RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01997
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150226
SEPARATION DATE:  20020830

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Air Traffic Controller) medically separated for dysthymic disorder.  The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty.  She was issued a temporary S4 profile and referred for a Medical Evaluation Board (MEB).  Dysthymic disorder, partner relational problems were forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The MEB also identified and forwarded personality disorder for PEB adjudication.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “dysthymic disorder, partner relational problems” as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining condition determined to be Category III, not separately unfit and not compensable or ratable.  The CI made no appeals and was medically separated.

CI CONTENTION:  “My condition was not adequately assessed.”

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:

 IPEB – Dated 20020628	VA* - (Based on STR) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Dysthymic Disorder…	9433	10%	Dysthymic Condition with Depression and Insomnia	9433	NSC	STR	
Personality Disorder	Cat III	Not Rated	
Other x 0 (Not In Scope)	Other x 0 	
RATING:  10%	RATING:  N/A	
*Derived from VA Rating Decision (VARD) dated 20051110 (most proximate to date of separation (DOS).

ANALYSIS SUMMARY:  

Dysthymic Disorder, Partner Relational Problems (subsumes all Mental Health Conditions).  The record shows that the CI was first seen in mental health (MH) on 27 February 2001 for issues related to weight gain and marital discord.  She was diagnosed with an adjustment disorder with a depressed mood and it was recommended she begin counseling and classes for depression management and marriage enrichment.  On 20 March 2001, she began anti-depressants and was removed from controlling status (automatic then with the medication regardless of how well the individual is doing or absence of side effects).  She continued follow-up in MH over the next year, but her treatment was complicated by “no-shows” and cancelled appointments.  At a psychiatry evaluation on 2 August 2001, her symptoms were still present.  She had discontinued her medication which was re-started at that appointment.  At a follow-up appointment on 9 September 2001, neither social/industrial nor military impairment was present.  On 2 November 2001, she was seen in family advocacy for alleged family maltreatment; this was later determined to be unsubstantiated.  However, on 29 January 2002, she again was seen in family advocacy for “crisis intervention.”  This was subsequently substantiated.  She and her spouse continued to be followed in the family advocacy and MH clinics until 2 months prior to separation.

The narrative summary was dated 1 May 2002, 4 months prior to separation and dictated by the chief of psychiatry.  It was noted that she had been functional at work on medications.  She reported being stressed about her impending divorce and concerns of her husband’s fidelity.  She desired to remain on active duty.  On examination, her speech was soft and mood dysphoric (a sense of unease or dissatisfaction).  It was otherwise unremarkable.  She was diagnosed with a dysthymic disorder and with partner relational problems.  She also had a personality disorder not otherwise specified with dependent histrionic features.  She was assigned a Global Assessment of Function of 65, indicative of some mild symptoms or impairment.  Her prognosis was thought to be fair with treatment and re-classification recommended with a caveat that her future performance and behavior would be similar to the past performance and behavior.  The commander noted on 3 June 2002 that she worked a normal 8-to-9 hour day, but could not deploy.  The latter fact was not compatible with retention.  It was also noted that she declined further counseling and had discontinued her medication.

The VA Compensation and Pension examination was not accomplished until over 3 years after separation.  The CI did not show for the examination scheduled on 17 September 2005.

The Board directed its attention to its rating recommendation based on the above evidence.  The VA initially determined the MH disorder to be not-service-connected as she had not appeared for her examination.  However, this was later rated at 30%, effective on 16 March 2005, based on the 19 January 2006 examination.  This examination noted that she had been working full-time as an administrative assistant since separation without impact from her illness.  The PEB rated the condition at 10% using the code 9433 (dysthymic disorder).  The Board noted that the CI was working in her career field at the time of the commander’s letter, less than 3 months prior to separation.  Following separation, she reported that she worked as an administrative assistant and had no impairment from the MH condition other than being able to deploy.  She had stopped both counseling and medications at the time of separation.  Her impairment was best described by “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.”  This corresponds to a 10% rating IAW VASRD §4.130.  The Board noted for the record that a personality disorder is not a ratable condition IAW DoDI 1332.38 E5.1.2.9.2.  In addition, as the contribution from the unfitting dysthymia and the personality disorder were not separated by the MEB psychiatrist, any impairment from the personality disorder was considered in the rating for the unfitting dysthymia.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the dysthymic 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 dysthymia 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140430, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

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

Dear XXXXXXXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §1554a), PDBR Case Number PD-2014-01997.

	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,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR