RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03974
BRANCH OF SERVICE:  cOAST GUARD 	SEPARATION DATE:  20051206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Boatswain’s Mate, medically separated for “panic disorder,” with a disability rating of 10%.  

CI CONTENTION:  “Panic Disorder.”  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 - 20050929	VARD - 20060719	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Panic Disorder	9412	10%	Panic Disorder	9412	30%	20060322	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Panic Disorder.  According to service treatment records (STR), the CI reported severe shortness of breath, requiring ambulance transport to the hospital during training.  No mental illness was diagnosed and he returned to duty.  In August 2004 during firefighting training, he had a panic attack while working in an enclosed space and wearing protective equipment.  He described a feeling of being trapped, fear of putting something on his face, dizziness, shortness of breath, and a cramp leg feeling  He was lost to follow up.  In June 2005, after an incident involving him occurred that endangered other personnel, he was referred for evaluation.  He reported increasing symptoms of claustrophobia: anxiety, nausea, panic and often vomited after meals.  He had intrusive thoughts that prevented him from going to sleep.  He felt he was under a lot of stress from supervisors who told him he was not performing well.  It was determined he could not function effectively on ship and he was assigned shore duty. 

At the narrative summary (NARSUM), dated July 2005, the CI noted he felt symptoms of claustrophobia when he is in the back seat of a car or in an elevator.  At the Psychiatric NARSUM he reported he did not have a full blown panic attack until he witnessed a potentially life threatening accident in June 2005.  Since then he had severe panic attacks in association with being in a job in a closed space.  He was treated with counseling and with a medication to which he had a reaction.  Current symptoms also included difficulty with sleep, weight loss of 15 lbs. in 2 months with decreased appetite, moderate depression of 7-8/10, severe anxiety, and decreased adaptation to functioning on a ship.  He had panic attacks without agoraphobia but with claustrophobia.  Mental status exam (MSE) was unremarkable.  A diagnosis of panic disorder without agoraphobia and adjustment disorder with anxiety was rendered with a Global Assessment of Functioning (GAF) score of 51-60 (moderate impairment, symptoms.)  The commander’s statement noted “the CI’s performance in all of his duties was substandard, not fit for sea duty or worldwide deployment, only fit for limited and shore duty…felt compelled to initiate Administrative assignment.. He was placed TDY for two months for past two months for mental health screenings …I believe his medical issues the underlying cause of his performance issues”
 
At the VA Compensation and Pension (C&P) exam performed 3 months after separation, the CI reported anxiety and panic attacks especially when he is in an elevator.  He had the panic attacks in enclosed spaces and they occurred most days.  Sleep was variable.  He was in school full time to become a radiographer.  He was generally able to do the job and focus on his studies.  He had a girlfriend and other friends to talk to and liked to spend time with people.  MSE was essentially normal, except for a blunted affect.  He liked to go out to places at times and he liked to play with his dog.  A diagnosis of panic disorder was rendered with a GAF of 55 (moderate impairment, symptoms)

The Board directed 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), the PEB assigned a 10% rating, and the VA assigned a 30% rating.  The Board considered if a rating higher than 10% was warranted at the time of separation.  It was agreed that the 50% rating (“occupational and social impairment with reduced reliability and productivity”) was not described by the evidence, and deliberation settled on arguments between a 10% and 30% rating.  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 Board considered that the NARSUM exam reported several current threshold symptoms (panic attacks, depression, sleep difficulty) of a 30% rating and a GAF score that reflected moderate symptoms or impairment.  While 30% threshold symptoms (depression, anxiety) were reported by the C&P examiner, these were very mild or situational (sleep somewhat variable, some degree of depression.)  Board members debated the relevance of a reported GAF score near the time of separation suggesting moderate symptoms or impairment, and noted the CI’s apparently successful college performance and relatively intact social functioning during the months after separation.  On balance, the Board majority concluded that there was not adequate reasonable doubt favoring the next higher 30% rating, and agreed that at the time of separation the condition more nearly approximated the criteria for the 10% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the panic disorder condition.
BOARD FINDINGS:  In the matter of the panic disorder 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 20140912, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

Commandant
United States Coast Guard	Mail Stop 7907
2703 Martin Luther King Jr. Ave SE
Washington, DC 20593-7907
Staff Symbol: CG-1
Phone: (202) 475-5000

								   1850

Dear XXXXXXXXXX,
I am the Designated Decision Authority for the Coast Guard on applications submitted to the Department of Defense Physical Disability Board of Review (PDBR).  Under the authority of Title 10, United States Code, section 1554a, I accept the PDBR’s recommendation in your case (Case Number PD-2014-03974) and decline to modify your findings. 

Enclosed for your information are a copy of the PDBR’s recommendation and a copy of the record of proceedings. 

A copy of this decision has also been provided to Coast Guard Enlisted Personnel Management Branch, the PDBR, and the Department of Veterans Affairs. 

If you have any further questions, please contact the Coast Guard Personnel Service Center at (202)795-6645. 
	Sincerely,
2 Enclosures		
	
Copy:	CG Personnel Service Center (EPM-1)
DoD Physical Disability Board of Review
Department of Veterans Affairs