RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-01196
BRANCH OF SERVICE:  AIR FORCE		SEPARATION DATE:  20080311

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Ground Radio Communication Journeyman, medically separated for “undifferentiated somatoform disorder” with a disability rating of 10%.

CI CONTENTION:  He was only rated for undifferentiated somatoform disorder, but contends multiple other conditions.  The complete submission, with attachments, is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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 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 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 PEB - 20080122	VARD - 20080628	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Undifferentiated Somatoform Disorder	9423	10%	No VA Placement**	20071009	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Undifferentiated Somatoform Disorder.  The record shows that the CI entered active duty on 17 January 2006 and was transferred to a northern tier base for his first assignment.  The first record in evidence is a primary care note dated 9 November 2006, which was a follow-up for an anaphylactic reaction (a severe allergic response).  He had been seen twice in the emergency room the prior 48 hours and only noted chocolate candy with peanuts as a possible etiology.  He endorsed a childhood history of oral swelling after eating peanuts.  An extensive allergy evaluation was unrevealing.  In January 2007, he reported atypical chest pain and dizziness.  A work-up for this, which included a hospitalization for observation and testing, was also unremarkable other than high blood pressure; he was treated for this.  Control was inadequate, but there was concern that he was not compliant with this medication use.  The CI was also evaluated for possible asthma, but this was excluded as a diagnosis.  The CI was evaluated in life skills on 13 April 2007 by a social worker and reported that his symptoms arose after assignment to his current base.  He denied symptoms associated with generalized anxiety, depression, or panic attacks; he reported that he was calm when symptomatic.  The Medical Evaluation Board (MEB) process was initiated that day with the concurrence of the CI per a primary care note also dated 13 April 2007.

A primary care appointment on 18 May 2007 documented that the CI had recurrent symptoms of atypical chest pain since arrival at his current duty station the previous November, but that all his symptoms resolved when he returned home for visits.  Five days later on 23 May 2007, he was diagnosed with an undifferentiated somatoform disorder in Life Skills.  In mental health on 13 June 2007, the CI noted, regarding his current assignment, that “there is something about being here” and inquired on how long an MEB would take.  Secondary gain (return to his home of record) was noted as present, but a factitious disorder was thought to be unlikely.  The MEB narrative summary (NARSUM) was dated 12 July 2007, 8 months prior to separation.  The CI reported resolution of his symptoms the 2 times he returned to his home of record and recurrence upon return to his current assignment.  The full criteria for a somatization disorder were not met and he was diagnosed with an undifferentiated somatoform disorder.  The Board observed that this does not impact the rating assigned.  On 27 July 2007, the CI was evaluated for neck pain 5 days after he was rear ended in a parking area by another vehicle.  Each vehicle had a small dent in the bumper, but no other damage was recorded.  He reported neck pain a day later, but had a normal examination.  The CI presented on 25 September 2007 reporting fatigue and morning headaches.  He requested a sleep study which was accomplished on 19 October 2007 and was essentially normal without evidence for sleep apnea.  A primary care note dated 16 January 2008 noted that the CI had not filled his prescriptions for his blood pressure medications.  The CI ascribed his symptoms to his current environment and/or altitude.  An addendum to the MEB mental health NARSUM was dated 14 September 2007, 6 months prior to separation.  It was noted that his condition and diagnosis had not changed from the prior assessment.

At the VA Compensation and Pension (C&P) examination performed on 9 October 2007, 4 months before separation, the CI reported that he could run 1 mile in 8 minutes, but that he could not run the full 1-½ miles for testing due to the altitude.  The CI was not specifically evaluated for a mental health condition until 10 June 2009, 15 months after separation.  He was working back in his home of record and no mental health condition was diagnosed.  He was noted to have “good functioning in all areas of his life.”

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the “undifferentiated somatoform disorder” at 10%, coded 9423 (undifferentiated somatoform disorder).  The VA did not initially rate the condition and later determined that it was not service-connected at the decision on 23 July 2009, which was based on the 10 June 2009 VA C&P examination, as no mental health condition was diagnosed.  The record shows that the CI did quite well after separation from the military and return to his home.  The Board found no route to a rating higher than the 10% adjudicated by the PEB.  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 undifferentiated somatoform disorder condition.

BOARD FINDINGS:  In the matter of the undifferentiated somatoform 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.  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 20140226, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SAF/MR
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-2014-01196.

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,

Attachment:
Record of Proceedings