder, not otherwise specified, as an aggravating/contributing factor, for a combined disability rating of 0%. 

CI CONTENTION:  “Major Depressive Disorder.”  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 - 20070904	VARD - 20080412	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder in Partial Remission	9434	0%	Major Depressive Disorder	9434	30%	20080218	
Personality Disorder Not Otherwise Specified [NOS]	Category III					
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Major Depressive Disorder (MDD) in Partial Remission.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s MDD was diagnosed in 2001 when she sought mental health (MH) treatment for a 2-year history of depressive symptoms, including low mood, sleep difficulty, anhedonia, low energy, and difficulties with concentration.  She was placed on psychotropic medication and in maintenance treatment for several years.  There were no psychiatric hospitalizations or suicidality.

At the 1 June 2007 MEB NARSUM psychiatric examination, 4 months prior to separation, the CI reported insomnia, anxiety and depression, and current psychotropic medication was noted.  During the mental status examination (MSE), she stated “I don’t like feeling this way.”  The provider documented that she was alert and oriented, well-groomed and appeared her stated age.  She made appropriate eye contact, demonstrated normal intonation, rhythm and rate in speech, and showed no psychomotor agitation or slowing.  Affect was anxious, dysphoric, reactive and congruent, with linear thought processes and good insight, judgement and impulse control.  She denied current suicidal and homicidal (SI/HI) ideations or hallucinations.  The examiner diagnosed recurrent, mild MDD in partial remission, with mild social and industrial impairment and a Global Assessment of Functioning (GAF) score of 75.

The commander’s statement, dated 15 June 2007, noted the CI was a capable non-commissioned officer, but that despite her MH treatment and prescribed medication, she was unable to work in her military specialty as an imagery analyst due to the “significant amount of stress during day-to-day operations.” She was assigned to the command section, but the commander stated that her inability to deploy and work under stress was “not conducive” to continued military service.  

The 17 July 2007 MEB psychiatric addendum, 3 months before separation, noted insomnia and irritability, and that the CI was currently taking prescribed psychotropic medication.  The MSE was unremarkable, with normal eye contact, speech, and thought content/process.  Affect was euthymic, reactive and congruent, and insight, judgement and impulse control were good, but the CI stated “I keep acting like that.”  The diagnosis was recurrent, mild MDD in partial remission with a GAF score of 80, and the psychiatrist recorded the following: “Strong consideration was given to pulling the MEB prior to meeting locally after back measurements were taken, and this addendum prepared. The patient had an ETS [estimated time of separation] date at the end of September, and was subjectively and objectively doing much better. She had reached a plateau in terms of acute treatment, and was better prepared to address long-standing (personality based) issues in her mental health treatment. However, she continued to experience physical pain, and her conditions were not amenable to the treatment routinely available in the military.  In addition, she was prescribed an anticonvulsant for a psychiatric indication.  In accordance with SG DOC 07-013 (26 Feb 2007), members who are prescribed anticonvulsants for psychiatric indications [are] not qualified for deployment and this is not waiverable.”

At the 5 February 2008 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported MH problems since 2000, shortly after a break-up with her boyfriend, and that she felt her mood had improved and “stabilized” since leaving the service. She had worked as a government contractor since October 2007, and exercised and did yoga to help her anxiety and depression.  The MSE was unremarkable with good eye contact, calm and pleasant demeanor, coherent and logical thought processes, normal cognitive functions and adequate insight and judgement; she denied any psychotic symptoms or SI/HI.  The examiner noted that although she was functioning well, she had some difficulties adapting to stressful events and continued to have “recurrent bouts of depression” for which she was “maintained on medication.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MDD 10%, coded 9434 (MDD), specifying “less aggravating/contributing factors (personality disorder)” for a 10% deduction and combined 0% rating.  The VA rated the MDD 30%, coded 9434, based on the C&P examination, citing current symptoms of depression with anxiety.  Panel members noted the PEB determination of MDD in partial remission, with mild social and industrial adaptability impairment, as evidenced by the MEB psychiatric examinations and unremarkable MSEs in June and July 2007.  The MEB addendum psychiatrist also opined that due to her significant subjective and objective improvement, there was consideration for “pulling the MEB.”  The VA MSE was also unremarkable, with the examiner stating her condition was improved and that she was stable on medications, though she had some difficulty adapting to stress.  The panel agreed that the CI’s symptoms most closely approximated a 10% rating IAW VASRD §4.130 for decreased work efficiency and ability to perform occupational tasks only during periods of significant stress.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the MDD, coded 9434.

Contended PEB Conditions:  Personality Disorder, NOS.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  A personality disorder does not constitute a physical disability, IAW DoDI 1332.38, and thus the panel has no basis for recommending it as unfitting.  After due deliberation, and in consideration of the preponderance of the evidence, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended personality disorder and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the major depressive disorder, the panel recommends a disability rating of 10%, coded 9434 IAW VASRD §4.130.  In the matter of the contended personality disorder, 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.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Major Depressive Disorder in Partial Remission	9434	10%	

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05658.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.