RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01270
BRANCH OF SERVICE:  NAVY	 SEPARATION DATE:  20080415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Submarine Nuclear Propulsion Plant Electrician) medically separated for a mental health disorder condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Rating.  He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  Anxiety state, unspecified and depressive disorder, not elsewhere classified were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated anxiety disorder not otherwise specified as unfitting, rated 10% with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The remaining depressive disorder not otherwise specified was determined to be Category II (contributing to the unfit condition) and costochondritis gastroesophageal reflux disease was determined to be Category III (not separately unfitting and do not contribute to the unfitting condition).  The CI made no appeals, and was medically separated.

CI CONTENTION:  The CI elaborated no specific contention in his application.

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 condition 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 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.

RATING COMPARISON:

Service IPEB – Dated 20080117	VA* - (~7 Mos. Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder (NOS)	9400	10%	Panic Disorder with Agoraphobia	9412	30%	20081103	
Depressive Disorder (NOS)	Cat II					
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 7	
RATING:  10%	RATING:  50%	
*Derived from VA Rating Decision (VARD) dated 20090212 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Anxiety Disorder NOS.  Available treatment records noted the CI presented to the emergency room after experiencing symptoms of a panic attack, on 30 July 2007.  He reported symptoms of rapid breathing and tingling sensations in his arms, feet and around his face and head.  He noted he was working in a very stressful job.  The following day he presented to primary care for follow-up and reported a past history of similar anxiety attacks in both intensity and duration.  He noted his attacks worsened since he moved to his current command.  He was not happy with the new command.  The examiner diagnosed anxiety disorder not otherwise specified (NOS) and referred him to psychiatry for evaluation and treatment.  The CI underwent a comprehensive psychiatric evaluation on 22 August 2007 and was diagnosed with anxiety disorder NOS and adjustment disorder with depressed mood.  He was provided prescriptions for antidepressant medication and anti-anxiety medications (Celexa, and Klonopin, respectively).  The record suggested follow-up mental health treatment was provided by his primary care provider.  The MEB narrative summary (NARSUM) was accomplished 7 months before separation.  The CI reported his panic attacks began in March 2006 following the birth of his son.  His attacks intermittently lasted up to 30 minutes, and consisted of chest pain, shortness of breath, anxiety, light-headedness, and numbness.  He avoided public places and driving out of fear of having panic attacks.  The CI also reported he had been very unhappy secondary to his dislike of his assigned duties.  His unhappiness was associated with a depressed mood, sleep disturbance, “poor appetite, a 30-pound weight gain”, decreased motivation, and problems with concentration.  The mental status examination (MSE) was normal with the exception of mild motor restlessness and anxiety (moving his feet and fidgeting with his ring).  The examiner noted his antidepressant caused insomnia; therefore, he took Ambien for sleep which was effective.  He took the anti-anxiety medication ‘as needed’ for panic attacks.  The diagnoses of anxiety disorder NOS and depressive disorder NOS were recorded with a Global Assessment of Functioning (GAF) score of 51 (moderate symptoms or moderate difficulties in social or occupational functioning).  The examiner opined his degree of industrial, military, and civilian impairments were moderate, and he would require psychotropic medications and psychotherapy.

At the VA Compensation and Pension (C&P) examination, 3 November 2008, 7 months after separation, the examiner noted the absence of a psychiatric hospitalizations and emergency care treatment since the initial presentation.  The CI noted he was not in any form of mental health treatment and the examiner documented last outpatient mental health treatment occurred in December 2007.  He reported having panic attacks one every few days to few weeks.  He continued to avoid public places and driving out of fear of having a panic attack.  His panic attacks consisted of palpitations, unexpected anxiety attacks, sweating, and tingling sensations.  He had no issue with sleep or concentration, and there were no reports of depressive symptoms, lack of pleasure, or changes in appetite.  He reported good marital and family relations and noted he spent time out of the home with friends and had good quality social relationships.  The MSE was normal, although he reported an anxious mood.  There were no reports of violence, psychotic symptoms, suicidal or homicidal thoughts, and his judgment was not impaired.  The examiner opined that his psychosocial functioning status was “fair to good due to his panic attacks which at times interfered with his social functioning.”  Current occupational history or functioning was not addressed.  The diagnosis of panic disorder with agoraphobia was recorded with a GAF score of 75 (connotes if symptoms are present, they are transient and expectable reactions to psychosocial stressors).

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the condition of anxiety disorder NOS at 10%, coded 9400.  The VA rated the condition identified as panic disorder with agoraphobia, coded 9412, and granted a 30% rating. The Board acknowledged that the depressive disorder NOS was subsumed under the primary diagnosis of anxiety disorder NOS and recorded as a category II condition; however, both conditions were taken into account under the 4.130 rating since the VASRD is based on occupational and social impairment and related symptoms and not on diagnosis.  The Board first noted that the provisions of §4.129 were appropriately not applied.  The higher rating of 30% requires evidence of “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to such symptoms as depressed mood, anxiety, panic attacks weekly or less often, and chronic sleep impairment.”  The Board undertook a careful review of the record in evidence and noted the absence of documentation of frequent panic attacks, or chronic sleep impairment secondary to a mental condition.  The MEB NARSUM noted he was prescribed medications to prevent panic and anxiety attacks; however, that medication was prescribed to be taken as needed.  The NARSUM noted that he took sleep medication to combat the adverse effect of his antidepressant medication.  NARSUM examiner documented moderate impact, which would suggest his condition was more than mild or transient; however, the MSE was essentially normal.  The commander noted that his mental health diagnoses had a significant impact on his ability to perform his duties.  The CI was seen in the pulmonary clinic for a sleep evaluation, one month after the NARSUM.  At that visit he reported that he had discontinued the antidepressant and that he was taking a short-acting benzodiazepine every 3 days.  However, it was not clear if he experienced panic attacks on those days, nor was it clear if the medication was effective. The record documented minimal mental health treatment or symptoms beyond anxiety attacks.  The VA C&P mental exam, 7 months after separation, documented no issue with sleep impairment and noted he had not received any mental health treatment since separation.  The examination also documented good social functioning, a normal MSE, but the CI reported panic attacks that were described as anxiety attacks which occurred “every few days to few weeks.”  His GAF was 75, and although it was not apparent that he was working, he indicated he was socially active outside of the home, despite the report of frequent panic attacks.  All Board members agreed, his level of functioning was most reflective of the 10% disability criteria.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board majority concluded there was insufficient cause to recommend a change in the PEB adjudication for the anxiety disorder NOS 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 majority recommends no change in the PEB adjudication.

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 20140305, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 8 Jan 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USN   
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXX, former USN  
- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USN 
- XXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC 

				XXXXXXXXXXXXXXX
	     			Assistant General Counsel
				(Manpower & Reserve Affairs)