RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-06125
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060724

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an E4, Aerospace Ground Equipment Journeyman, medically separated for “major depressive disorder” with a disability rating of 10%. 

CI CONTENTION:  Condition continues to worsen and negatively affects daily activities.  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 - 20060609	VARD - 20071012	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder (MDD)	9434	10%	Major Depressive Disorder 	9434	30%	20070612	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

MDD.  According to the service treatment record (STR) and MEB mental health (MH) narrative summary (NARSUM), the CI sought MH treatment in March 2006 and was hospitalized for expressing thoughts of suicide.  During hospitalization, the CI was diagnosed with MDD and borderline personality disorder (BPD).  She had problems with sleep, loss of interest, poor energy and concentration and suicidal ideation.  There were also multiple symptoms consistent with BPD such as abandonment issues, patterns of unstable interpersonal relationships, impulsivity, affective instability, chronic feelings of emptiness and inappropriate/intense anger.

The 10 April 2006 MEB NARSUM examination, 4 months prior to separation, noted problems with sleep, disinterest, poor energy, poor concentration and ongoing problems with occupational and interpersonal stressors.  The examiner noted the CI had received counseling services in 2004 for depression and BPD, and had a history of self-mutilating behavior consisting of superficial cutting of wrist (once).  The examiner also noted the CI had been out of the hospital for 20 days and was taking a mood stabilizer.  The mental status examination (MSE) was unremarkable with the exception of variable range of affect and stated mood of “better since going in the hospital.”  She had a Global Assessment of Functioning (GAF) score of 50 for serious impairment and was diagnosed with MDD and BPD.

The STR showed the CI was hospitalized twice in January 2007, 6 months after separation. The first of the two hospitalizations was due to suicidal ideation.  The CI had lived with a friend after discharge from service but was put out of the home just prior to hospitalization.  The second hospitalization occurred at the end of January.  The CI reported she had felt overwhelmed, which led to her taking an overdose of her prescription medication.  The CI reported that after the discharge in mid-January she moved back in with some acquaintances where drugs were frequently used, and where stress level was high due to frequent visits by her ex-boyfriend.  The CI stated that she thought about suicide on a daily basis.  She averaged seven hours of sleep, had no problem with her appetite, but admitted to occasional marijuana and alcohol use.  The nurse documented an unremarkable MSE.  

During the 31 January 2007 psychiatry inpatient visit, the CI stated, “I just want all this to be over,” which was clarified as referring to her homelessness, unemployment and lack of finances. The MSE noted depressed mood and affect.  There were no significant symptoms of MDD documented during the inpatient period.  There was no report of problem with concentration, memory, anxiety or chronic sleep impairment, and no evidence of depression-related suicidality.
During the 3 May 2007 social work encounter, 9 months after separation, the CI reported smoking pot “all day every day” and frequently used cocaine, available to her through her housemate.  She reportedly described herself as ‘addicted’ to money and dependent on boyfriends who were drug dealers and had a lot to spend on her.  She was not satisfied with living this way, but it was familiar and therefore easy.  The CI denied suicidal ideation or intent.

At the 12 June 2007 VA Compensation and Pension (C&P) evaluation, 11 months after separation, the CI reported she “was never involved in any type of psychiatric treatment until this current year.”  The CI reported discontinuing the mood stabilizing medication and only took Ambien for sleep.  The examiner noted the CI was unemployed; however, was capable of obtaining employment but would likely have difficulty maintaining employment due to mood issues and marijuana abuse.  The CI was inconsistent in reporting her current relationship status.  She reported she had friends and enjoyed watching TV with them.  The CI reported that she suffered from mood swings, and was often tearful, depressed and irritated.  The MSE was unremarkable, although she stated her concentration was “horrible.”  There was no evidence of any cognitive or memory impairment.  The CI also reported she was “always” tired despite achieving seven hours of sleep.  Panic or anxiety attacks were endorsed and were caused by “everything.” The CI reportedly told the examiner that her suicidal thoughts and gestures were because she was lonely.  In regards to the CI’s functioning, the examiner wrote, “there is no obvious connection between [the CI’s] military service and her impairment of functioning.  Although she is clearly significantly impaired both in her occupational and social functioning at this point in time, it is not obvious that her service in the military caused her functioning to worsen above and beyond what one would have expected had she not served in the military.” The examiner diagnosed MDD, cannabis dependence and BPD.  A GAF score in the moderate range was assessed.

The panel directed its attention to the rating recommendation based on the evidence just described.  Panel members first agreed that the provisions of VASRD§ 4.129, for a “mental disorder that develops in service as a result of a highly stressful event,” were not applicable.  The PEB rated the MH disorder 50%, coded 9434 (MDD); however, this was reduced to 10% after a deduction of 40% “for aggravating/contributing factors.”  The PEB noted the CI’s BPD significantly affected “the severity of [the] depressive symptoms.”  The CI entered an appeal to return to duty.  The PEB opined that were it not for the non-ratable/non-compensable condition, social and industrial adaptability impairment rating would best be described as mild.  The VA rated the MH disorder 30%, coded 9434, citing 4.130 criteria for 30% rating.  Both the NARSUM and the C&P examinations reported similar MSEs.  The NARSUM indicated a considerable level of military occupational impairment due to MDD and also noted definite impairment for military secondary to BPD.  The examiner opined that the coexistence of a personality disorder and the nature of her MH presentation had led her to the MEB, implying that the BPD contributed significantly to the overall MH disability picture.  The STR reflected two hospitalizations in the 6 months after separation, but the CI responded well to medication when she took it, and both hospital admissions were in response to personal and financial issues.  The panel also noted the CI had one admission before separation but was able to maintain relative stability for 10 months (4 months while still in service and 6 months after separation) although medications were used sporadically.

The commander’s statement, dated after the CI was discharged from the hospital, noted that the CI had not missed work secondary to her condition.  There was no indication the CI had interpersonal problems at work, or significant mood or anxiety symptoms.  However, the CI continued to demonstrate a relative inability to manage stressful situations that culminated in suicidal thoughts and behavior.  The panel opined that the CI’s MH history reflected a pattern of response to stressors that could impact negatively on her ability to remain in the service. Therefore, members agreed, although there were several indicators of primary personality disorder, the co-morbid depression and inadequate coping style posed a reasonable long-term risk to her health and safety and the 40% deduction was not appropriate in this case.  Thereupon, after due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 50% for the MDD, coded 9434.  

BOARD FINDINGS:  In the matter of the MH disorder, the panel recommends a disability rating of 50%, 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	50%	

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-2017-06125.

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 your separation be re-characterized to reflect disability retirement, rather than 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 determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at  to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.