RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02272
BRANCH OF SERVICE:  Army	                        SEPARATION DATE:  20040521

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E-4, Truck Driver, medically separated for “anxiety disorder, NOS,” with a disability rating of 0%.  

CI CONTENTION:  The applicant requests consideration of all conditions in his application.  The CI’s complete submission 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 - 20040329	VARD - 20040727	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder, NOS	9413	0%	Anxiety Disorder, NOS (PTSD)	9413	0%	STR	
Migraine Headaches	Not Unfitting	Tension-Type HA w/Syncope…	8045-8100	0%	STR	
Stress reaction, B/L Tibias		B/L Tibial Stress Reactions	5262	NSC		
Dilated Unreactive Pupil OS		No VA Entry				
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Anxiety Disorder, Not Otherwise Specified (NOS).  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first experienced anxiety symptoms during deployment to Iraq from 20 April - 8 June 2003.  He was medically evacuated after a fainting episode during a migraine headache.  The CI reported the deployment was highly stressful due to family and marital problems.  His wife miscarried, there were financial problems and other family problems while he was deployed.  He worried his wife might leave him.  He first visited mental health in August 2003 reporting exposure to trauma in Iraq and development of symptoms including irritability, nightmares of people trying to kill him, sense of foreshortened future and excessive guilty regarding not taking care of his family, leaving his peers in Iraq, and not being able to help his wife when she had a miscarriage.  Anger was an issue and he had anxiety about supporting his family if he was disabled.  There was no suicidal or homicidal ideation.  A diagnosis of posttraumatic stress disorder (PTSD) was rendered without documentation of the nature of the trauma.  He received a medication to treat nightmares and hypervigilance, and attended group counseling.  

During the NARSUM exam, the CI reported his major problem was worrying about his wife.  He slept poorly, getting 2-3 hours per night.  He was taking a medication to help with sleep but was taking no other medications.  A diagnosis of anxiety disorder was rendered with a Global Assessment of Functioning (GAF) score of 60 (mild to moderate symptoms, impairment.)  His primary stressor appeared to be waiting for MEB process to end so he could return to his family.  Impairment for social and industrial adaptability was mild.  The commander’s statement did not mention a MH condition.  The CI did not appear for the VA Compensation and Pension (C&P) exam.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 9413 code (anxiety disorder NOS), citing mild current symptoms.  The VA also assigned a 0% rating using the 9413 code based on failure to report for VA C&P exam.  Application of VASRD §4.129 is considered by the Board for all cases of Service connected psychiatric conditions resulting in separation; but, all members agreed that the ‘highly stressful event’ requisite for §4.129 was not satisfied in this case.  The Board considered whether there was a pathway to a higher rating.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” and for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.” The Board noted the commander did not implicate a mental health condition as interfering with performance of duty and symptoms did not appear to interfere with social and occupational functioning.  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 anxiety disorder condition.  

Contended PEB Conditions: Migraine Headaches, Stress Reaction Bilateral Tibias, Dilated Unreactive Pupils OS.  The Board’s main charge is to assess the fairness of the PEB’s determination that migraine headaches, stress reaction bilateral tibias, dilated unreactive pupils OS conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  These conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.   All were reviewed and considered by the Board.   There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  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 migraine headaches, stress reaction bilateral tibias, dilated unreactive pupils OS contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the anxiety disorder condition and IAW VASRD §4.130, the Board recommends no change in the PEB adjudication.  In the matter of the contended migraine headaches, stress reaction bilateral tibias, dilated unreactive pupils OS conditions, the Board recommends no change from the PEB determination as not unfitting.  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 20140501, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXX AR20160013538 (PD201402272)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA