RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00430
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051003

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Chemical Operations Specialist, medically separated for “panic disorder with agoraphobia,” with a disability rating of 10%.

CI CONTENTION:  “Review 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 on 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 - 20050901	VARD - 20060517	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Panic Disorder with Agoraphobia	9412	10%	Panic Disorder with Agoraphobia and Dissociative Features	9412	30%	20060124	
Dyslipidemia	Not Unfitting 	Dyslipidemia with High Triglycerides	7099-7005	NSC		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:  

Panic Disorder with Agoraphobia.  According to service treatment records and the Medical Evaluation Board (MEB) mental health (MH) narrative summary (NARSUM), the CI’s panic disorder condition began in January 2002 while in basic training.  He had a second panic attack in July 2003, and was not formally evaluated until November 2004.  Despite treatment, his condition did not improve sufficiently enough to allow continued service and he was referred to the MEB.  The MEB forwarded panic disorder with agoraphobia for PEB adjudication.  

At the NARSUM, dated 14 June 2005, approximately 4 months prior to separation, the CI reported a history of having two panic attacks over more than a 2-year period.  He had a third attack about a year before separation, at which time he sought care and was diagnosed with panic disorder.  It was noted the CI received 2 months of therapy and his condition was thought to have improved to allow a second deployment; however, 3 months into the deployment, he was medically evacuated.  At the time of the NARSUM, the CI was taking anti-anxiety medication.  The mental status examination (MSE) was unremarkable with the exception of restricted affect.  The diagnosis of panic disorder with agoraphobia was documented, and the examiner recorded a Global Assessment of Functioning score of 65 for mild symptoms and/or impairment.  The psychiatrist opined the CI’s prognosis was favorable if he continued treatment.  The General NARSUM in August 2005, 2 months prior to separation, noted the CI’s reported he was “better” and his medication had helped him.  

The VA Compensation and Pension (C&P) mental examination was conducted in January 2006, 3 months after separation.  There was no report of post-separation panic attacks, and he continued to take his medication.  The CI was not employed, but looking for work.  He remained married and was socially active with his family and engaged in recreational activities.  The MSE was unremarkable.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition of anxiety disorder at 10%, coded 9412 (panic disorder with agoraphobia).  The VA assigned a 30% rating under the 9412 code and cited panic attacks, occasional isolation from others, “which appears to cause mild impairment with your social and occupational functioning.”  The Board considered whether the provisions of VASRD §4.129 (Mental disorders due to traumatic stress) was applicable based on the evidence.  The Board concluded the provisions of VASRD §4.129 were not applicable in this case.

The Board proceeded to rate under §4.130.  The treatment record demonstrated the CI was never seen in the emergency room for panic attacks, or hospitalized for his MH conditions.  The NARSUM noted his medication had improved his condition and he required medication and therapy for continued improvement.  The record demonstrated infrequent pattern of attacks.  Both the NARSUM and the C&P exam recorded unremarkable MSE and no evidence of panic attacks since the CI’s evacuation in April 2005, 6 months before separation.  The Board also noted the NARSUM examiner based the CI’s anxiety disorder solely on his social phobia symptoms.  The Commander’s Statement acknowledged his MH condition, but made no mention of panic attacks or significant anxiety in the workplace since his medical evacuation.  Board members concluded at the time of separation his disability was most reflective of the 10% level for mild symptoms.  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 adjudication of the panic disorder condition.  

Contended PEB Conditions:  Dyslipidemia.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, 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 panic disorder with agoraphobia condition and IAW VASRD §4.130, the Board recommends no change in the PEB adjudication.  In the matter of the contended dyslipidemia 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 20150602, 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

07 Feb 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160019847 (PD201500430)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA