RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00777
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20040430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Financial Management and Comptroller Craftsman, medically separated for “anxiety disorder not otherwise specified [NOS]” with a disability rating of 10%. 

CI CONTENTION:  The CI contends that he should have been medically retired for his anxiety attacks, depression, and panic disorder.  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 – 20040224 	VARD - 20050124	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder NOS	9413	10%	Generalized Anxiety Disorder…	9400	30%	20040929	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

Anxiety Disorder NOS.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first sought intervention for his 4-year history of anxiety and panic attacks in January 2003.  He said he was embarrassed to discuss his problems.  He described an anxiety attack as feeling trapped, chest tightness, shortness of breath and difficulty moving, which often lasted for hours.  The anxiety included constant dread and worthlessness but he was able to function at work.  The psychiatrist treated him with an anti-depression medication, which he stopped after 4 months due to side effects.  

However, symptoms increased in intensity and frequency upon receiving orders to deploy to Korea.  He developed severe panic symptoms and crying during transport to Korea and he developed suicidal ideation without a plan upon arrival in Korea.  He was admitted to a General Hospital in Korea for safety precautions on 6 January 2004 and treated with anti-depression and anti-anxiety medication.  He was medically evacuated to a US Medical Center for further inpatient treatment on 12 January 2004.  He had no other history of mental illness and had incurred no disciplinary actions in the military.  The CI reported his two sisters were taking anti-depression and anti-anxiety medications for treatment of panic attacks.  

The 17 January 2004 MEB NARSUM examination, conducted at his admission to psychiatric inpatient services in Texas, 4 months prior to separation, noted complaints of anxiety/panic attacks, suicidal ideation and depression.  He described his challenges as “moving” and adapting to change.  He was taking two anti-depression medications daily, one anti-anxiety medication twice daily and one anti-anxiety medication as needed.  His wife noted their relationship was 8 years old and there were no marital or financial problems.  She reported he held everything in and one had to drag things out of him.  She noted that 2-3 weeks prior to transferring to Korea, he wanted to be with her all the time.  His supervisor noted he had no problems with peers and no behavioral problems.  She was unaware of his issues until his call from the airport in route to Korea, stating he was unable to get on the plane.  Mental status examination (MSE) showed increased movement with fidgeting and crossing of arms, sad mood and mild to moderately restricted affect.  While an inpatient, he participated minimally in unit activities and was easily frustrated.  He was easily angered and showed mild anxiety.  He endorsed frequent anxiety attacks but none were observed.  He repeatedly expressed concern about his career and negative effects.  Diagnoses of anxiety disorder NOS and personality disorder NOS were rendered with a Global Assessment of Functioning (GAF) score of 55 (moderate symptoms, impairment.)

At the 29 September 2004 VA Compensation and Pension (C&P) psychiatric evaluation, 5 months after separation, the CI reported he had difficulty due to worrying about all of his everyday concerns with his mind churning away.  He even worried about video games he played, had some checking behaviors and problems going to sleep but awakened early.  He used three alarm clocks due to concerns of not waking up on time.  He kept lists regarding things he needed to get done.  He had many anticipatory worries and tried to avoid crowded places, heights, busy traffic areas and enclosed spaces.  His panic attacks occurred more often at night.  He reported that he became depressed easily if he thought too much about his panic attacks.  His energy level was low and he stopped playing sports because they also seemed to increase his panic attacks.  He was looking for work and felt optimistic about obtaining a job.  He reported that he would enjoy doing his military job again and was NCO of the year when he left the military.  MSE showed an anxious mood and affect.  A diagnosis of “generalized anxiety disorder (GAD) with panic attacks, without agoraphobia” was rendered and obsessive-compulsive features (making lists) were noted.  His GAF score was 58 (moderate.)

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the anxiety disorder 30%, coded 9413 (anxiety disorder NOS), citing definite social and industrial impairment, but reduced the rating to 10%, citing that the CI’s non-compensable, non-ratable personality disorder significantly affected the severity of the anxiety disorder.

The VA rated the anxiety disorder 30%, coded 9400 (generalized anxiety disorder), based on the C&P examination 5 months after separation, citing “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, [and] mild memory loss (such as forgetting names, directions, recent events).”  Application of VASRD §4.129 is considered by the Board 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.  The panel next considered the rating deduction and noted the CI had served since 1992 without incident.  He had excellent to superior EPRs during that time.  His commander noted there had been no problems with peers, no behavioral problems, and no known mental issues prior to transfer to Korea.  The NARSUM examiner did not provide evidence that a personality disorder of any type interfered at any time with the CI’s performance in the service.  Both the NARSUM and C&P examiners identified anxiety disorders as the primary Axis I diagnoses.  While panel members agreed that personality disorders can carry significant psychopathology for which deduction could be warranted, the NARSUM psychiatric examiner gave no information on which to base such a mathematical calculation.  Members concluded that it was not possible to clinically dissect the psychiatric impairment from the available evidence into ratable and unratable origins, and any such attempt would require undue speculation.  Members concluded the 20% deduction was not warranted, and thus agreed that its recommendation should concede the total §4.130 impairment in evidence as subject to service rating.

The panel then considered the evidence for a §4.130 rating.  Stabilization for the CI’s anxiety condition required a hospitalization that exceeded one month (January 6-February 9, 2004.)  Both the NARSUM and the C&P examinations documented impaired mental status.  The C&P examination noted the CI was actively looking for a job, was optimistic, but had not yet found work since separation.  The MEB was initiated prior to hospital discharge and the C&P examination, 5 months after separation, noted continued anxiety, panic attacks, sleep difficulty and depression, meeting criteria for a 30% disability.  The §4.130 criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  The panel agreed there was no evidence of impaired reliability and productivity.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the anxiety disorder, coded 9413.

BOARD FINDINGS:  In the matter of the anxiety disorder, the panel unanimously recommends a disability rating of 30%, 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; 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	
Anxiety Disorder	9413	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160915, 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-2016-00777.

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.  The Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay

I 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 this 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 XXXXXXXXXXXXXXXXXX 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,

Attachment:
Record of Proceedings