RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01239
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Security Forces, medically separated for “panic disorder with agoraphobia,” with a disability rating of 10%.  

CI CONTENTION:  The CI makes no contentions.  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 -  20050617	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Panic Disorder…	9412	10%	No VA Examination Proximate to Separation 	
Tobacco Habituation	Category III		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Panic Disorder with Agoraphobia.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had counseling after her parent’s divorce while she was in school although she denied any mental health counseling on the accession history dated 26 September 2002.  In February 2004, she was decertified from PRP (personnel reliability program) access due in part to suicidal ideation.  A performance report, which covered the period from 10 June 2003 through 10 February 2005, noted that she needed continuous supervisor reinforcement and guidance to get the job done and done right.  She was issued an S4 profile on 4 March 2005, but it was noted that she could return to weapons status and it was anticipated that she would return to an S1 profile in 4-6 months.  
The 24 March 2005, MEB NARSUM examination, 4 months prior to separation noted a history of panic attacks which had recently worsened although she did benefit from medications.  She noted that she had seen a therapist following her parents’ divorce (prior to service), but denied panic symptoms at that time.  She did note some anxiety attacks prior to service, but these did not interfere with functioning.  In addition, she found out that she had been adopted a few years earlier and had occasional suicidal ideation for about a year.  She denied suicide attempts.  She worked in security police and “loved” her work, but realized that she was not well suited for the stress.  She was engaged to another service member who was deployed and she was scheduled to deploy shortly after his return, conflicting with her wedding plans.  This was a major stressor for her.  A hospital admission (3 May 2005) for less than 24 hours was documented.  On examination, she was visibly shaking and anxious, but relaxed after making a plan to address her problems.  This was the only mental health record in evidence other than the NARSUM examination.  Her mood was anxious and affect stable; the mental status examination was otherwise unremarkable.  Her social/industrial impairment was thought to be mild although her military impairment was marked.  

On 3 May 2005 the CI presented to the emergency room citing suicidal ideation with a plan to drive into oncoming traffic although it was also noted that she had no clear intent to harm herself.  Her fiancé was deployed and scheduled to return in July.  She had recently been told that she was scheduled to leave for a 2-week TDY and possible deployment in August, which is when she planned to marry and honeymoon.  It was noted that she was future oriented and wanted to be a wife and mother.  She was determined to have a panic disorder and histrionic traits.  She was admitted overnight for observation to determine if further stabilization was needed.  It was noted that she had no prior admissions for a mental health condition.  The commander’s letter was dated 1 June 2005.  It was noted that she was prone to anxiety attacks which were manifested in stressful situations, and that reacting to these was necessary in her career field.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the panic disorder with agoraphobia condition 10%, coded 9412 (panic disorder and/or agoraphobia).  The panel considered the evidence.  It noted that the dates were somewhat confusing and that it appears that the NARSUM was prepared in March, but later updated without clear documentation of when.  Regardless, the commander noted that the CI did not do well in stressful situations.  However, the stresses faced by a member of the security forces are not the typical stresses of most civilian occupations.  The CI was admitted overnight on one occasion and this was due to suicidal ideation.  This was in the context of being identified for deployment shortly after her fiancé returned from his deployment and during the time they planned to marry and honeymoon.  Subsequent records show that they did marry in 2005 and remained married 10 years later with 2 children.  She was on medications at separation, but subsequently discontinued these.  The use of daily medications supports a 10% rating.  The commander and NARSUM psychiatrist both noted that the CI was unable to function in the stressful environment of security forces due to her anxiety disorder, although the latter commented that she might do well in a civilian job.  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 adjudication for the panic disorder with agoraphobia condition.  

Contended PEB Condition:  Tobacco Habituation.  The panel’s noted that this, substance abuse, is not considered a physical disability IAW DoDI 1332.38E5.1.2.9.1., and is not compensable or ratable.

BOARD FINDINGS:  In the matter of the panic disorder with agoraphobia condition and IAW VASRD §4.130, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended tobacco conditions, the panel unanimously recommends no change from the PEB determination as not unfitting and not compensable or ratable.  There were 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 20150609, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01239.

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