RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01047
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060419

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Electronic Warfare Systems Journeyman, medically separated for “Obsessive-Compulsive Disorder associated with Dysthymic Disorder and Pain Disorder,” with a disability rating of 20%.

CI CONTENTION:  The CI requested consideration of all conditions.  The CI’s 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 - 20060125	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Obsessive-Compulsive Disorder Associated with Dysthymic Disorder and Pain Disorder, Social and Industrial Adaptability Impairment, Definite	9404	20%	No VA Exam in Evidence	
Low Back Pain, Musculoskeletal  	5237	Cat II		
Bilateral Benign Hand Tremor	8199-8103	Cat II		
Bilateral Wrist Pain	8799-8715	Cat II		
Personality Disorder, Not Otherwise Specified 	Cat III		
History of Alcohol Abuse, in Remission	Cat III		
Tobacco Habituation	Cat III		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Obsessive-Compulsive Disorder (OCD) Associated with Dysthymic Disorder (d/o) and Pain d/o.  According to service treatment records (STR) and the mental health (MH) Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s was diagnosed with OCD and dysthymic disorder d/o and obsessive-compulsive personality traits in April 2004.  After a few visits, the CI was deployed and he did not return for MH treatment after deployment.  The CI was evaluated over several years for pain in multiple joints and following comprehensive evaluations no specific cause could be identified.  He was referred to behavioral health in June 2005 for evaluation of possible psychological factors.  Evaluations by a psychiatrist beginning in June 2005 led to diagnoses of OCD, dysthymic d/o, pain d/o, associated with psychological factors, alcohol dependence in full remission, nicotine dependence and an Axis II diagnosis of personality disorder (PD), not otherwise specified (NOS).  The MEB NARSUM examiner indicated that between his OCD diagnosis in 2004 and June 2005, the CI’s symptoms had increased, noting the CI had been disciplined for refusing to comply with an official hurricane evacuation order due to OCD symptoms.  At the 8 June 2005 psychiatrist initial examination, the CI reported “I enjoy what I do and have compensated.”  At serial psychiatric examinations the Global Assessment of Function (GAF) was initially 70 to 65, which reflects mild impairment on this scale.  The CI was treated with multiple psychotropic medications with little improvement in his OCD symptoms.  The 5 December 2005 commander’s statement indicated the CI was working in his primary military specialty and was fully qualified, but his “medical condition” prevented him from performing all the duties required.  The commander noted the CI missed many hours due to medical appointments and when at work he complained of joint pain.  

The MEB NARSUM examination on 4 January 2006, 4 months prior to separation, noted complaints of compulsive behaviors that were excessive and time consuming (organizing closets, pantry, refrigerator), often several hours per evening.  The CI avoided physical contact with people; he could shake hands but then would wash his hands and he engaged in some hoarding behavior (collected hundreds of movies and games he did not use).  The CI did not endorse significant mood symptoms, but was noted to have several year history of low mood, trouble sleeping, and low self-esteem.  He used tobacco, but denied illegal drug use.  He had a history of alcohol abuse with a one month inpatient rehabilitation in 1999, but was in full remission and abstinent from alcohol.  He continued on multiple psychotropic medications.  There was no history of psychiatric hospitalizations.  The CI was divorced, he said related to his “particularities.”  The mental status examination showed the CI was alert and oriented and made good eye contact.  His mood was normal with a congruent affect.  The CI denied hallucinations or suicidal/homicidal ideations.  Thought and speech processes and content were normal.  There was no psychomotor slowing or agitation.  The CI’s insight and impulse control were deemed poor due to the CI’s inability to modify his OCD behaviors and his lack of belief that he should.  The Axis I and II diagnoses remained the same with a GAF assignment of 60, which reflects moderate impairment on this scale.  

During January, February, and March 2006 psychiatric visits after the MEB NARSUM examination, the diagnoses remained the same and the GAF assignment was again noted to be 65 at all three visits.  At the final visit in March, the CI reported “I am doing OK.”  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the OCD associated with dysthymic d/o and pain d/o condition 30% and deducted 10% for less aggravating/contributory factors, coded 9404 (obsessive compulsive disorder), citing DoD and VASRD guidelines.  The PEB deducted 10% on the basis that the CI’s personality disorder, NOS, which is not ratable (IAW DoDI 1332.38, Enclosure 5), contributed significantly to the disability due to the OCD.  The panel agreed it was not possible to extricate the social and occupational impairment due to the personality disorder versus the OCD in this case.  Therefore, the panel does not recommend a ratings deduction.  The PEB assigned a 30% rating without regard to a deduction and the panel may not recommend a lower combined rating than that of the PEB.  Therefore the panel reviewed to see if a higher rating than 30% was supported by the evidence.  At the start of his psychiatric visits in June 2005, the CI indicated he enjoyed his work and that he had compensated for his OCD symptoms and proximate to separation the CI reported he was doing okay.  Although the CI exhibited obsessive-compulsive behaviors, the evidence does not show they resulted in impairment causing “deficiencies in most areas” and the panel agreed that the threshold for a 70% rating was not met.  A 50% rating which is specified as “reduced reliability and productivity” was considered based on the CI being divorced, missing work frequently, chronic pain complaints, and reduced reliability as demonstrated by the incident when the CI disobeyed an order to evacuate.  However, the panel also considered that the commander noted that the CI was working in his primary military specialty and according to the EPR, which covered the year before separation, the CI continued to perform exceptionally well in all areas, including those requiring social interaction.  Therefore, the panel determined the 50% rating was not supported.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the OCD condition, coded 9404.  

Contended PEB Conditions:  Low Back Pain, Musculoskeletal; Bilateral Benign Hand Tremor; Bilateral Wrist Pain; Personality Disorder, Not Otherwise Specified; History of Alcohol Abuse, in Remission; and Tobacco Habituation.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended low back pain, bilateral hand tremor, bilateral wrist pain PD, NOS, history of alcohol abuse, in remission, and tobacco habituation conditions were not unfitting.  Other than the PD, discussed above under the unfitting MH condition, none of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  IAW DoDI 1332.38, Enclosure 5, the personality disorder NOS, history of alcohol abuse, in remission, and tobacco habituation conditions are not a conditions constituting a physical disability and are not eligible for rating.  

The panel therefore has no basis upon which to recommend them as unfitting.  Additionally as noted above in the rating discussion for the CI’s MH condition, any impairment due to the personality disorder NOS is subsumed in the panel’s rating recommendation IAW VASRD §4.130.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of these conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the OCD condition, associated with dysthymic disorder and pain disorder the panel recommends a disability rating of 30%, coded 9404 IAW VASRD §4.130.  In the matter of the contended low back pain, musculoskeletal, bilateral benign hand tremor; bilateral wrist pain, personality disorder, not otherwise specified, history of alcohol abuse, in remission, and tobacco habituation conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Obsessive-Compulsive Disorder	9404	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150611, w/atchs
Exhibit B.  Service Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01047.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at XXXXXXXXXXXXXXXXXXX to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings