RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2015-01443
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060710

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Information Management Craftsman, medically separated for “panic disorder without agoraphobia” with a disability rating of 10%.

CI CONTENTION:  “All issues and disabilities are service connected.  All issues combined justify medical retirement.”  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 - 20060327	VARD - 20070723	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Panic Disorder without Agoraphobia	9412	10%	Panic Disorder without Agoraphobia	9412	10%	20070521	
Hypertension	Cat II	Hypertension	7101	10%	20070521	
Gastroesophageal Reflux Disease	Cat II	Gastritis	7307	10%	20070521	
Migraine Headaches	Cat II	Migraine Headaches	8100	0%	20070521	
Benign Positional Vertigo	Cat II	Benign Positional Vertigo	6204	10%	20070412	
Tobacco Habituation	Cat III	No VA Exam in Evidence
	
Alcohol and Opiate Abuse	Cat III		
Hyperlipidemia	Cat III		
Overweight	Cat III		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Panic Disorder without Agoraphobia.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s panic disorder began approximately in early 2000.  Over the course of treatment the CI was treated with many different anti-anxiety medication regimes, each of which he stated worked for 1-2 years before his anxiety symptoms would return.  In March of 2005 the CI was treated for chronic anxiety but noted his last panic attack was a year earlier.  The CI’s psychotropic medications were changed in August 2005 (Remeron at night, Zoloft and Valium twice daily).  In September 2005 the CI reported he was doing better with no work problems or panic attacks and in October 2005 at a psychiatric visit, he reported the same.  

The 5 December 2005 MEB NARSUM examination, 7 months prior to separation, noted the CI was sent for a command directed evaluation by Life Skills on 5 October 2005 and reported his anxiety was well controlled, he had not experienced further panic attacks and he stated “I’m my old self again.”  The CI had no history of suicide attempts or psychiatric hospitalizations.  Psychological testing indicated that while the CI may have elevated anxiety, he was not experiencing symptoms consistent with a psychiatric disorder.  The CI reported being a binge drinker in the past but currently reported only one drink per episode and the examiner noted the CI had “a long history of narcotic use for pain management.”  No mental status examination (MSE) was performed.  The Axis I diagnosis was “panic disorder without agoraphobia, in early remission with medication and the global assessment of functioning (GAF) assignment was 65, which reflects mild impairment on that scale.    

At the 21 May 2007 VA Compensation and Pension (C&P) evaluation, 10 months after separation, the CI reported he was fired from his first job after military separation due to missing time from work due to vertigo related to an inner ear problem.  The CI reported that he was not doing well and he was “a wreck.”  He reported that his children had thrown away all his medications except Zoloft and the General Medical examination the same day noted he had not taken any medication in a week.  He reported he felt shaky, nervous, sweaty and unable to relax frequently.  He reported a “bad attack” every couple of months which he described as a racing heart with hyperventilation to the point of nearly fainting.  The CI also reported paranoid thoughts like people were talking about him.  The examiner indicated the paranoia was not to a delusional degree.  The CI was under severe financial stress, having received notice they would have to vacate their home due to late payments and some family stress.  He remarried his first wife, but reported the marriage was strained.  He got along well with his children.  After work, he would cook and clean house and spend time with his children.  The CI denied having problems making friends but was more socially withdrawn than in the past and had lost interest and pleasure in activities he once enjoyed.  He was currently employed at an insurance office.  He reported anxiety made his work difficult because he had difficulty with concentration and memory but he also noted that he was completing his work without difficulty and looked forward to taking the exam to become an insurance agent in the near future.  At the MSE the CI reported an anxious mood, but the examiner noted that his affect appeared “quite calm.”  There was no suicidal ideation, delusions, hallucinations or other symptoms suggestive of psychosis, speech disturbance, objective cognitive impairment, or other abnormality.  The VA examiner indicated there was no evidence of alcohol or substance abuse.  The Axis I diagnoses were panic d/o without agoraphobia and relational problems and the GAF assignment was 65.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the panic disorder condition 10%, coded 9412 (panic disorder and/or agoraphobia), citing mild social and industrial impairment.  The VA also rated the panic disorder 10% coded 9412, based on the VA C&P examination 10 months after separation, citing occupational and social impairment due to mild or transient symptoms which decrease work efficiency and inability to perform occupational tasks only during periods of significant stress; or symptoms controlled by continuous medication.”  The panel noted that there was no traumatic event causing the unfitting mental health condition and therefore concluded that application of VASRD §4.129 was not appropriate in this case.  

The panel considered whether the evidence at the time of separation supported a rating higher than the 10% rating adjudicated by the PEB.  During active duty there was evidence that between approximately 2000 and early 2005, the CI experienced occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks which is supportive of the 30% rating.  However, after his medication adjustment in August 2005, the CI reported significant improvement in his symptoms and functioning.  At the NASRUM examination, the examiner indicated there was no evidence of symptoms of a psychiatric disorder on his current medications.  At the VA examination, which was 10 months after separation, he was on Zoloft, but had not taken medication in the past week.  The CI was employed and though he noted some difficulty at work due to his anxiety symptoms, he also reported he was able to complete his job assignment without difficulty and was looking forward to advancing soon.  At the time of separation the CI was well controlled on medications and at the time of the post-separation C&P examination, despite significant stressors, the CI was working and his own description of his functioning was consistent with the 10% rating for “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.”  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 without agoraphobia condition.  

Contended PEB Conditions:  Hypertension, Gastroesophageal Reflux Disease (GERD), Migraines, Vertigo, Tobacco Habituation, Remote History of Alcohol and Opiate Abuse, Hyperlipidemia, and Overweight.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The PEB AF Form 356 listed a single Category I unfitting condition of panic d/o without agoraphobia and four conditions as Category II conditions (conditions that can be unfitting but are no currently compensable or ratable) - hypertension, GERD, migraines, and vertigo.  Under the remarks section, however, the PEB noted that “none of your medical conditions individually prevent you from reasonably performing…however, taken in totality they make you unfit.”  The PEB further indicated that in that case the PEB “rates the condition that was would be most advantageous” to the CI.  
	
Whether these four conditions were adjudicated as not unfitting or whether the four conditions along with the panic d/o were adjudicated based on overall effect as described above does not matter to the panel.  The standard of evidence required for the panel to recommend a condition determined by the PEB to be not unfitting as unfitting is the same as the standard required to recommend individual conditions that were considered unfitting based on overall effect as separately unfitting.  In both cases there must be a preponderance of evidence in record to overcome the PEB’s fitness adjudication.  None of the four Category II 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.  

The PEB also adjudicated tobacco habituation, remote history of alcohol and opiate use, hyperlipidemia, and overweight as Category III conditions (conditions that are not separately unfitting and are not compensable or ratable.  All of these conditions except hyperlipidemia are conditions that do not constitute a physical disability, IAW DoDI 1332.38 and hyperlipidemia is a laboratory finding and is not associated with disability by itself.  Therefore, the panel has no basis for recommending any of these four conditions as unfitting.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the panic disorder without agoraphobia condition and IAW VASRD §4.130 the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension, gastroesophageal reflux disease (GERD), migraines, vertigo, tobacco habituation, remote history of alcohol and opiate abuse, hyperlipidemia, and overweight conditions, the panel unanimously recommends no change to 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 20150615, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01443.

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,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings