RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02629
BRANCH OF SERVICE: AIR FORCE	SEPARATION DATE:  20050110

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Electronic Warfare Systems Journeyman, medically separated for “panic disorder without agoraphobia associated with generalized anxiety disorder and social phobia,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends panic disorder and PTSD.  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 based upon a 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 - 20041026	VARD - 20111026	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Panic Disorder w/o Agoraphobia	9413	10%	PTSD w/Panic and Bipolar Disorders	9411	70%	20110927	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Panic/Generalized Anxiety Disorder.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) documented an onset of anxiety and other mental health (MH) symptoms in early 2001 (basic training); but, the earliest STR entry addressing MH complaints was in July 2002.  At that time the CI endorsed symptoms of depression, anxiety and panic attacks.  He was started on an anti-depressant (Paxil), followed by behavioral health, and his symptoms remained stable.  There were no significant abnormalities on mental status examinations (MSE); Global Assessment of Functioning (GAF) assignments ranged from 60 to 68 (generally mild impairment); and, the Axis I diagnosis was panic disorder.  The first examination by a psychiatrist was in June 2003 and recorded a normal MSE except for mood and affect disturbance, rendered Axis I diagnoses of panic and generalized anxiety disorders, assigned a GAF of 60 (cusp of moderate and mild ranges), and adjusted medications (Effexor).  

In February 2004 the CI presented to the Alcohol and Drug Abuse Prevention and Treatment (ADAPT) Program, relating a 4 month history of heavy drinking.  Treatment was successful and he was weaned off psychoactive medications.  According to outpatient STR entries beginning in April 2004 (9 months before separation), he denied any recurrence of panic attacks or other significant MH symptoms and there were no entries to the contrary.  All subsequent ADAPT and other MH entries recorded a normal MSE, and GAF assignments rose from 70 (cusp of slight and mild) in June 2004 to 90 (good functioning in all areas) in September 2004.  There was no STR evidence for suicidal ideation or attempts, psychotic or other acute symptoms, serious disciplinary or legal issues, or psychiatric admissions.

The MEB psychiatric NARSUM was conducted in September 2004 (4 months before separation) and was supplemented by an addendum from a clinical psychologist on the same day.  The examiner documented the CI reported continued abstinence from alcohol and remained off medication.  In conflict with contemporary outpatient entries, the NARSUM reported the CI “continues to experience anxiety and panic attacks with significant intensity on a regular basis ... [which] ... appear to have some impact on his daily functioning at work as evidenced by his avoidance of social ... and anxiety-provoking situations (riding with others).”  The MSE recorded “euthymic to anxious” mood with “appropriate” affect, and was otherwise normal (no suicidal ideation, delusional or hallucinatory symptoms, speech disturbance, cognitive impairment, etc.).  The Axis I diagnoses, as submitted by the MEB to the PEB, were “alcohol dependence,” “panic disorder without agoraphobia,” “generalized anxiety disorder,” and “social phobia.” The GAF assignment was 60 and the examiner opined that the prognosis was “poor to fair based on the patient’s continuation of symptoms.”  

The commander’s performance statement from June 2004 documented that the CI’s “medical profile has not had a significant impact on his productivity or his ability to perform his duties,” and recommended a return to duty.  A week after the NARSUM, the MEB psychiatrist revised the temporary S4 profile to a permanent S1, specifying “return to duty.”  The CI’s last enlisted performance report was from October (3 months before separation) and he received the highest assessment (“absolutely superior”) in all areas, and it related he was a lead trainer and a supervisor.    

The CI did not present to the VA for well over 6 years following separation.  That marginally probative Compensation and Pension (C&P) examination documented the CI “had recently lost his job as waiter due to episodes of panic” and indicated the CI was recovering from an alcohol relapse.  A history of sexual abuse in basic training (not evidenced in the STR) was the basis for the VA diagnosis of post-traumatic stress disorder (PTSD).

The Board directed attention to its recommendations based on the above evidence; and, first considered whether the provisions of VASRD §4.129 for any “mental disorder that develops in service as a result of a highly stressful event” were applicable to this case.  Members agreed that, although there may have been contributory stressors that developed in service, there was no service-connected event which was logically consistent with the meaning and purpose of §4.129; thus, its application was not appropriate for this case.  The PEB’s decision arrived at its 10% rating under code 9413 (anxiety disorder, not otherwise specified) after a 20% deduction for “contributing/aggravating factors” from a 30% baseline.  No rationale was elaborated, although members surmised that the deduction was likely for the overlay with alcohol abuse as authorized under (the now rescinded) DODI 1332.39 (6.1.3, 6.1.4.2, and 6.1.8).  Members agreed that the Board should not apply a formal deduction of this nature to its recommendations, since it is not countenanced by the VASRD; and, that the Board’s assessment should be based entirely on criteria of VASRD §4.130.  
 
With this decision in mind, members turned to deliberation of a fair rating recommendation at the time of separation.  Members first agreed the fairly intact functioning evidenced at separation would not support the §4.130 criteria for a 50% rating (“occupational and social impairment with reduced reliability and productivity”).  Deliberations thus settled on recommendations for a 10% rating (“occupational and social impairment due to mild or transient symptoms which decrease work efficiency…only during periods of significant stress”) vs. a 30% rating (“occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks”).  Members agreed that, although the work impediments referenced by the NARSUM might reasonably justify a 30% rating, the overall evidence at the time of separation was compelling that the CI was functioning at a significantly higher level than portrayed by the NARSUM.  The evidence could be convincingly argued there was no longer unfitting psychiatric impairment at separation (deployment and prognosis issues notwithstanding).  The CI was off medication and performing his duties better than most peers (according to his commander), and the MEB psychiatrist had cleared him for full duty without a profile.   There was no evidence at that time for “decrease in work efficiency” and no identifiable “periods of inability to perform occupational tasks.”  Members concluded, therefore, the evidence was better aligned with the §4.130 criteria for a 10% rating than with those for 30%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient cause to recommend a change in the PEB adjudication of the panic disorder.  

BOARD FINDINGS:  In the matter of the panic disorder 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 20140602, 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-2014-02629.

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