RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01311
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040405

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Aircraft Armament Systems Journeyman, medically separated for “specific phobia” with a disability rating of 10% minus a 10% deduction for “less aggravating/contributing factors,” for a final disability rating of 0%.  

CI CONTENTION:  His depression and knee pain conditions continue to worsen and negatively impact daily activities.  He was not evaluated for jaw and tinnitus 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 MEB, but determined by the PEB 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 - 20040126	VARD - 20041207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Specific Phobia	9403	10%- 10%*=0%	Depression and Specific Phobia	9434	NSC	20041124	
Adjustment disorder with depressed mood	Not Unfitting					
Bilateral Knee Strain	Not Unfitting 	Left Patellofemoral Syndrome	5260			
		Right Patellofemoral Syndrome				
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	
*10% deduction for less aggravating/contributing factors

ANALYSIS SUMMARY:  

Specific Phobia.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health (MH) condition began in October 2001 after a bomb he was loading fell from a trailer nearly missing his leg.  He initially complained of labile moods beginning in February 2002, one month after returning from deployment.  After an MH evaluation, he was diagnosed with adjustment disorder with mixed emotional features and no follow-up appointment was scheduled.  At the end of May 2002 he was reevaluated and additionally diagnosed with partner relational problems.  He was advised to enroll in individual counseling along with anger management and communication classes.  The next MH examination occurred in February 2003 and he was diagnosed with major depressive disorder after which he enrolled in individual therapy which he attended intermittently at intervals from 1 week to 3 months until separation.  The CI underwent a command-directed MH evaluation in July 2003 that rendered a specific phobia diagnosis.  

The 15 December 2003 MEB NARSUM examination, 4 months prior to separation, noted his intense fear of loading munitions after the October 2001 incident.  He reported that since being away from the flight line his MH symptoms had resolved, but he experienced feeling a lack of pleasure, depressed mood and hopelessness, with loss of energy and appetite.  He denied any suicidal ideation.  He attributed these symptoms to a recent breakup with his fiancé, curtailment of his military specialty duties, and having to mop floors and perform miscellaneous janitorial work.  He also reported interpersonal work difficulties and feeling like he was not given the opportunity to succeed.  The CI was not taking depression or anxiety medications.  The mental status examination (MSE) showed normal psychomotor activity and speech.  “Mood is mildly dysphoric, affect restricted, appropriate and mood congruent, no lability."  Insight and judgment were fair; thought processes were logical and goal-directed.  There was no evidence of psychosis.  The psychiatrist’s summary stated the CI had significant occupational difficulty but the specific phobia could not be treated due to his command’s refusal to allow him to be in close proximity to munitions for desensitization. 

At the 24 November 2004 VA Compensation and Pension (C&P) evaluation, 7 months after separation, the CI reported a generally good mood with some “bad days.”  The CI did not feel like he needed to return to therapy and stated he believed he could return to bomb loading without phobia; although he believed he would be hypervigilant during the process.  The CI was working as a security guard and liked his job.  He also maintained good relationships with his parents, sister and one close friend with whom he enjoyed socializing.  The MSE showed a normal appearance and he was oriented and cooperative throughout the interview.  There were no signs or symptoms of psychosis.  His mood was normal and affect was ranging and self-modulated.  No evidence of problems with impulse control or cognitive impairments were noted.  The psychiatrist concluded the CI had no MH diagnosis at the time of this evaluation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the phobia condition 10%, coded 9403 (specific phobia),  then deducted 10% for less aggravating/contributing factors, citing an opinion that the adjustment disorder was not ratable and it significantly affected the severity of the specific phobia.  The VA did not service-connect the phobia condition, coded 9434 (major depressive disorder), based on the C&P evaluation 7 months after separation, citing the medical evidence of record failed to show that the disability had been clinically diagnosed.  

The panel noted the CI had one or more MH diagnoses with occupational and social impairment due to mild or transient symptoms that decreased work efficiency and ability to perform occupational tasks only during periods of significant stress for a 10% rating under the General Rating Formula for Mental Disorders as adjudicated by the PEB.  There was no evidence of intermittent periods of inability to perform occupational tasks due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment or memory loss to validate then next higher 30% rating.  The panel found no justification for a deduction from the disability rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the specific phobia condition, coded 9403.  

Contended PEB Conditions:  Bilateral Knees and Adjustment Disorder with Depressed Mood.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The panel noted that the knee condition was profiled three times in the 2 years prior to separation and each time was for 2 or 3 weeks; however, the knee condition was not included in the permanent profile.  The knee condition was not implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the knee condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended knee condition and so no additional disability rating is recommended.  

The panel further noted that adjustment disorder is rated using the general rating formula for mental disorders as is the specific phobia and therefore could not be separately rated IAW VASRD §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited) so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the phobia condition, the panel unanimously recommends a disability rating of 10%, coded 9403 IAW VASRD §4.130.  In the matter of the bilateral knees condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the adjustment disorder with depressed mood condition IAW VASRD §4.130 the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Specific Phobia	9403	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160930, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAF/MRB

XXXXXXXXXXXXXXXXXX

Dear Applicant:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-01311.

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.  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,

Attachment:
1.  Directive 
2.  Record of Proceedings