RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01252
BRANCH OF SERVICE:  coast guard	SEPARATION DATE:  20091211

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Damage Controlman, medically separated for       “anxiety disorder not otherwise specified (NOS),” with a disability rating of 10%.

CI CONTENTION: The CI made no specific contention. His complete submission is 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 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 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:  

IPEB - Dated 20090611	VA – No VA Claim or Rating	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder, NOS	9413	10%	No VA Claim or Rating	
RATING:  10%	RATING:  No Rating	

ANALYSIS SUMMARY:  

Anxiety Disorder, NOS.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI reported symptoms (dizziness, pressured speech, hyperventilation, increased heart rate) consistent with a panic attack while deployed to Kuwait and Iraq for 21 days.  He was command-referred to mental health (MH) and medically evacuated in June 2006 to San Diego for further evaluation.  Cardiac examination was normal.  Psychiatric evaluation in July 2006 noted the CI had continuous active duty for 5 years, 7 months without MH symptoms.  He had five or six panic attacks since the first attack 1 month previously.  He attributed most of the anxiety to stressful situations at work since being at the present command.  He was treated with medications for anxiety.  He did not report posttraumatic stress disorder symptoms or trauma.  He had a paternal history of panic attacks.  He received a diagnosis of anxiety disorder with a Global Assessment of Functioning (GAF) score of 68 (mild symptoms, impairment.)  The examiner opined he was psychologically fit for duty (FFD.)  He was treated with cognitive behavior therapy and medication management over about 20 MH visits from 2006-2008.  He was treated with various medications for anxiety and depression and completed other deployments without difficulty.  He reported he was sensitive to side effects and discontinued the last prescribed medication in September 2008.  He had an anxiety attack while on the range during training and was removed.  On 1 October 2008, the psychiatrist recommended a medical board because the CI was not FFD.

The NARSUM, dated 27 October 2008, noted that given the chronic nature of the CI’s condition, the effect on his ability to train and deploy, and his need for follow-up appointments, he was not fit for service and should be medically separated.  The family practice examiner for the NARSUM examination noted the CI was taking medication for depression and for sleep.  She noted he appeared disheveled and had a depressed mood.  A diagnosis of anxiety disorder NOS with depression was rendered.  The commander’s statement, dated December 2012, noted he served in a support capacity instead of his usual assignment due to his medical condition (anxiety disorder.)  The applicant made no VA claim and there was no evidence of a Compensation and Pension examination and no other records could be located.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB adjudicated the anxiety disorder condition as unfitting with a disability rating of 10%, coded 9413.  The Board first considered if the definition of VASRD §4.129 was met for the unfitting MH condition resulting in medical separation; i.e., “a mental disorder that develops in service as a result of a highly stressful event.” Board members agreed that although some contribution of deployment stressors to his MH condition was possibly present, the CI reported the anxiety developed due to “stressful situations at work due to present command.” Therefore, the requisite §4.129 link that the condition occurred “as a result of a highly stressful event” was not adequately satisfied.  

The Board therefore will consider only the VASRD §4.130 impairment present at separation for a single rating recommendation.  Members considered if there was evidence for a §4.130 rating higher than PEB’s 10% at time of separation.  The PEB cited “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” as the reason for its rating.  The 30% rating requires “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.”  The physician examiner determined the CI was not FFD.  He had several 30% threshold symptoms that included anxiety, depressed mood, and difficulty with sleep.  Sensitivity to medications interfered with achieving stability through continuous medication After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the anxiety disorder condition.  

BOARD FINDINGS: In the matter of the anxiety disorder condition, the Board recommends a disability rating of 30%, coded 9413 IAW VASRD §4.130.  There were no other conditions within the Board’s scope of review for consideration.  The Board 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 his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Anxiety Disorder, NOS 	9413	30%	
RATING	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150613, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

								   

Dear XXXXXXXXXX,
I am the Designated Decision Authority for the Coast Guard on applications submitted to the Department of Defense Physical Disability Board of Review (PDBR).  Under the authority of Title 10, United States Code, section 1554a, I accept the PDBR’s recommendation in your case (Case Number PD-2015-01252) and hereby modify the disability rating previously assigned to reflect a rating of 30% and re-characterization of your separation to permanent disability retirement. This decision will be effective as of the date of your prior medical separation.  Please allow up to ninety (90) days for the corrections to be made. 

Please note, if you received a lump-sum or other payment of back pay and allowances at separation, your disability retired pay may be reduced to take into account receipt of such lump-sum or other payment.  Please contact the Coast Guard Pay and Personnel Center at (800) 772-8724 for questions relating to retired pay matters. 

Enclosed for your information are a copy of the PDBR’s recommendation and a copy of the record of proceedings. 

A copy of this decision has also been provided to Coast Guard Enlisted Personnel Management Branch, the PDBR, and the Department of Veterans Affairs. 

If you have any further questions, please contact the Coast Guard Personnel Service Center at (703) 872-6628. 
	Sincerely,
2 Enclosures		
	
Copy:	CG Personnel Service Center (EPM-1)
DoD Physical Disability Board of Review
Department of Veterans Affairs