RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	    CASE:  PD-2014-03612
BRANCH OF SERVICE:  Air force	SEPARATION DATE:  20040828

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Mental Health Technician, medically separated for panic disorder, with a disability rating of 10%.  

CI CONTENTION:  The CI has asked for consideration of all conditions. The applicant’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 - 20040609	VARD - 20060428	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Panic Disorder…	9412	10%	Panic Disorder…	9412	10%	20060308	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Panic Disorder Condition.  Service treatment records note the CI began active duty in March 2002 as a mental health technician and reported to the emergency in April 2002 with a report of anxiety attacks.  She had five in one week and had a history of similar symptoms in 7th grade.  Symptoms included sweating, nausea, increased heart rate and rapid breathing.  Sometimes she fell to the floor.  Evaluations that included laboratory studies were negative.  A diagnosis of panic disorder was rendered.  She had a childhood history of attention deficit attention disorder (ADHD) that was treated until 5th grade.  She also began to experience symptoms of depression in the fall of 2002 which included depressed mood, intense anger, weeping episodes when alone, self-blame and criticism, poor motivation and passive death wish.  She was treated with medication for depression and for anxiety with improvement in both panic and depression symptoms. 

At the narrative summary (NARSUM) the CI noted the panic attacks were occurring monthly and she had no depressive symptoms for months, although they were disabling when they occurred.  She was working in non-patient care since she had fallen during an attack several weeks previously.  She was receiving medicines for depression and for anxiety and noted the combination of medications had a significant positive impact.  Mental status examination (MSE) was unremarkable.  Diagnoses of panic disorder without agoraphobia, major depressive disorder, and ADHD were rendered with a Global Assessment of Functioning (GAF) score of 60 (moderate bordering on mild impairment, symptoms.)  Psychological testing showed evidence of mild suggestions of anxiety.  The examiner noted her symptoms were “rare, brief, but unsightly and briefly disabling panic attacks are her only residual difficulty.”  The examiner recommended she be retained and cross-trained into a position that would not require a high degree of vigilance or be adversely impacted by her symptoms and that it was “quite likely that within the next year she would be entirely free of panic attacks and not require medications that could interfere with being deployable or cognitive ability.”  

The commander noted “her condition had impaired her capability to fulfill her duty requirement and there had been no significant improvement in her functioning over time.  Attitude remains positive…not interested in separating at this time…condition is such that…it is not likely that cross-training would be of any immediate benefit to Air Force.”  

At the VA Compensation and Pension (C&P) examination performed 19 months after separation, the CI admitted a history of ADHD but denied the presence of anxiety attacks when she was younger.  She was currently in treatment and was taking medications for depression and for anxiety.  She denied depression and anxiety and reported her symptoms were well controlled by her medications.  She was living alone, though married less than 2 years.  Her small children were living with her father.  MSE was unremarkable.  Diagnoses included Panic disorder without agoraphobia, depressive disorder NOS, ADHD by history with a GAF score of 71 (mild, transient symptoms, impairment.)

The Board directed its attention to its rating recommendation based on the above evidence.  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.  Under the 9412 code (panic disorder), both the PEB and the VA assigned a 10% rating.  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 “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.”  A 30% rating requires “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”

The NARSUM examiner noted that her symptoms were rare and briefly disabling but the commander noted her condition impaired her ability to fulfill her duties and there had been no significant improvement over time.  Both the NARSUM and the later C&P exam agreed that her symptoms were greatly improved with medication.  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 Panic disorder condition.  

BOARD FINDINGS:  In the matter of the panic condition and IAW VASRD §4.130, the Board 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 20140725, 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-2014-03612.

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