RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX 	CASE:  PD-2015-01220
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20020926

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Surgical Service Apprentice, medically separated for “eating disorder” with a disability rating of 10%.

CI CONTENTION:  “Review 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 - 20020801	VARD - 20030423	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Eating Disorder	9521	10%	Eating Disorder	9520-9521	10%	20030205	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Eating Disorder.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s symptoms of an eating disorder began shortly after boot camp where she gained greater than 20 pounds during training.  With a declining personal self-image, increasing body image sensitivity, and adverse physical symptoms, she began to binge, purge, and maintain strict dietary restrictions.  She received a complete physical work-up and eventually, she self-referred to mental health for help.  Despite diet control, medications, and psychological therapy, the CI did not achieve symptom improvement sufficient to allow unrestricted duty.  The MEB forwarded “Eating Disorder, Not Otherwise Specified (NOS) for PEB adjudication.  
At the MEB NARSUM dated mid-2002, within 6 months prior to separation, the CI’s extensive history was chronicled to include inpatient treatment from 4-26 December 2001.  The provider documented, “[The CI] identified her primary issues as being trust stemming from difficulty trusting in her family, as well as impulsivity and loss of control.”  Her mental status examination (MSE) revealed a frustrating mood, appropriate affect, and fair insight and judgment.  There was “some hopelessness” without suicide ideation, intent, or plan.  Her diagnosis remained as “Eating Disorder, NOS, predominantly anorectic at this point but with some bulimic symptoms”.  

A life skills support clinic encounter dated 10 July 2002, 8 days after the NARSUM, listed the CI’s weight as 117.5 pounds.  At the VA General Medical examination performed on 20 December 2002, 3 months post separation, the CI’s weight was documented at 109 pounds.  At the VA mental health Compensation and Pension examination performed in February 2003 (4 months after separation), the CI reported being “…extremely concerned about food and will eat very little, and many times would like to purge herself if she does eat something.”  She also noted, “Over the last several months things have been in pretty good control…then had a bad bout of going out and gorging on pizza and things she normally would never eat, and then causing herself to throw up.”  This occurred when she temporarily lost her live-in support.  Her MSE was essentially normal excepting the provider’s statement of, “[The CI] showed no signs of any thought disorder, except this rather encapsulated, distorted view of her body.”  She maintained a marked fear of gaining weight, particularly in the abdominal area.   

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the eating disorder at 10%, coded 9521 (Bulimia Nervosa) while the VA rated 10% under the dual code of 9520-9521 (Anorexia Nervosa-Bulimia Nervosa) citing, her symptoms warrant a higher than a non-compensable evaluation.  The panel first considered and agreed with the PEBs coding choice of 9521 as being appropriate for the eating disorder condition.  The next higher rating criteria under 9521 included self-induced weight loss to less than 85% of expected minimum weight with incapacitating episodes of more than 2 weeks but less than 6 weeks total duration per year.  Although the CI was hospitalized (incapacitated) for more than 2 weeks during her last year in service,  her measured weight of 117.5 and 109 pounds both within 6 months either side of separation was well above published high minimum weight standards for a female with a height of 59 inches.  Therefore, the next higher impairment level of 30% cannot be recommended on this basis.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB’s adjudication for the eating disorder condition.

BOARD FINDINGS:  In the matter of the eating disorder condition and IAW VASRD §4.130, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150611, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01220.

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