RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00627
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20050325

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Information Management Apprentice) medically separated for an anxiety disorder.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Air Force Specialty (AFS).  He was issued a permanent S4 profile and referred for a Medical Evaluation Board (MEB).  The MEB forwarded anxiety disorder not otherwise specified (NOS), depressive disorder NOS to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB adjudicated anxiety disorder, NOS as unfitting, rated 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  Tobacco abuse was determined to be Category III (not separately unfit and not compensable or ratable).  The CI made no appeals and was medically separated.  

CI CONTENTION:  His back pain condition was not considered in the Disability Evaluation System process.  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 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.  In addition, the Secretary of Defense Mental Health Review Terms of Reference directed a comprehensive review of Service members with certain mental health (MH) conditions referred to a disability evaluation process between 11 September 2001 and 30 April 2012 that were changed or eliminated during that process.  The MH condition was reviewed regarding diagnosis change, fitness determination and rating in accordance with VASRD §4.129 and §4.130.

RATING COMPARISON: 

IPEB – Dated 20050117	VA* - (~5 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder, NOS	9413	10%	Major Depression with Anxiety Disorder	9434	30%	20050824	
Other x 1	Other x 0	
RATING:  10%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20051021 (most proximate to date of separation (DOS))
ANALYSIS SUMMARY:

Anxiety Disorder, NOS. The CI first presented for depression on 25 February 2003, 8 months after entry.  Follow-up was recommended.  He next presented a month later on 25 March 2003 reporting suicidal ideation and was admitted for observation and treatment.  After discharge, he stated that he was better, but concerned that if he failed an upcoming test, cross-training would be required.  He was diagnosed with an adjustment disorder and to have immature personality features.  On 15 June 2004, he was no longer seen in the mental health clinic as his treatment was complete.  However, at a family practice appointment on 21 July 2004, he reported insomnia and panic attacks as his third and fourth “complaints.”  He was again seen in mental health on 9 August 2004 and reported sleep disturbances in high school and the onset of the panic attacks in September 2002, several months after accession.  He was begun on medications.  He noted difficulty with work.  He also noted difficulties with his ex-girlfriend and her friends and had received “harassing” phone calls.  Some of the work issues related to his recurrent tardiness.  This was secondary to his turning off his alarm and not getting up in time to get to work without being late.  He was again admitted on 1 November 2004 the day after he had been late for work and had received a letter of counseling.  He had “washed out” of air traffic controlling school and was working in the post-office which he considered beneath him.  He wanted to remain in the USAF to finish his college degree.  By discharge he was doing much better with a pleasant and upbeat mood and affect.  At a follow up on 15 November 2004, he reported doing better, but that he hated his job and supervisor.  He was later able to move to a different dorm room and was happier with the change.  He also discussed issues with his family of origin.

The MEB narrative summary (NARSUM) was dated 29 November 2004.  The CI reported that his last severe panic attack had been in February 2004 and that he had not had any since September 2004.  He was thought to have both an anxiety disorder NOS (not otherwise specified) and a depressive disorder NOS.  However, his social/industrial impairment was mild and military impairment “minimum.”  The CI submitted a series of letters from friends and supervisors dated between 30 November and 3 December 2004 which uniformly commented favorable about his duty performance other than one by his supervisor which noted that he was unable to report to work on time (but improved) and another flight superintendent who noted that the CI was tardy and failed to notify his supervisors of his medical appointments.  A letter from the CI to the MEB noted that “my depression and anxiety are not a factor in my job or my ability to do my job.  The problem I had was an abnormal sleeping patter linked to my depression…”.  On 22 December 2004, the CI reported to the psychiatrist that his tardiness was from “turning off the alarm & just not making myself get up.”  He had a normal mental status examination and had an “utter lack of personal insight & completely unmotivated for treatment.”  He described his anxiety and depression as “fine” and the mental status examination was normal.  At a 27 January 2005 mental health evaluation, noted that he got in trouble for little things for which others did not and that “they were ‘out to get me.’”  At the final clinical visit prior to separation on 15 March 2005, the CI reported that he was doing well, had a plan after separation, and had a girlfriend.

At the VA Compensation and Pension (C&P) mental health examination performed 5 months after separation, the CI reported that he had received no treatment since separation and had not refilled his medications when they ran out even though they had been helpful.  He again endorsed a pre-military history of sleep disturbances, but exacerbated in the military.  He was enrolled in college and taking 13 hours without academic difficulties and was employed in a temporary job position (but had had not work assignments).  He had been interviewed successfully for a different job which would start in October.  He was in a serious relationship which he described as “as good as it can be.”  It had begun in January 2005, prior to separation.  

The Board first considered the appropriateness of the changes in the mental health diagnoses and a disability rating recommendation in accordance with VASRD §4.130.  The MEB forwarded the mental health diagnoses of anxiety disorder NOS and depressive disorder NOS to the PEB for adjudication.  The PEB adjudicated the CI for the diagnosis of anxiety disorder NOS.  The Board determined that while the description changed, the severity of the diagnosis did not and that these changes were semantic without impact on the level of disability awarded.  The Board determined this applicant therefore did not meet the inclusion criteria in the Terms of Reference of the Mental Health Diagnosis Review Project.  The evidence does not support that the mental health condition was secondary to a traumatic event; therefore, the application of VASRD §4.129 is not warranted.  

The Board then directed its attention to its rating recommendation based on the above evidence.  The PEB rated the anxiety disorder at 10% using the VASRD code 9413, anxiety disorder NOS.  The VA used the code 9434, major depressive disorder, and rated the CI at 30% for major depression with anxiety disorder.  The CI had normal mental status examinations leading up to separation.  At the time of the VA C&P, the mental status examination was normal other than anxiety.  His functional impairment was mild and he was assigned a Global Assessment of Functioning (GAF) of 66, indicative of mild symptoms or impairment.  Prior to separation, the CI asserted that his anxiety and depression had not impaired his duty performance other than the sleep disturbance, a condition which predated his accession.  He was employed and had successfully interviewed for a different job.  He was in college and was in a stable relationship.  This level of impairment is most consistent with the description for a 10% rating, “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, or; symptoms controlled by continuous medication.”  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 fitness determination for the anxiety 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 anxiety disorder NOS 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140128, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00627.

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.

Sincerely,

XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings