RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2018-00152
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20071123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Airborne Battle Management Systems Apprentice, medically separated for “mood disorder, not otherwise specified (NOS)” with a disability rating of 10%.   

CI CONTENTION:  No specific contention was made.  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 - 20070815	VARD - 20080107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mood Disorder, NOS	9435	10%	Bipolar Disorder with Alcohol Abuse	9432	50%	20071011	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Mood Disorder, NOS.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI first presented to mental health (MH) services in November 2006.  He was diagnosed with mood disorder early on, and that remained his Axis I diagnosis throughout treatment.  He also carried an Axis II diagnosis of abnormal personality traits (Cluster B) that subsequently evolved to a diagnosis of personality disorder, NOS (confirmed by psychological testing [MMPI 2]).  He was treated with medication (lamotrigine, risperidone, gabapentin) and individual therapy.   There were periodic reports of alcohol abuse, although none required treatment or raised disciplinary issues.  There was no STR evidence of psychotic or other acute psychiatric symptoms, or of a psychiatric crisis or requirement for hospitalization.
A formal mental status examination (MSE) was documented on multiple occasions by different MH providers in STR clinical entries.  It was often normal with a euthymic mood, congruent affect, and no cognitive impairment or other abnormalities.  There was occasional “slight” to “mild” dysphoria, irritability or anger, and constricted affect, but no additional abnormalities.  Suicidal and homicidal ideation were always listed as negative, although there were two suicide assessments that noted fleeting and mild suicidal ideation without plans or attempts.  There was no documentation of panic attacks.  The Global Assessment of Functioning (GAF), when assigned, was consistently 70 (slight to mild range of impairment).  The commander’s performance statement documented the CI was not eligible for his current position because of removal from flight status and deployability; but, noted he was a good performer and recommended cross-training and retention.  He had not suffered any work loss and his enlisted performance evaluations were outstanding.  

The 28 June 2007 MEB NARSUM examination (psychiatrist), 5 months prior to separation, documented that the CI “continues to experience significant mood instability as well as interpersonal conflict with his spouse, despite his medication regimen.”  The examiner noted some hypomanic episodes and anger issues, but there was no documentation of vegetative symptoms of depression, panic attacks, or other concurrent symptoms.  The MSE recorded a “mildly dysphoric” mood and a full range of affect, without suicidal ideation or other acute features, and “fair” judgement and insight.  The Axis I diagnosis was “mood disorder, NOS” with an Axis II diagnosis of “personality disorder, NOS.”  The GAF assignment was 70 and the DoDI 1332.39-derived assessment of social and industrial impairment was “definite.”  

At the 11 October 2007 VA Compensation and Pension (C&P) examination, a month before separation, the CI reported “constant” symptoms of “severe mood swings, depression, crying spells, angry outburst, isolation ... hopelessness ... fatigue ... panic attacks weekly or less often ... manic-type behaviors ... and mild memory loss.”  The examiner also noted daily use of alcohol.  The MSE recorded an “abnormal” mood, intermittent pressured speech, and concurrent suicidal ideation.   The Axis I diagnosis was “bipolar disorder, moderate” with an Axis II diagnosis of “personality disorder, NOS.”  The GAF assignment was 63 (still in the mild range).  The VA examiner quoted VASRD §4.130 criteria for a 50% rating as his opinion for the degree of impairment. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the mood disorder 10%, coded 9435 (specific to mood order, NOS), citing criteria of DoDI 1332.39 (E2.A1.5).  The 10% rating (“mild” impairment IAW DoDI 1332.39) was derived after a 20% deduction by the PEB from a baseline 30% rating (“definite” impairment IAW DoDI 1332.39) for the personality disorder.  The latter is not service compensable IAW DoDI 1332.38 (E5.1.3.9.2).  The PEB’s stated opinion was that the non-compensable condition “significantly affects the severity of your mood disorder” and that “were it not for” that condition the DoDI 1332.39 impairment would be mild.  The VA rated the MH condition 50%, coded 9432 (bipolar disorder), based on the C&P examination and citing the applicable §4.130 criteria “occupational and social impairment with reduced reliability and productivity.”

After determining that the provisions of VASRD §4.129 for any “mental disorder that develops in service as a result of a highly stressful event” were not applicable to this case, the panel next deliberated the applicability of the above PEB deduction.  Although it could be reasonably conceded that the personality disorder aggravated the mood disorder, clinically separating the disability attributed to one diagnosis versus the other in psychiatric cases requires a directed opinion from the examiner addressing the degree of contribution from each diagnosis.   Since no such input from a psychiatrist was provided in this case, panel members agreed that the basis of the PEB’s deduction was overly speculative.   In this circumstance, the deduction is not countenanced by the VASRD and cannot be applied to the panel’s recommendation.  
Having determined that a minimum 30% rating was indicated on the above basis, the panel deliberated whether a higher rating was justified.  Although the psychiatric acuity reported at the VA examination might reasonably justify a 50% rating, there was a distinct disparity between the VA evidence and a great preponderance of the overall evidence which reflected much less acuity.  The commander’s statement and other performance evidence indicated that there was not any significant occupational impairment.  This was much more consistent with the §4.130 criteria for a 30% rating “occupational and social impairment with occasional decrease in work efficiency.”  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a 30% rating for the mood disorder under code 9435.

BOARD FINDINGS:  In the matter of the major depressive disorder, the panel recommends a disability rating of 30%, coded 9435 IAW VASRD §4.130.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that 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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Mood Disorder, Not Otherwise Specified 	9435	30%	

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2018-00152.

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 in accordance with 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 the 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 (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 90 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, in such a case, failure to render an election will result in automatic enrollment by law.