RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	     CASE:  PD-2014-02609
BRANCH OF SERVICE:  AIR FORCE                                                    Date of seperation:  20080617	

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Aircraft Armament Systems Journeyman, medically separated for “major depressive disorder associated with panic disorder,” with a disability rating of 10%.

CI CONTENTION: The applicant has asked for consideration of all their conditions.  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 - 20080317	VARD - 201306069	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder Associated with Panic Disorder	9434	10%	Generalized Anxiety Disorder w/Panic Disorder & Major Depressive Disorder	9434-9400	30%	20130503	
Adjustment Disorder	Cat III					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Major Depressive Disorder (MDD).  Service treatment records indicate the CI experienced a panic attack at home that resulted in an emotional breakdown.  He went to the hospital and was referred to mental health (MH).  The CI presented to the MH clinic in April 2007 with a feeling of being overwhelmed by situational problems.  He reported he received an Article 15 due to sexually inappropriate behavior and behavior unbecoming of a soldier.  He felt anxious and depressed for a year by marital and financial stressors.  He was irritable, angry with his wife, had low energy and concentration, increased appetite and low libido.  He denied suicidal and homicidal ideation.  He reported recurring panic attacks, ongoing depression and difficulty adjusting to military life.  He also reported alcohol misuse.  He was initially diagnosed with adjustment disorder with depressed mood and treated with therapy and medication for depression and anxiety.  Despite treatment, he developed multiple panic attacks and required several medication adjustments that were associated with various side effects.  A MEB was initiated due to persistent benzodiazepine requirements.  The commander’s statement noted the CI was incapable of working on the flight line and could not maintain a weapons certification due to his medical profile.  His duty schedule had not been modified but he was assigned to the unit support section.  He worked full shifts but had missed 8-10 hours per week of work due to medical appointments.

The narrative summary (NARSUM) noted the CI was taking three medications for anxiety and depression and remained in therapy.  He continued to have side effects and his anxiety increased significantly when the medicine for anxiety was decreased.  He reported depressed mood and motivation, low interest, lethargy, recurrent anxiety and irritability, problems with concentration, and a desire to sleep constantly.  Mental status exam (MSE) was essentially unremarkable with the exception of an “angry” mood.  Diagnoses of MDD, panic disorder without agoraphobia, and adjustment disorder with anxiety were rendered.  He had a Global Assessment of Functioning of 75 (transient symptoms, slight impairment.)  An addendum NARSUM noted no change in his MH condition since the original MEB narrative.  He was still not able to perform all his required duties.  Medications, MSE, and diagnoses remained the same.  

At the VA Compensation and Pension (C&P) exam performed 72 months after separation, the CI reported weekly panic attacks that usually occurred around 6 pm.  He had racing thoughts, nervousness, chest tightness, initial insomnia, and depressive symptoms of mild to moderate intensity.  He continued to have marital and financial stressors.  Marriage was strained.  He stayed to himself and avoided many social situations.  He was working in the landscaping business, worked regularly, and got along with everyone.  He had also worked in marketing and sales.  He was not taking medication for anxiety or depression due to limited transportation and distraction with life.  He knows he needs to resume medication.  He had been in a few fights and had a much shorter temper which made him more isolated.  He worked out often and played video games.  MSE showed a depressed mood but no suicidal or homicidal ideation.  Diagnoses of MDD, generalized anxiety disorder (GAD), and panic disorder without agoraphobia were rendered.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated at the condition at 10%, coded 9434 (MDD associated with panic disorder), and assigned adjustment disorder as Category III, a condition not separately unfitting, compensable or ratable.  The VA rated the condition at 30%, coded 9434-9400 (GAD with panic disorder and MDD), under the VASRD §4.130.   

The Board first considered if the definition of VASRD §4.129 was met for the unfitting MH condition resulting in medical separation; i.e., “a mental disorder that develops in service as a result of a highly stressful event.”  The Board members agreed that although some contribution of service stressors to his MH condition was present, the overwhelming stressors stemmed from his marital/financial difficulties (marital strain, child support.)  Therefore, the requisite §4.129 link that the condition occurred “as a result of a highly stressful event” was not adequately satisfied.  Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130.  

The Board considered if a rating higher than 10% was warranted at the time of separation.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  The C&P exam exceeded the probative period.  The commander’s statement suggested the CI worked full time although he was assigned to a different unit section, only missing work due to medical appointments.  The NARSUM examiner noted social/industrial impairment was mild based on not being able to do his job because of his medications and the need for the anxiety medication to control his symptoms limited job availability.  Despite treatment, the CI continued to report panic attacks, anxiety, depression and sleep disturbance, 30% threshold symptoms, at the time of separation.  Non-stabilization of symptoms with continuous medication was the stated reason for an MEB.  The Board agreed his disability most closely approximated criteria for a 30 percent disability rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 30% for the MDD with panic disorder condition.  

BOARD FINDINGS:  In the matter of the MDD condition, the Board recommends a disability rating of 30%, coded 9432 IAW VASRD §4.130.  In the matter of the contended adjustment disorder condition, the Board agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
		PERMANENT	
MDD	9434	30%	
Adjustment Disorder	Category III	N/A	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140528, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR
XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-02609.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at XXXXXXXXXXXXXXXXXXXXX to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

	XXXXXXXXXXXXXXXXXXXXX
	Principal Deputy Assistant Secretary 
	(Manpower and Reserve Affairs)

Attachment:
Record of Proceedings

cc:
SAF/MRBR
DFAS-IN