RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01513
BRANCH OF SERVICE:  army	SEPARATION DATE:  20070407

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E5, Heavy Equipment Operator, medically separated for “anxiety disorder not otherwise specified [NOS]” with a 0% disability rating.  

CI CONTENTION:  The CI contends he is unsure what conditions made him unfit to remain in service.  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 - 20070214	VARD - 20060823	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder NOS	9413	0%	Post-Traumatic Stress Disorder (PTSD)	9411	NSC	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Anxiety Disorder, NOS.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s anxiety condition began in April 1991 after deployment to Operation DESERT STORM.  

The 10 October 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of persistent symptoms of intermittent weakness, trouble talking and walking, dizziness, headaches, and tremors in his arms and legs.  He reported he usually had a foreboding sense before and felt impending doom during the spells.  The CI had been able to maintain his job working road construction because his supervisor allowed him time off when he experienced a spell.  At the time of the NARSUM, he was on a trial of an anti-anxiety medication twice daily as needed.  The CI was able to maintain social relationships and participate in social activities when well.  Mental status exam revealed a mild intention tremor and a frustrated mood.  A diagnosis of anxiety disorder NOS was rendered with a Global Assessment of Functioning of 75 (mild symptoms, impairment).  The examiner noted the CI had considerable disability from his physical complaints and could not perform the duties of his military specialty.  He described symptoms as intermittent, noting that if he did not work in such an understanding environment it would be difficult for him to maintain stable employment.  

The 2 February 2007 MEB addendum, 2 months prior to separation, noted the CI complained of intermittent upper extremity weakness, consistent with physical symptoms occasionally associated with anxiety disorder.  His somatic symptoms and occasional anxiety attacks were consistent with a diagnosis of anxiety disorder.  The VA did not perform a Compensation and Pension evaluation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the anxiety disorder NOS condition 0%, coded 9413 (anxiety disorder), citing no industrial impairment.  The VA, using the STR, determined a PTSD condition, coded 9411 (PTSD), was not service connected (NSC), citing a lack of confirmed diagnosis.  Application of VASRD §4.129 is considered by the panel for all cases of service-connected psychiatric conditions resulting in separation, but members unanimously agreed that the ‘highly stressful event’ requisite for §4.129 was not satisfied in this case.  The panel next considered whether there was sufficient evidence for a §4.130 rating higher than the 0% assigned by the PEB.  

The §4.130 criteria for a 10% rating is “mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or controlled by continuous medication,” and for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  The NARSUM noted the CI was able to work because he had an understanding employer who allowed him to take off from work and rest when needed.  He was currently taking anti-anxiety medication twice daily as needed.  The panel noted the NARSUM examiner described the CI’s symptoms as “intermittent” and “occasional,” and that they were unpredictable, and when present, they interfered with his ability to perform his duties.  The panel determined his symptoms met criteria for a 10% disability rating IAW VASRD 4.130.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the anxiety disorder NOS condition, coded 9413.

BOARD FINDINGS:  In the matter of the anxiety disorder NOS condition, the panel unanimously recommends a disability rating of 10%, coded 9413 IAW VASRD §4.130.  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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Anxiety Disorder NOS	9413	10%	

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 

AR20170009055, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXXXX.

Sincerely,	
Enclosure