RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01365
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20041001

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Intelligence Specialist, medically separated for “anxiety disorder, not otherwise specified (NOS)” with a disability rating of 10%.  

CI CONTENTION:  “Anxiety 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 Medical Evaluation Board (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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040812	VARD - 20050330	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder NOS	9413	10%	PTSD w/ Depressive Features…	9434-9411	70%	20040818	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Anxiety Disorder NOS.  According to the service treatment record and MEB narrative summary (NARSUM), the CI requested evaluation for a mental health (MH) condition the day after accession in 1995 due to a history of repeated sexual trauma (multiple rapes).  She was evaluated in MH and allowed to complete training.  She next was evaluated on 29 December 1998 when she reported a recent “rape” by an acquaintance.  She did not press charges and the physical examination was normal (no trauma).  A subsequent note documented that is was a “date rape.”  The record then falls silent until October 2003 when she was evaluated in psychiatry for anxiety and depression following the suicide of a brother.  The panel noted that this same psychiatrist provided ongoing care for the CI and prepared the MEB NARSUM (below).  She was begun on medications which were adjusted over the next few months.  During this time, she was thought to be fit for unrestricted duty.  On 31 December 2003 she was seen in the emergency room for an anxiety attack, the only one in the record.  She was then seen by the treating psychiatrist on 20 January 2004.  This was the last MH note in evidence prior to the MEB NARSUM.  It was noted that the anxiety and depressive disorders were well controlled by her medications and that she remained fit for unrestricted duty.  

On 1 April 2004, the CI underwent cardiac surgery for which she was placed on 8 months limited duty.  The non-medical assessment (NMA), dated 16 June 2004, noted restrictions from the surgery, but also recorded that her performance as the “Command Indoctrination Coordinator” had been outstanding.  

During the 1 July 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported depression, anxiety, post-traumatic stress disorder (PTSD), and panic attacks as well as a pre-service suicide attempt.  The MH examination noted she was tense and talkative.  

The 2 July 2004 MEB psychiatric NARSUM examination, 3 months prior to separation and accomplished by the treating psychiatrist, noted significant pre-service emotional and sexual trauma exacerbated by the recent death of a brother.  She endorsed symptoms from depression and anxiety, but denied dysfunction in her life although the sexual aversion did result in some marital discord.  There was some psychomotor retardation with slowed speech and low volume.  Her mood was dysphoric and affect congruent.  Cognition was intact.  The depressive disorder was thought to be resolved and the anxiety disorder thought to be in partial remission.  Ongoing panic attacks were not recorded.  A Global Assessment of Functioning score (GAF) was assessed as in the low 60s, indicative of mild symptoms.  She remained fit for full duty in the opinion of the psychiatrist.  

At the 18 August 2004 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported symptoms of PTSD and ongoing depression which predated the suicide of her brother.  She endorsed panic attacks one to two times a week.  She reported she had been stalked in 1998 and forcibly raped by the perpetrator in her home while her three children were present. The panel observed that this history was inconsistent with the contemporaneous records.  The mental status examination revealed symptoms of depression and anxiety.  Thought processes were intact, but some impairment of memory was present.  A GAF of 50 was assigned, indicative of severe symptoms.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated anxiety disorder NOS at 10%, coded 9413 (anxiety disorder, NOS), citing minimal impairment and noting family stressors.  The VA rated the MH condition as PTSD “with depressive features…” at 70%, coded 9434-9411 (major depressive disorder-PTSD), based on the C&P examination, citing a significant functional impairment. 

The panel observed that the MEB NARSUM was prepared by the treating psychiatrist who consistently had determined the CI to be fit for duty at multiple encounters.  The NMA also noted the CI’s performance was outstanding.  The history provided by the CI to the VA examiner was not entirely consistent with the historical record, reducing the probative value of this examination.  The preponderance of evidence supported the 10% adjudication by the PEB.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the anxiety disorder NOS condition.  

BOARD FINDINGS:  In the matter of the anxiety disorder NOS condition and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160926, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN