RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00826
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O2, Intelligence Officer, medically separated for “generalized anxiety disorder” with a disability rating of 0%.

CI CONTENTION:   The CI requests all conditions.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20060530	VARD - 20070220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Generalized Anxiety Disorder	9400	0%	Anxiety Disorder with Bipolar Disorder	9432-9413	10%	20060824	
Borderline Personality Disorder	Not Unfitting					
Irritable Bowel Syndrome		Irritable Bowel Syndrome	7319	0%		
History of Migraine Headaches		Migraines	8100	NSC		
History of Right Ankle Sprains		Right Ankle Sprains	5299-5271	NSC		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Generalized Anxiety Disorder.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s anxiety symptoms began around the time of her irritable bowel syndrome (IBS) diagnosis in May 2004.  She was prescribed psychotropic medication and in November 2004 she sought psychiatric counseling.  She received no formal treatment and was ultimately considered fit to deploy in March 2005.  
However, during deployment her IBS flared up and this worsened her anxiety symptoms.  A month later, the CI returned to the U.S. for mid-tour leave and encountered multiple emotional stressors related to relationships.  

Soon after returning to Iraq she stopped eating and drinking, and was ultimately medically evacuated due to dehydration in October 2005.  She returned to the U.S. and was subsequently evaluated by psychiatry in November 2005.  She was diagnosed with generalized anxiety disorder (GAD).  In January 2006, the CI was admitted to a local civilian inpatient psychiatry facility for approximately 3 days.

At the February 2006 psychiatric NARSUM, 5 months before separation, the CI noted she continued to suffer from frequent episodes of severe anxiety, frequent insomnia, and intermittent impulses to overdose on medication.  She noted frequent mood swings of normal mood alternating with severe depression and high anxiety on a daily basis.  The CI also reported that she was able to attend to the duties of her occupational specialty for the most part but was worried about maintaining her security clearance given her mental health (MH) problems.

Mental status examination (MSE) recorded mood as mildly anxious.  She reportedly had moderate difficulty with sustained attention, however no other cognitive deficits were observed.  She denied suicidal or homicidal ideation, there was no evidence of psychosis or thought disorder, and an impairment in judgment was not recorded.  The examiner recorded diagnoses of GAD, severe, borderline personality disorder, and IBS, and assessed a Global Assessment of Functioning (GAF) score of 60 (on the cusp of mild-moderate).  

During the May 2006 general MEB NARSUM, approximately 6 weeks prior to separation, the CI reported she still had sleep problems as well as panic attacks that were primarily related to acute stressors and which occurred approximately two times per month.  She denied any suicidal ideations since February 2006.  At the time, she was not taking any psychotropic medication for anxiety or mood symptoms, and had no recorded visits to the emergency room (ER) or inpatient psychiatric hospitalizations since February.  

At the 24 August 2006 VA Compensation and Pension (C&P) mental evaluation, 2 months after separation, the CI reported she was deployed to Iraq from March 2005 to October 2005 where she was not in active combat and never under fire.  She reported that she left Iraq due to her IBS condition.  She noted that she had been in MH treatment since November 2005, was currently taking medications and that her medications were helpful to stabilizing her mood and sleep.  She reported some difficulties at times with sleep, feeling hyper or depressed, or displaying decreased attention, but reports that her overall MH functioning had significantly improved to a 2 on a scale of 1-10 with 10 being severe.  Since leaving the military she took vacation and was looking for a job.  She worked as a babysitter and had no difficulties performing babysitting duties.  The CI reported that she would soon be starting to work as a personal trainer at a fitness center.  There were no visits to the ER or inpatient hospitalizations since February 2006.  MSE was unremarkable with the exception of a slightly anxious affect.  The examiner diagnosed “anxiety disorder not otherwise specified and bipolar disorder 2. “ A GAF of 60 was recorded.

The panel directed attention to its recommendations based on the above evidence.  The PEB rated the GAD at 0%, coded 9400 (GAD), citing “rating takes into account the AXIS II diagnosis” (borderline personality disorder).

The VA rated the condition of anxiety disorder with bipolar disorder 10%, coded analogously 9432-9413 (anxiety, bipolar) based on the evidence showing “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.” 
First, the panel noted there was no specific, highly stressful event to invoke §4.129 for a mental disorder due to service-related traumatic stress.  All panel members agreed the provisions of §4.129 were not applicable. 

Regardless of diagnosis, VARSD §4.130 rates conditions based on symptoms and therefore all symptoms related to MH are considered in the rating scheme.  Since the evidence indicates no deduction was taken, the panel proceeded to rate under §4.130 and compared the psychiatric NARSUM, 4 months before separation, the MEB NARSUM, 6 weeks before separation, and the C&P examination, 2 months after separation.  The panel noted the psychiatric NARSUM was conducted 1 month post-hospitalization, and during the time of medication adjustments, and therefore, it was considered less probative than the examinations that followed.  The MEB NARSUM noted that the CI continued to have sleep problems and was not taking any psychotropic medication for her anxiety symptoms.  Her symptoms were stable.  The C&P examination was unremarkable.  The CI reported she was working full-time as babysitter, noted her symptoms were mild and transient, she had married and enjoyed several social activities, and was planning a career as a fitness trainer.  Her MSE was essentially normal.  

The panel considered the above evidence, which demonstrated significant improvement in the 2 months after separation, and stability of symptoms in the 7 months before separation.  Panel members agreed the CI’s condition exceeded the 0% disability level.

Deliberations settled on recommendations for a 10% rating (“occupational and social impairment due to mild or transient symptoms which decrease work efficiency…only during periods of significant stress”) versus a 30% rating (“occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks”).  
At the time of the MEB NARSUM and the C&P examinations, 6 weeks prior to, and 2 months after separation, respectively, the CI’s condition was most reflective of the 10% disability level, and the 30% disability level was not justified. 

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the GAD condition, coded 9400.  

Contended PEB Conditions: Borderline Personality Disorder, IBS, History of Migraine Headaches, and History of Recurrent Right Ankle Sprains.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, and with the exception of the IBS condition, none were implicated in the commander’s statement or judged to fail retention standards.  The commander’s statement noted that the CI had lost time from work due to her discomfort and pain related to IBS.  However, the statement was written 2 months prior to the MEB NARSUM.  The NARSUM indicated that the CI’s irritable bowel condition had improved since the initiation of a new medication and the C&P examination documented the CI’s report that her IBS was well under control.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the GAD condition, the panel recommends a disability rating of 10%, coded 9400 IAW VASRD §4.130.  In the matter of the contended borderline personality disorder, IBS, history of migraine headaches, and history of recurrent right ankle sprains, the panel recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the Board’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Generalized Anxiety Disorder	9400	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150604, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure