RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02146
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantryman, medically separated anxiety disorder, NOS [not otherwise specified]” with a disability rating of 10%.  

CI CONTENTION:  “During my med board release I was given 10% rating from the DOD which should have been 50%.”  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 - 20051128	VARD - 20070918	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder. NOS	9413	10%	PTSD	9411	70%	20070802	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Anxiety Disorder, NOS.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI deployed from 18 August 2003 to 20 May 2004.  On the post-deployment survey dated 13 April 2004, he denied seeing anyone wounded or killed, engagement in direct combat, or feeling that he was in great danger of being killed.  He denied mental health symptoms and did not request counseling.  There are no additional records in evidence for a mental health issue in evidence until the MEB NARSUM examination which was dated 14 June 2005, 6 months prior to separation.  It noted that the CI began to experience both anxiety and depression following his re-deployment.  
The CI reported that while deployed, he engaged the enemy and witnessed locals being injured and the loss of his fellow soldiers.  The Board observed that this is contrary to the post-deployment survey.  He began to drink heavily and presented to division mental health (the NARSUM states May 2004, but this is probably May 2005).  He was referred for anger management and substance abuse.  Despite this, he continued to have issues with anger.  He reported that his symptoms lessened significantly if away from his work environment.  He denied PTSD-like symptoms such as recurrent intrusive thoughts of combat, flashbacks, or other symptoms.  It was noted that prior to military service, he had a significant history of drug abuse of both cannabis and (psychedelic mushrooms).  He also reported discipline problems at home and two school suspensions.  On examination, his speech was monotone and he was angry when describing problems at work.  His affect was labile with anxiety and tearfulness.  He reported impulses to act on his anger, but did not report that he had done so.  Judgment, insight, cognition, and thought content appeared to be normal and suicidal ideation was absent.  He was thought to be a high risk of decompensation if redeployed.  He was diagnosed with both an anxiety disorder not otherwise specified (NOS) and depressive disorder NOS.  The impairment for military duty was moderate for both, but the social and industrial impairment (civilian) was mild for both.  He was also noted to have alcohol dependence in early remission.  Mushroom and cannabis abuse were both in sustained full remission.  Anti-social personality traits were also noted as evidenced by disciplinary problems, disregard for the rules, regular illegal drug use, and disciplinary problems in school.  

The commander’s evaluation dated 17 June 2005, noted the CI had poor duty performance, showed lack of discipline, and was disrespectful.  The panel observed that these problems are encompassed by the Axis II listing, anti-social personality traits.  The CI was seen for an unrelated medical problem on 8 July 2005.  On the mental health screen, he denied any symptoms of depression and was noted to be doing well and in no distress.  The mental status was noted to be normal.  .  The record shows that the CI refilled his mental health medications on 27 October 2005, 6 weeks prior to separation.  The CI was separated for anxiety associated with depression effective 16 December 2005.  The PEB did not find that the criteria for 10.A. or 10.C. were present.  

The VA Compensation and Pension (C&P) evaluation was not performed until 2 August 2007, 20 months after separation.  The CI reported that he was separated and that his wife left him while he was deployed.  He was unemployed and living with his mother.  Prior to that he had been homeless.  The examiner recorded that the CI had been in outpatient treatment at the VA since February 2007.  There is no record of treatment between that date and separation from the military.  He was admitted for one day in May following that appointment for an increase in symptoms, but signed out against medical advice the next day.  He was prescribed medications, but took them inconsistently.  He was again abusing marijuana 1-2 times a week.  He reported that he was exposed to rocket and mortar attacks while deployed, being in fire fights, witnessed women and children abuse, and losing “buddies” to enemy action.  Following separation, he sold televisions in a retail store for 5-6 months, but did not feel comfortable around people and quit.  He was then a shift leader at a pizza restaurant for 6-7 months.  He reported that a manager brought him to the VA for treatment after the CI broke down crying at work.  It is not clear from the record when this was, but the first evidence of post-separation treatment is in February 2007, 14 months after separation.  The mental status examination was abnormal, but 20 months from separation and not probative for rating purposes at separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the anxiety disorder condition 10%, coded 9413 (anxiety disorder, not otherwise specified).  The VA rated PTSD 70% coded 9411 (post-traumatic stress disorder), based on the VA C&P examination 20 months after separation, citing severe occupational and social impairment.  The VA based the diagnosis on a history which is not supported by the record.  The rating was effective 23 February 2007, over 14 months after separation.  

There was no evidence of hospitalization or emergency room visits prior to separation.  The post-separation hospitalization was almost 18 months after separation.  The clinical visit closest to separation, for a non-mental health condition, noted that the CI was asymptomatic.  The CI was able to work following separation for at least 11 months and perhaps until May 2007 when hospitalized.  The CI did report that he was taken to VA mental health by his supervisor, but the C&P noted that his first visit was in February 2007, 14 months after separation.  The CI abused drugs after separation, but less than he had prior to enlistment.  The evidence showed that he was taking his medications at separation, which supported a 10% rating at separation.  The evidence does not show that the CI was unable to perform occupational tasks at separation or proximate to it; accordingly, a 30% rating at separation was not supported by the evidence.  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 anxiety disorder condition.  

BOARD FINDINGS:  In the matter of the anxiety disorder NOS associated with a depressive disorder NOS condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication.  There are no other conditions within the Board’s scope of review for consideration.  The Board, 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 20150804, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014670, XXXXXXXXXXXXXXXXXXP. 

XXXXXXXXXXXXXXXXXX
Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
						      					
Enclosure