RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00608
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050819

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Engineering Tech, medically separated for “specific phobia (gas mask and MOPP gear) associated with anxiety” with a disability rating of 0%.  

CI CONTENTION:  Claims discharge code on DD 214 is inaccurate.  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 - 20050603	VARD - 20060203	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Specific Phobia…	9403	0%	Panic Disorder without Agoraphobia (with Significant Claustrophobia) 	9413	0%	20051025	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Specific Phobia.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s phobia condition began in 2003 when he experienced difficulty tolerating wear of the MOPP ensemble.  Although treatment with relaxation techniques and stress management skills was initially effective, difficulties returned. Ultimately, the phobia condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for MEB.  The MEB forwarded “claustrophobia/anxiety in MOPP ensemble & gas mask” for PEB adjudication.  

At the NARSUM examination on 9 May 2005, 3 months prior to separation, the CI’s chief complaint was “I feel hot when wearing the MOPP gear.”  Wearing the gear invariably provoked an immediate anxiety response, and the CI dealt with this by refusing to wear it or by taking it off prematurely.  He was taking no psychotropic medications.  He was happily married and denied any significant marital problems.  A detailed mental status examination was normal.  The examiner rendered a diagnosis of “Specific Phobia, gas mask.”  A Global Assessment of Functioning (GAF) was 75, connoting no more than slight occupational or social impairment.  In the final performance report prior to separation, covering the period from 23 July 2004 to 22 June 2005, the CI was given the highest possible evaluation in all categories, and was recommended for immediate promotion.  
 
At the 25 October 2005 VA Compensation and Pension (C&P) examination, performed 2 months after separation, the CI reported the aforementioned difficulty with wearing MOPP gear for longer than 5-10 minutes, and experienced similar symptoms if he was in a crowded vehicle. Either of these circumstances resulted in a “panic attack” which could last up to 2 hours.  If he avoided those 2 situation, he was psychiatrically asymptomatic and had no occupational or social impairment.  He never required medication.  A detailed mental status examination was normal. A diagnosis of panic disorder without agoraphobia was rendered, and an assigned GAF was 80.  

The Board directs 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.  The Board therefore will consider only the VASRD §4.130 impairment present at separation for a single rating recommendation.  

The PEB rated the phobia condition 0%, coded 9403 (specific, [simple] phobia), citing no civilian social and industrial adaptability impairment as the rationale.  The VA rated the phobia condition 0% coded 9413 (anxiety disorder), citing symptoms not severe enough to interfere with occupational or social functioning or to require continuous medication.  The Board notes that the disability associated with all psychiatric conditions, regardless of the diagnosis, is subsumed under a single rating using the same criteria IAW VASRD §4.130.  Therefore the applicant’s service disability rating assigned by the PEB, and the recommendation from the Board, is unaffected by the specific psychiatric diagnosis determined to be unfitting by the service.  The Board considered if a rating higher than 0% was warranted at the time of separation.  It was agreed that the 30% rating criteria (occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks) was not approached.  The §4.130 criteria for the next higher 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.” Board members concluded that the 10% criteria were not supported by the evidence.  Therefore, the 10% rating was not justified.  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 specific phobia condition.  

BOARD FINDINGS:  In the matter of the specific phobia associated with anxiety condition and IAW VASRD §4.130, 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 20150602, w/atchs
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 XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00608.

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,

XXXXXXXXXXXXXXXXXXXXX
Principal Deputy Assistant Secretary 
(Manpower and Reserve Affairs)

Attachment:
Record of Proceedings