RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05893
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20080509

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Sonar Technician, medically separated for “major depressive disorder [MDD]” with a disability rating of 30%. A 20% deduction was applied for existing prior to service (EPTS), with a final rating of 10%.

CI CONTENTION: “Condition still effecting life in adverse ways. Percentage downgraded while in discharge process.” 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 – 20080328	VARD - 20080610	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent, Severe MDD	9434	30%-20%=10%	Panic Disorder with Agoraphobia and MDD	9434-9412	10%	20080324	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

MDD. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI reportedly had mental health issues since approximately age 16, which became more severe in the months prior to separation. He was diagnosed with MDD in January 2008. The NARSUM recorded history of recurrent, severe depression with decreased sleep, energy, concentration, and appetite. The CI had suicidal ideation and self-mutilation behavior in the form of superficial wrist cutting. He was hospitalized for one week and discharged to a medical hold unit. The 1 February 2008 MEB NARSUM examination was the date of discharge from psychiatry inpatient care, and 3 months prior to separation, and noted the CI was admitted voluntarily for evaluation and suicide risk assessment. The CI denied history of psychiatric hospital, or history of self-mutilation, or suicidal, homicidal or violent behavior prior to January 2008. At the time of admission he continued to have suicidal thought without intent or plan. He was started on medication for depression and anxiety. At the time of discharge, the mental status examination (MSE) was unremarkable. Memory was intact (remote, recent, short-term and immediate).

Insight, judgment and impulse control were felt to be adequate. He convincingly denied both homicidal and suicidal ideations. The diagnoses were recurrent, severe MDD, with a notation that the condition had not existed prior to enlistment, and panic disorder with agoraphobia, also did not exist prior to enlistment.

At the 24 March 2008 VA Compensation and Pension (C&P) mental health examination, 2 months before separation, the CI reported he no longer had panic attacks, had no suicidal thoughts since January 2008, and had no problems with sleep. All of his symptoms had improved significantly with medication. The MSE was unremarkable with the exception of an anxious mood and affect. A Global Assessment of Functioning (GAF) score was recorded in the mild range, for mild symptoms/impairment. During the 24 April 2008 psychiatry clinic follow-up examination, one month prior to separation, the CI expressed some anxiety over leaving the military. He planned to pursue community college. He still had some desire to cut but stated he was trying to cope more rationally now. The MSE noted anxious mood but no depression, and no suicidal ideation. Judgment was not impaired.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the MDD 30%, citing the condition was EPTS and reduced the rating by 20%, for a final 10% rating, coded 9434 (MDD). The VA rated the MDD 10%, analogously coded 9434-9412 (panic disorder and/or agoraphobia), based on the C&P examination. The PEB made no remarks regarding rationale for its decision. It simply noted “EPTS-reduced by 20%.” The JDETS noted “sleeps only 4 hours a night, self-destructive behavior, symptoms present since 16 years old but aggravated.” The panel carefully adjudicated, and noted, first of all, the underpinning for the condition being EPTS, on which the deduction hinges, is overly tenuous. The NARSUM examination indicated moderate disability for continued military service and moderate disability for occupational functioning. The examiner wrote, “Did not exist prior to enlistment.”

The NARSUM noted the self-report of a pre-existing mental condition, but offered no evidence to support a pre-existing MDD, albeit, the condition was noted as “recurrent.” However, the diagnosis of MDD or any mental disorder was not recorded in the STR at the time of entry into service. Secondly, even if the MDD was in fact EPTS, the process itself of clinically extricating the disability attendant to pre-service impairment versus the in-service is overly speculative without a directed opinion from the examiner addressing the degree of contribution from each timeframe. No such input from a psychiatric examiner is in evidence; thus the panel could not fairly apportion a deduction even if the condition was EPTS. Having concluded that no deduction should be applied, members turned to deliberation of a fair rating (IAW VASRD §4.130) of the overall psychiatric disability in evidence at separation.

The NARSUM at the time of inpatient discharge, indicated the CI no longer expressed suicidal ideation, and his symptoms had improved with medication. However, the examiner stated the symptoms were severe and recurrent in nature and prohibited him from effectively serving in the Navy. The last mental health encounter, one month prior to separation, recorded no symptoms with the exception of feeling anxious over leaving the Service. The CI reported absence of panic attacks and no feelings of depression. The C&P examination 2 months prior to separation recorded no problems with sleep, mood, and no panic attacks since January 2008. Therefore, panel members agreed, although the STR supports only a 10% rating for mild social and industrial impairment, the deduction of 20% cannot be recommended by the panel. 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.

BOARD FINDINGS: In the matter of the major 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	
Major Depressive Disorder	9434	30%	

The following documentary evidence was considered: 

DEPARrnENT OF THE NAVY
SECRETARY OF TI-IE 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:	Director, Secretary of the Navy Council of Review Boards To:	
Subj:	PHYSICAL DISABILITY BOARD OF REVIEW {PDBR) Ref:	{a) DODI 6040.44
{b) PDBR ltr of 12 Feb 20

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.