RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03621
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20040802

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Communications Computer Systems Operations Journeyman, medically separated for mood disorder rated at 10%.

CI CONTENTION:  The applicant requests all conditions be considered.  His complete application 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 - 20040316	VARD - 20050105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mood Disorder Not Otherwise Specified Associated with Depression /Anxiety	9435	*30%-20% =10%	Obsessive Compulsive Disorder: Depressive Disorder	9404	30%	20041118	
Personality Disorder Not Otherwise Specified	Not Unfitting/Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	
*30% initial rating with a 20% deduction for the contributing category III Personality Disorder for a final 10% rating  

ANALYSIS SUMMARY:   

Mood Disorder (NOS).  The narrative summary (NARSUM) dated 5 February 2004 noted that the CI’s history of emotional struggles began after he was notified of his non-voluntary assignment to Osan AB, Republic of Korea.  It was noted that the CI had a lifelong history of anxiety related to obsessive behaviors.  His depression worsened in the 3 months after he left for Osan.  His difficulty with the assignment related to his need for strict routines and minimal changes.  He did not like changes in his environment, which confused him.  He reportedly was doing well at his previous assignment where he had less interaction with people. The NARSUM was conducted by his treating psychiatrist.  His current symptoms included depressed and anxious mood, insomnia, lack of energy and decreased interest and concentration.  The examiner referenced a report from the CI’s First Sergeant. who provided information regarding the CI’s behavior in the workplace.  At work, his behavior was characterized by stuttering, difficulty in communicating with customers, difficulty with dealing with multiple stimuli, overcome by anxiety, and “variable personality,”  At times he was observed rocking back and forth, asking “Why am I here?”  His medication included Haldol 2mg daily, Paxil and Cogentin.  In addition to medication, the CI participated in counseling to address coping skills.  Mental status examination (MSE) noted that he was energetic and animated.  He fidgeted with his hands and displayed a nervous and constricted, odd, affect.  All other aspects of the MSE were normal.  The examiner noted that the CI’s current condition demonstrated improvement in sleep, appetite, mood and affect.  The CI was also enjoying activities related to movies, astronomy, and online conversations.  The recommendation was for continued medication management and supportive talk therapy.  The examiner diagnosed mood disorder NOS, with depressed and anxious mood, and personality disorder NOS with obsessive compulsive symptoms and schizotypal symptoms.  A Global Assessment of Functioning (GAF) score of 50 (moderate impairment or moderate symptoms) was recorded.  

The VA psychiatric Compensation and Pension (C&P) examination was accomplished 3 months after separation.  The psychiatrist diagnosed obsessive compulsive disorder (OCD) and depression NOS with rule out diagnoses of autism and schizophrenia.  The examiner noted the absence of psychiatric hospitalization.  The CI reported feeling down and depressed secondary to not being able to get along well with other people.  He had persistent symptoms of anxiety and mood symptoms, and noted that he had discontinued his medication since separation.  He was living alone and it was noted that he has never had a girlfriend.  He had no history of suicidal ideation.  The CI also noted that he had experienced auditory hallucination, hearing multiple voices sometimes telling him what to do, and he described having experienced visual hallucinations.  Other symptoms suggestive of schizophrenia were absent.  MSE documented avoidance of eye contact, he was slow to warm up to the examiner, and he demonstrated more emotion when talking about computer games.  The MSE did not document mood, evidence of psychosis, or difficulties with cognition, or judgment. Additionally, the examiner noted that the CI underwent personality testing and the results indicated traits of avoidance, schizophrenia undifferentiated, anxiety, depression and PTSD.  Personality disorder was not identified.

The Board directed attention to its recommendations based on the above evidence.  The PEB rated the condition at 30% coded 9435 with a 20% deduction for contributing/aggravating factors.  The personality disorder was adjudicated as a Category III condition (not separately unfitting and not compensable or ratable).  The VA rated the condition of obsessive compulsive disorder at 30% coded 9404.  The Board first noted there was no specific, highly stressful service related event to invoke §4.129 for a mental disorder due to traumatic stress.  The Board next considered the rating deduction.  The Board next noted that IAW DoDI 1332.38, enclosure 5, the personality disorder which was found to be not separately unfitting is not a condition that constitutes a physical disability and therefore is not eligible for service disability rating.  The mood disorder was the sole MH condition eligible for disability rating.  However, MH disability rating is based on total social and occupational functioning.  The PEB’s AF Form 356 noted the Board opined the personality disorder “significantly affects the severity of his mood disorder”.  It was also opined that “were it not for the non-ratable/non-compensable condition, the member’s social and industrial adaptability impairment would best be described as mild.

All members agreed that the PEB’s deduction could not be upheld for the following reasons.  The contribution from a diagnosis of personality disorder, on which the PEB deduction hinges, is very tenuous.  Although the psychiatrist diagnosed personality disorder, there was no documentation to support that the CI’s behavioral issues were not the by-product of the primary mood disorder diagnosis with anxiety and depressed mood.  Although there were symptoms and behaviors that likely reflected schizotypal or obsessive compulsive influences, there was insufficient evidence that any of the behaviors or symptoms were directly attributable to the personality disorder.  The behaviors/symptoms described by the First Sergeant likely reflected the severity of his anxiety which was determined to be related to his mood disorder.  Lastly, the process of clinically extricating the disability attributed to one diagnosis versus the other in cases involving psychiatric disorders is overly speculative without a directed opinion from the examiner addressing the degree of contribution from each diagnosis.  No such input from a psychiatrist was provided; thus the Board could not fairly apportion a deduction even if the competing diagnosis were not in question.  All Board members agreed, there is sufficient evidence to support a disturbance in mood in which a personality disorder may have contributed negatively.  However, there was insufficient evidence to support the notion that in the absence of a personality disorder, his mood disorder would have had no impact on occupational functioning.  All members agreed that the PEB’s deduction could not be upheld for application to the Board’s recommendation.  The Board next proceeded with the rating recommendation IAW VARSD 4.130.  The 30% rating is for “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.”  The Board consensus was that the condition did not support a rating higher than 10%, based on the evidence of occupational functioning.  The performance report dated 4 months before separation recorded the CI was a good performer, performed routine duties satisfactorily, and that he organized and expressed thoughts satisfactorily.  The Board majority agreed, the overall totality of the CI’s disability more accurately reflects the 10% description, “occupational and social impairment due to mild or transient symptoms which decrease work efficiency only during periods of significant stress, or symptoms controlled by continuous medication,” at separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board recommends a 10% disability rating (no deduction) for the mood disorder NOS condition.

BOARD FINDINGS:  In the matter of the mood disorder NOS with depressed and anxious mood condition, 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 20140721, with attachments
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-2014-03621.

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