RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX						            CASE:  PD-2013-01952
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050124

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Air Force E-5 (Communication, Computer System Control) medically separated for delusional disorder.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).   He was issued a permanent S4 profile and referred for a Medical Evaluation Board (MEB).  The mental health (MH) condition, characterized as “delusional disorder, somatic type bereavement” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB adjudicated “delusional disorder somatic type associated with bereavement” as unfitting, rated 10%.  The CI appealed to the Formal PEB (FPEB) and the Secretary of the Air Force Personnel Council (SAFPC), which both affirmed the PEB finding and rating. 

CI CONTENTION:  CI believes others received higher ratings for similar conditions.  His complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:  
   
Service FPEB – Dated 20041004	VA – (1 Mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Delusional Disorder; Somatic Type, Associated with Bereavement	9208	10%	Major Depressive Disorder  (MDD)	9434	10%	20050228	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 5 (Not in Scope)	
Rating:  10%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20050613 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:  

Delusional Disorder, Somatic Type Condition.  Service treatment records show the CI was prescribed a medication for high cholesterol in November 2002.  He had a “bad reaction” and developed a fever, low appetite, sleep problems, severe headaches, and tingling sensations “all over” and, for the first time in his life, depression.  He was first seen by a psychologist for an emergency walk-in session December 2002, reporting anxiety due to “unprotected sex” and fear that he had contracted AIDS.  This was followed by 21 individual follow-up sessions and four stress management sessions.  He worried obsessively about contracting HIV although his tests were negative.  He was diagnosed with delusional disorder, somatic type, and obsessive compulsive disorder during a 12-day inpatient hospitalization.  He was treated with anti-psychotic and anti-anxiety medication that was helpful but discontinued due to side effects.  He returned to his duties with an abatement of symptoms, although headaches and tingling sensations continued.  His mood stabilized.  Treatment was terminated in March 2003.  While deployed, his mother died unexpectedly in October 2003.  He became deeply depressed and was re-admitted to an inpatient psychiatric unit in January 2004.  He was in treatment on “antidepressant and antipsychotic medications” and talk therapy.  After his psychiatrist moved and his therapy was interrupted without follow-up, he stopped taking his medication.  The Air Force began the process for medical discharge.  

A commander’s statement dated June 2004, noted the CI’s work performance since March 2004 was outstanding; he had been performing at a high level over the last few months.  A supervisor’s statement dated September 2004, noted the CI had put delimiting aspects behind him and was a contributing member to the office and the Air Force and should be retained if possible.  The CI submitted a rebuttal letter in October 2004, requesting return to active duty, noting he had not required Life Skills assistance since April, he had not disobeyed doctor’s orders regarding medication, and he had put his problems behind him.  A memo from the SAFPC noted the CI’s mental disorder which resulted in two hospitalizations, posed a long-term safety risk for himself and the mission, and upheld the board decision for a disposition to discharge.

At the VA Compensation and Pension (C&P) exam performed a month after separation, the CI reported a constant low level of depression, deepened by reminders of his mother.  He reported excessive worry along with additional worry about job prospects and the current relationship with his girlfriend.  He was restoring interest in music, photography and the internet.  Sleep disturbance and appetite had improved over the last several months.  He was not in treatment and was not taking medication.  Mental status exam (MSE) showed a calm and bland affect, somewhat slowed speech, listless energy level, well organized thoughts, and no suicidal/homicidal ideation.  A diagnosis of MDD was rendered with a Global Assessment of Functioning (GAF) of 65 (mild impairment, symptoms.)

The Board directed attention to its rating recommendation based on the above evidence.  Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for MH conditions.  The PEB adjudicated the delusional disorder condition as unfitting and rated it at 10%, coded 9210 including a statement that impairment was mild.  The VA rated MDD at 10%, coded 9434.  

The Board adjudged that there was no traumatic stress or highly stressful event for application of VASRD §4.129 (mental disorders due to traumatic stress).  The Board therefore will consider only the VASRD §4.130 impairment present at separation for a single rating recommendation.  Members considered if there was evidence for a §4.130 rating higher than PEB’s 10% at time of separation.  Although the NARSUM exam was not in evidence, the commander and supervisor noted the CI’s work performance was outstanding and he should be retained.  The CI himself requested retention in the Air Force, stating he had overcome his problems.  At the C&P exam, the CI reported a low level of depression and worry but was not in treatment and was not taking medication.  Sleep, appetite and interests in pleasurable activities were improving.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the delusional disorder condition.  

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the delusional disorder condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration. 

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination, as follows:  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131028, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2013-01952.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Attachment:
Record of Proceedings