RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00107
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060321

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Integrated Avionics Systems Journeyman, Airborne Surveillance Radar Systems, medically separated for “anxiety disorder,” with a disability rating of 10%.

CI CONTENTION:  He continues to have anxiety attacks.  He also contends high blood pressure and acid reflux.  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 - 20060201	VARD - 20060526	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder, NOS	9413	10%	Anxiety Disorder	9413	30%	20060316	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Anxiety Disorder Not Otherwise Specified (NOS).  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s anxiety disorder condition began in October 2004 with no identifiable precipitant.  By December 2004 he had been seen in the emergency room on four occasions due to mild confusion, being “zoned out.” Primary care manager referred him in March 2005 to mental health for assistance in managing anxiety episodes. He “no showed” for his mental health (MH) consult and declined offers for counseling or stress management classes.  He returned in July 2005 after a negative medical work-up of medical symptoms attributed to anxiety i.e. dizziness, confusion, “out of body experience,” tunnel vision and non-cardiac chest pain.  He had trials of anxiolytic medication and anti-depression medications. He had a history of claustrophobia.  He denied prior counseling or diagnosis prior to service.  His twin brother had similar medical symptoms attributed to anxiety.  Despite treatment, the anxiety disorder condition could not be adequately rehabilitated to meet the requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “anxiety NOS” for PEB adjudication.  

The MEB NARSUM examination on 5 October 2005, 6 months prior to separation, noted complaints of one to three episodes of symptoms on good days and “on bad days it lasts all day,” although he was taking anti-depression and anxiolytic medication with subsequent improvement.  Mental status examination (MSE) showed mild edginess, with mild fidgeting and “ok” mood.  He was functional in a light duty military capacity for the past 9 months.  Diagnosis of anxiety NOS was rendered with a Global Assessment of Functioning (GAF) score of 65 (mild symptoms, impairment.) There was no combat history.  

At the 16 March 2006 VA Compensation and Pension (C&P) evaluation, performed 5 days before separation, the CI reported sleeping problems since October 2005, with anxiety, difficulty in breathing, racing heart and sense of dizziness.  Symptoms occurred up to once per week and lasted 10-15 minutes.  The CI reported weekly panic attacks. He felt better with anti-depression medication.  He had psychotherapy up to once per month for the past year and had no emergency room visits or hospital admissions for his MH problem.  The CI was working and had good relationships with his supervisor and co-workers and had lost no time from work.  MSE was unremarkable.  A diagnosis of anxiety disorder was rendered with a GAF score 70-75 (mild symptoms, impairment.)  At the 08 February 2006 VA C&P examination, performed 2 month prior to separation, the CI reported he was working in the same job he had for 3 years.

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 the anxiety disorder condition 30% coded 9413, based on the VA C&P examination before separation.

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.  The Board then 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,” and for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.” Both the MEB and the more proximal to separation VA C&P examination suggested mild symptoms and impairment.  Medication was helpful, he was working and had good relationships with co-workers.  The Board agreed that he did not meet criteria for a higher 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 anxiety disorder condition.  

BOARD FINDINGS:  In the matter of the anxiety disorder condition and IAW VASRD §4.3 (reasonable doubt), 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 20140812, w/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-2015-00107.

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