RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03842
BRANCH OF SERVICE: Army		SEPARATION DATE:  20051021

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aircraft Powertrain Repairer, medically separated for “anxiety disorder, not otherwise specified” with a disability rating of 10%.

CI CONTENTION:  “Please consider all 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 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 - 20050908	VARD - 20060414	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder, NOS	9413	10%	Anxiety Disorder, NOS	9413	0%	STR	
Personality Disorder, NOS, with Cluster B Personality Traits	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 0%	

ANALYSIS SUMMARY:

Anxiety Disorder, Not Otherwise Specified (NOS).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s anxiety disorder condition began in December 2002 after he witnessed and assisted victims of a motor vehicle accident prior to deploying to Iraq from January 2003 to September 2003.  He began having nightmares and intrusive thoughts and was seen over a 2 to 3 month period in January 2003 and received medication for sleep.  He denied a prior history of psychiatric treatment.  During this deployment he experienced other traumatic incidents resulting in nightmares and recurring images of traumas experienced in Iraq.  After return from Iraq he continued to have difficulty with anger, irritability, sleep, poor concentration, and decreased range of affect.

The CI first presented to mental health in December 2004 due to worsening anxiety and anger.  He described panic attack like symptoms of chest pain, shortness of breath and occasional hot and cold flashes daily, and subsiding after he returned from work.  He was treated with psychotherapy and a medication for anger, irritability and anxiety as well as a sleep aid.  Although there was overall improvement, the panic attacks persisted.  By April 2005 he reported the inability to stay in the military because he could not endure another deployment, go to work, put on his uniform, or be in the military environment.  He began to feel symptoms of depression but felt fine once he started doing something.  He endorsed passive suicidal ideation intermittently.  Medications were changed but he presented to mental health multiple times, often as a walk-in, to express feelings that he “was drowning, not feeling strong, thoughts of hurting others, and difficulty with memory.  He reported nervous chewing of his mouth and hyperventilating when thinking of work.  He was anxious and shaky with panic-attack like symptoms in crowded places. The MEB forwarded anxiety disorder NOS for PEB adjudication.

The MEB NARSUM examination on 21 August 2005, 2 months prior to separation, noted complaints of heightened anxiety and agitation, difficulty relating to others, frequent externalizing, aggressive impulses and avoidance of being at work as well as other situations involving people.  An anti-depression/anxiety medication, another anxiety medication and a sleep aid resulted in overall improvement in mood and anxiety with decreased symptoms.  The mental status examination noted occasional mild psychomotor agitation with trembling and fidgeting, speech occasionally rapid, aroused affect and a mood described as “not good.”  An Axis I diagnosis of anxiety disorder NOS and an Axis II disorder of personality disorder NOS was rendered with a Global Assessment of Functioning (GAF) score of 55-60 (moderate.)  The examiner opined the CI would do much better outside of the military and noted mild social/industrial adaptability.  The examiner opined the CI’s anxiety disorder existed prior to service (EPTS).  The CI failed to report for the VA Compensation and Pension (C&P) evaluation.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the anxiety disorder condition 10%, coded 9413 (anxiety disorder), citing mild social and industrial impairment.  The VA rated anxiety disorder 0%, also coded 9413 based in the CI’s STR.  The Board first considerED if application of VASRD §4.129 (mental disorder due to traumatic stress) was applicable in this case.  All members agreed that the ‘highly stressful event’ requisite for §4.129 was not satisfied in this case.  The Board considered if there was evidence for a §4.130 rating higher than the 10% assigned by the PEB.  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 MEB NARSUM examination noted the CI had approximately 14 years of service and did not present to mental health until December 2004, less than a year prior to separation.  Additionally, entrance examinations did not reflex any mental health issues.  The Board agreed there was no evidence of pre-service psychiatric illness or treatment; therefore, the assertion that the anxiety disorder condition was EPTS appears invalid.  As mentioned above, the CI’s anxiety began after witnessing and assisting with a motor vehicle accident which was followed by his deployment to Iraq.  Anxiety resulting in panic attacks escalated after redeployment; especially after notification of another combat deployment.  His symptoms escalated with continued decompensation and poor function.  The MEB NARSUM examiner noted persisting anxiety, difficult relationships, aggression, and work avoidance albeit with overall improvement in mood and anxiety.  Board members agreed the CI’s symptoms were neither mild nor transient and he was not stabilized despite receiving two medications for anxiety and a sleep aid.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the anxiety disorder NOS condition.

Contended PEB Condition:  Personality Disorder NOS with Cluster B Traits.  Personality disorder is a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the Board has no basis for recommending it as unfitting.  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 contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the anxiety disorder not otherwise specified condition, the Board unanimously recommends a disability rating of 30%, coded 9413 IAW VASRD §4.130.  In the matter of the contended personality disorder not otherwise specified with cluster b traits condition, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	RATING	
Anxiety Disorder, Not Otherwise Specified	9413	30%	
COMBINED	30%	

The following documentary evidence was considered:

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

SAMR-RB																		

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, AR20160018211 (PD201403842)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA