RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02000
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040907

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Integrated Avionics Systems Journeyman, medically separated for “dissociative amnesia” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  The CI’s 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 - 20040504	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Dissociative Amnesia	9416	10%	No VA Exam in Evidence	
Adjustment Disorder	Cat III		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Dissociative Amnesia.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s amnesia condition began in November 2003 after having awakened from his sleep 11 days later without any specific memory leading up to this encounter.  He had been away without leave from a detail during the first week of November and had been absent from his duty station during the first 3 days of the second week of November.  He denied any symptoms suggestive of a psychiatric disorder.  The CI was hospitalized for 7 days for further evaluation, which was negative.  Neuroimaging showed the presence of an enlarged area in the back of the brain, a normal variant of no consequence.  He eventually developed depressive symptoms and was treated with an anti-depression medication which was not beneficial and therefore discontinued after a month.  Past psychiatric history included report of an overheard plan to commit suicide with the ex-wife of a deceased friend in June 2003.  He denied suicidal ideation at the time and declined further services at the time.  He denied substance abuse but reported two episodes of blackouts associated with alcohol use in the past.  He eventually used a sleep aide and anti-depression medication.  The STR noted significant episodes of dizziness associated with increased dose of his anti-depression medication.  All medications were stopped until episodes of dizziness abated pending an evaluation for a seizure disorder.  The CI made over 30 visits to mental health (MH) from June 2003-July 2004, during which diagnoses of dissociative amnesia and depression not otherwise specified (NOS) were made.  A major stressor was the suicide of the close friend.  There was no other MH history over his 6 years of active duty.  Magnetic resonance imaging (MRI) was normal and electroencephalogram was to be ordered.  The MEB forwarded “dissociative amnesia” for PEB adjudication.  

The 12 March 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of frequent episodes of dizziness, lightheadedness and weakness followed by apparent sleep.  Upon awakening he was frequently amnestic for his activities of the period from a few minutes to hours prior to lapsing into sleep.  He has these episodes on average 4-5 times per week.  They were unpredictable and resulted in significant limitation of his duties due to safety concerns.  These symptoms were causing much distress.  He recently received an Article 15 for being late to work three times.  Mental status examination (MSE) showed a “down mood with sad affect but broad range.”  He had mild psychomotor retardation.  He denied suicidality and homicidality.  Mini-mental status examination was 30/30.  A neurology consult revealed a normal examination, with no evidence of seizures or other neurologic disease.  However, the examiner noted “episodes are secondary to psychiatric disease.”  Neuropsychological examination showed indicators of mild, transient depressive experience.  Diagnoses of dissociative amnesia and adjustment disorder with depressed mood were rendered with a Global Assessment of Functioning (GAF) of 55 (moderate symptoms, impairment.)  Social and industrial impairment was moderate.  The amnesiac episodes were unpredictable and caused a marked decrease in duty performance.  Prognosis was poor with high likelihood for continued episodes in the future.  The CI continued regular MH visits until 2 months prior to separation and was attending the Coping with Emotions class, which he found helpful.  There was no VA Compensation and Pension (C&P) evaluation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the amnesia condition 10%, coded 9416 (dissociative amnesia) after initially assigning a rating of 30% but deducting 20% for less aggravating/contributing factors, leaving a rating of 10%.  The PEB adjudged adjustment disorder to be Category III (conditions that are not separately unfitting and not compensable or ratable.)  Adjustment disorders do not constitute physical disabilities and are not ratable.    Application of VASRD §4.129 is considered by the panel for all cases of service connected psychiatric conditions resulting in separation; but, all members agreed that the ‘highly stressful event’ requisite for §4.129 was not satisfied in this case.  There was no history of an acute episode of abuse or witnessed trauma of any type.  

The panel then considered the 20% deduction for personality disorder.  The President of the Informal PEB, opined the CI’s adjustment disorder significantly affected the severity of his dissociative disorder and if not for this condition, the CI’s social and industrial adaptability impairment rating would best be described as mild.  The PEB adopted the position that “adjustment disorder with depressed mood” accounted for 20% of the rating, which was then deducted from 30% to achieve a rating of 10%.  It has already been noted that adjustment disorder is not a separately unfitting or ratable condition.  Members concluded it is impossible to clinically dissect the psychiatric impairment into ratable and non-ratable origins, and any such attempt would require undue speculation.  In addition, the basis for a diagnosis of adjustment disorder is unclear.  The panel determined that the evidence is not sufficient to uphold the deduction of 20% for adjustment disorder as a contributing factor at separation.  Members thus agreed that its recommendation should concede the total §4.130 impairment in evidence as subject to rating.

The panel next proceeded with the rating recommendation.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication; for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  The NARSUM examination noted the CI remained symptomatic with episodes occurring unpredictably several times per week that was limiting to his duty performance and causing significant distress.  Prognosis was poor with high likelihood for continued episodes in the future. He was taking no medication but remained in treatment, attending weekly follow-up MH appointments with therapy.  Panel members agreed that such unpredictable occurrences (dizziness, lightheadedness and weakness followed by apparent sleep) in association with significant distress met criteria for a 30% disability rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends unanimously a disability rating of 30% for the dissociative amnesia condition, coded 9416.  

Contended PEB Conditions: Adjustment Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The adjustment disorder condition is a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the Board has no basis for recommending it as unfitting.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the dissociative amnesia condition, the panel recommends unanimously a disability rating of 30%, coded 9416 IAW VASRD §4.130.  In the matter of the contended adjustment disorder condition, the panel recommends no change from the PEB determinations as not unfitting.  There were 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Dissociative Amnesia	9416	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150718, 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-2015-02000.

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 your separation be re-characterized to reflect disability retirement, rather than 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 determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at XXXXXXXXXXXXXXXXXXX to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings