RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2021-00106
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030821

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Chaplain Assistant, medically separated for “obsessive-compulsive disorder [OCD] and depressive disorder not otherwise [specified] [NOS]” with a disability rating of 10%.   

CI CONTENTION:  The CI attached a 3-page statement describing the severity of his condition.  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 – 20030325 	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
OCD and Depressive Disorder (NOS)	9434-9404	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Obsessive-Compulsive Disorder and Depressive Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was first seen by a mental health provider in the summer of 2001.  He was started on three different medications with no effect.  However, the fourth medication (Luvox for OCD) was reportedly effective along with talk therapy.  In October 2002, the CI transferred to Korea, but neither Luvox nor talk therapy was available at the installation.  He was prescribed an anti-depressant medication, which did not help his condition, and his OCD symptoms intensified so that his compulsion to pray prevented him from sleeping.  Prescribed sleep medications were not effective, and in late November 2002, he reportedly ingested pills in an overdose attempt, but ended up vomiting them back up.  In December 2002, he was admitted to a psychiatric ward after a suicide attempt using multiple prescription medications.  He was monitored in the intensive care unit overnight and first transferred to inpatient psychiatry services in Korea, and later to Walter Reed Army Medical Center (WRAMC).  He was diagnosed with OCD and started on clomipramine.  

During the 19 December 2002 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months before separation, the CI stated he was in treatment for OCD but made no specific complaint.  Physical findings were unremarkable except for eczema noted on the right hand.

During the 2 January 2003 MEB NARSUM examination, 7 months prior to separation, the CI was receiving inpatient psychiatric treatment at WRAMC for OCD.  He had a history of recurrent suicidal ideation that developed out of his OCD symptoms, with obsessive thoughts and images involving his family members being injured or contracting a serious illness.  To make these thoughts and images go away, he would perform ritualistic prayers under rigid guidelines (compulsion).  His felt hopelessness and helplessness about his obsessions and compulsions, which led to thoughts of suicide before the actual attempt in December 2002.  The examiner stated that he had improved ‘remarkably’ when first prescribed clomipramine in Korea.  After his transfer to WRAMC, prescribed medications provided relief from depression and insomnia, and he was able to utilize weekend passes without clinical distress.  The mental status examination noted the CI, who appeared slightly older than his stated age, was polite, cooperative, and maintained good eye contact.  Speech was normal in rate and volume, but there was mild psychomotor agitation in the form of increased hand movements (i.e., hand wringing).  Mood was described as "better," and affect was blunted, showing little variation with discussion of emotionally charged topics.  Cognition was intact, and thought process was normal with no evidence of psychosis.  Thought content was devoid of suicidal or homicidal ideation, and insight and judgment were intact.  Estimated intelligence was above average.  At the time of discharge from inpatient treatment, the CI’s obsessions and compulsions were minimal, his depression was in remission, and he was no longer expressing suicidal ideation.  He was looking forward to attending seminary school after his discharge from the military.  The examiner opined that his OCD and depression caused mild impairment for social and industrial adaptability.  There were no further STR entries in the 7 months before separation and no VA examination proximate to separation in evidence. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the OCD 10%, dual coded 9434-9404 (major depressive disorder-obsessive compulsive disorder), citing mild social and industrial adaptability impairment.  Panel members noted that the CI did not make his initial VA claim until 17 years after separation.  The VA rating decision did not demonstrate evidence of post-service treatment until a mental health evaluation in 2019. 

The panel 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 in this case.  Panel members next considered a rating recommendation and noted that the MEB NARSUM recorded a normal MSE and the absence of chronic insomnia, memory problems, and suicidal/homicidal thoughts.  The CI’s depressive symptoms were in remission and there was no evidence of significant impairment in social or occupational functioning.  Thus, the panel agreed that a 10% rating, but no higher, was justified for “occupational and social impairment due to mild or transient symptoms which decrease 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 concluded there was insufficient cause to recommend a change in the PEB adjudication for the OCD and depression NOS.  

BOARD FINDINGS:  In the matter of the OCD and depression NOS and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20211013, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20220010853

Dear XXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.