RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02471
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070402

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Information Management Journeyman, medically separated for “obsessive compulsive disorder (OCD) with anxiety disorder not otherwise specified (NOS) and tic disorder,” disability rating of 10%.

CI CONTENTION:  The CI contended for his MH and back pain conditions.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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.  Any conditions outside the Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations 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 at the time of separation.  The Board 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 Board 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 - 20070809	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Obsessive Compulsive Disorder (OCD) with Anxiety Disorder, NOS and Tic Disorder	9404	10%	Obsessive Compulsive Disorder	9404	0%	20070625	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

OCD with Anxiety Disorder NOS and Tic Disorder.  The PEB combined the OCD with anxiety disorder, NOS and Tic disorder conditions under a single disability rating, coded 9404 (obsessive compulsive disorder).  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s obsessive compulsive disorder with anxiety disorder, not otherwise specified (NOS) and tic disorder condition began in December 2005 after realizing that he would be separated from his son.  At the MEB examination (recorded on DD Form 2697) dated March 2007, 1 month prior to separation, the CI reported taking Zoloft daily and Klonopin as needed for his OCD.  No psychological or psychiatric examination was annotated.  

The 28 November 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of increased anxiety, repetitive excessive checking of “the doors and windows in his house to make sure that they were locked, having to open and close doors until the click of the lock sounded and felt a certain way, and having to repeat words up to 100 times until the vocalization was correct.”  The CI also reported worsening associated motor tics and OCD behaviors during periods of increased stress and worry.  The CI stated that he was late for work and avoided social situations for fear of detection by others.  He reported anxiety attacks evolved into panic attacks that lasted about 10 minutes.  Mental status examination showed the CI’s mood was mildly dysphoric with congruent affect.  The CI exhibited periodic spontaneous blinking.  However, the CI’s speech was normal.  There was no suicidal or homicidal ideation.  He denied any auditory or visual hallucinations.  There was no evidence of psychotic or paranoid perceptions or ideations.  The examiner diagnosed the CI with OCD and noted that the repetitive behaviors and mental acts “that the member feels driven to perform is chronic and will require life-long medication.”  The examiner also annotated tic disorder NOS, anxiety disorder NOS and deployment-related diagnoses.  A psychiatric addendum dated 8 January 2007 noted that there was no evidence of malingering and the CI fear of separation from his son accounted for the excessive anxiety and worry.

At the 20 June 2007 VA Mental Health examination, performed 2 months after separation, the CI reported loss of interest in recreational activities and that the only thing he looks forward to is time with his son.  He also reported obsessive compulsive symptom including repetitive showering, checking locks and doors, and other household cleaning activities.  He reported that he was not undergoing mental health treatment at the time of the examination.  The mental status examination was normal except for a mildly depressed mood.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the obsessive compulsive disorder with anxiety disorder not otherwise specified and tic disorder conditions at 10% coded 9404 (Obsessive compulsive disorder) citing mild social and industrial adaptability impairment.  The VA rated the obsessive compulsive disorder condition at 0% coded 9404 after deferral due to no show of his VA examination, but did not service-connect the Tic disorder.  The panel first considered if the OCD with anxiety disorder, NOS and Tic disorder conditions, having been de-coupled from the combined PEB adjudication, remained separately unfitting as established above.  In this case, the obsessive compulsive disorder with anxiety disorder not otherwise specified and tic disorder conditions were considered to fail retention standards; however, the obsessive compulsive disorder and anxiety disorder, NOS conditions were profiled S4 and implicated by the NARSUM and the commander’s statement.  Panel members agreed that the obsessive compulsive disorder and anxiety disorder, NOS conditions could be reasonably justified as separately unfitting.  Panel members also agreed that the evidence did not reasonably support that the functional limitations of the Tic disorder condition contributed to the CI’s inability to perform his military duties and concluded that it was not separately unfitting.  

The panel then considered its rating recommendation for the unfitting mental disorders (obsessive compulsive disorder and anxiety disorder, NOS). The panel noted that §4.130 (General Rating formula for Mental Disorders) rates on impairment of occupation and social functioning and not on individual diagnoses; therefore a single rating for the mental health conditions was rendered.  The panel noted that there was no STR evidence of psychiatric hospitalization or emergency room visit.  The commander stated that the CI could physically perform his duties, but required close supervision. The commander also stated that the CI could work full shifts and did not routinely miss duty time when closely supervised. The panel also noted that the CI’s increased anxiety symptoms were associated with separation from his son.  Panel member’s agreed that the evidence supports a 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.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that the mental disorders were separately unfitting and the Tic disorder was not unfitting. Because the rating would not result in a beneficial change for the CI, the panel determined that there was insufficient cause to recommend a change in the PEB adjudication for the obsessive compulsive disorder, anxiety disorder, NOS and Tic disorder.  

BOARD FINDINGS:  In the matter of the obsessive compulsive disorder and anxiety disorder, NOS condition and IAW VASRD §4.130 the panel unanimously recommends each condition as separately unfitting, but no change in the PEB’s 10% rating adjudication.  In the matter of the Tic disorder condition, the panel unanimously agrees that it cannot recommend a finding of unfit for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.  Therefore, the panel recommends no modification or no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151016, 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-2015-02471.

	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