RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01933
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060718

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Communications, Computer Systems Programming Journeyman, medically separated for “dysthymic disorder,” with a disability rating of 0%.

CI CONTENTION:  He requests review of all conditions.  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 - 20060523	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Dysthymic Disorder	9403	0%	No VA Examination in Evidence	
Social Phobia EPTS	Cat III		
Von Willebrand’s Disease, Type I	Cat III		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Dysthymic Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) mental health (MH) narrative summary (NARSUM), the CI was seen in the emergency room (ER) in July 2003 after making suicidal comments.  He was discharged from the ER with the diagnosis of adjustment disorder.  He was initially evaluated in the MH clinic in November 2004 for complaint of insomnia, and was diagnosed with dysthymic disorder.  The CI participated in talk therapy with good response.  He was referred to the MEB for his hematology condition (Von Willebrand’s), and during that process, he underwent a MH MEB.

The MH NARSUM examination on 7 April 2006, 3 months prior to separation, noted complaints of “mild” guilt, feeling worthless, decreased energy, poor concentration, and irritability and mood issues.  He also noted he had difficulty in large crowds but had no issues with talking in front of groups at work.  He noted that his work performance had not been impaired by his condition.  He had good relationships with co-workers and felt comfortable supervising others and giving briefings at work.  It was noted that the CI was not treated with psychotropic medications but had significant improvement after treatment with cognitive and behavioral therapy techniques.  

The mental status examination (MSE) was unremarkable.  The diagnoses of social phobia and dysthymic disorder were recorded, and a Global Assessment of Functioning (GAF) score of 70 for mild symptoms/impairment was assessed.  The examiner stated, “the service member has a long-standing social phobia that is most salient in social situations outside of the work place…he has been able to function effectively within the workplace…he has been able to perform his duties with success, as evidence by his self-report and EPR ratings.”  The examiner recommended S1 profile.  There were two MH encounter notes subsequent to the NARSUM.  Both demonstrated the CI’s condition remained stable.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the dysthymic disorder 0%, under the code for social phobia (9403), but deducted 10% to yield a 0% rating.  The PEB cited EPTS social phobia “a nonratable/non-compensable condition under disability law/policy, and opines it significantly affects the severity of your dysthymic disorder and represents your primary diagnosis.”  The PEB determined that given the contribution of the social phobia condition, the social and industrial adaptability impairment rating of the dysthymic disorder would best be described as 'none.'  The condition of social phobia was considered not separately unfitting.

The panel next considered the rating deduction.  The PEB assessed a 10% deduction for social phobia in adjudicating the dysthymic disorder.  Firstly, the NARSUM and STR provided no evidence that the social phobia condition had any impact on the condition of dysthymia.  The NARSUM treated each condition separately and there was no indication that the severity of the dysthymic condition was affected by social phobia.  Although the psychologist diagnosed social phobia disorder, there was no documentation to support that the condition had significantly interfered with duty performance as a cause for separation.  Secondly, the NARSUM specifically noted that this condition was most evident in social situations outside of the work place.  It is important to note that the CI engaged in social activity about once a week and there was no report of symptoms occurring during the social activities.  The psychologist also noted neither MH conditions significantly interfered with duty performance.  The psychologist indicated there was no MH condition requiring a restrictive profile, and assigned a S1 profile.

Lastly, the commander’s statement made no mention of MH issues and in fact, recommended that the CI be retained.  However, the commander stated the CI could continue to serve as a result of no physical limitations but could not deploy without a medical facility to treat his current condition.   Therefore, the panel agreed a deduction was not justified since evidence does not support that the social phobia condition had any impact on the dysthymic condition.  The panel next proceeded with the rating recommendation IAW VARSD 4.130.  Regardless of diagnosis VASRD 4.130 rates MH conditions based on symptoms and not diagnoses, therefore, all symptoms are included in the rating. The 10% rating is for “occupational and social impairment due to mild or transient symptoms which decrease work efficiency only during periods of significant stress, or; symptoms controlled by continuous medication.”  The STR demonstrated that the CI’s MH condition did not require continuous medication.  Based on the commander's statement and the record in evidence, his condition had no negative impact on occupational functioning and minimal impact on social functioning.  After careful deliberations, the panel agreed, the overall totality of the CI’s disability more accurately reflects the 0% description, “A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the panel majority recommends a 0% disability rating (no deduction) for the dysthymic disorder condition.

Contended PEB Conditions:  Social Phobia and Von Willebrand’s Disease Type I.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement nor 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.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the dysthymic disorder condition and IAW VASRD §4.130 the panel majority recommends no change in the PEB adjudication.  In the matter of the contended Von Willebrand’s disease and social phobia conditions, the panel recommends no change from the PEB determinations as not unfitting.  The single voter for dissent recommends modification of the disability rating to 10% citing there was no basis for a 10% deduction and therefore, the previously assigned 10% rating should apply.  There were no other conditions within the panel’s scope of review for consideration.  The minority voter did not elect to submit a minority opinion.  The panel therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150711, 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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01933.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR