DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD DC 20374-5023

From: To:

Director, Secretary of the Navy Council of Review Boards PD-2017-00525

IN REPLY REFER  TO

1850
CORB:003
12 Feb 20

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr of 3 Jan 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the ·Department of the Navy for appropriate action.

2.	On 31 January 2020, the Assistant Secretary of the Navy took action in your case by accepting the correct recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Physical Evaluation Board from 10 to 50 percent with assignment to the Permanent Disability Retired List.

3.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the Navy Personnel Command for correction of your records as stated above.	You will be notified once those changes are complete.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX		CASE: PD-2017-00525 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20070724

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

CI CONTENTION:  No specific contention was made.  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 - 20070521	VARD - 20071206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder, NOS	9413	10%	Depressive Disorder and Anxiety Disorder with Fainting Spells	
9434	
70%	
20071115	
Somatoform Disorder	Cat II					
Obsessive-Compulsive Disorder	Cat II					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Anxiety Disorder, NOS. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s anxiety disorder began in about 2005 or 2006 when she presented to the emergency room to rule out syncope after experiencing anxiety during an examination. In January 2007, she was seen for anxiety disorder with obsessive-compulsive and somatoform disorders ruled out; a Global Assessment of Functioning (GAF) score 65-70 (some mild symptoms) was rendered, and she was treated with an anti-anxiety medication and supportive therapy. She described experiencing acute anxiety due to the likelihood of being sent to Field Medical School and a deployment thereafter. She also had various stressors related to her boyfriend and family

issues, and reported symptoms such as having to line things up, including closet hangers, no cross outs on paperwork, difficulty touching door knobs, and constantly cleaning her cell phone. An antidepressant was added to the medication regimen, but her symptoms continued to worsen.

In March 2007, the CI complained of increasing problems with concentration and sluggish thought processes likely due to the new medications. She complained of extreme insomnia caused by the anxiety and had increasing troubles with her coworkers and commanding officer. She was very angry, agitated, and had visible tics. She improved during a vacation, but developed severe symptoms thereafter. She also complained of transient auditory and visual hallucinations, but denied any florid hallucinations; however, she reported acute paranoia, often looking over her shoulder or in the rearview mirror to see if someone were following or listening to her. She denied any consistent auditory hallucinations involving voices or several voices talking to each other. The CI also had fears about abandonment, which increased her obsessive compulsive rituals. The psychosis appeared to be transient in the context of the anxiety disorder. Despite medication and care, her symptoms continued to worsen.

The 12 April 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of anxiety and distress. Mental status examination (MSE) revealed the CI was alert and oriented, and appeared quite nervous and socially awkward. She displayed involuntary tics in her right arm and shoulder and was often easily overwhelmed with an anxious mood. Range of affect was restricted, but generally congruent with the subject matter discussed, and speech was mostly within normal limits. Thought processes were linear and goal directed, but often illogical and distorted; however, she did not appear to have a formal thought disorder. The examiner noted that as the CI progressed through treatment, she started reporting suicidal ideation, but without any plan or intent. Psychomotor activity was within normal limits, and insight, judgment, and impulse control were fair. The Axis I diagnoses were: obsessive-compulsive disorder, with symptoms causing marked anxiety and distress in social, emotional, and occupational functioning; and generalized anxiety disorder, marked by symptoms of restlessness, fatigue, difficulty concentrating or remembering minor details, complaints of her mind going blank, irritability, paranoia, physical complaints such as gastrointestinal problems and muscle tension, and sleep disturbance.  The GAF score was 50 (serious symptoms).

At the 15 November 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported severe anxiety, extreme stress, obsessive compulsive thoughts with a fear of germs, and being depressed. The MSE noted orientation to person, place, time and purpose, with normal appearance and hygiene as well as appropriate behavior. Affect and mood were anxious and depressed, and she reported anxiety and depression every day. She communicated well with normal speech and concentration. She denied panic attacks, suspiciousness, delusions, or hallucinations; however, she did have obsessive rituals with constant cleaning. Her thought processes were normal with judgment and memory intact and the ability to think abstractly; there was no suicidal or homicidal ideation. The Axis I diagnoses were major depressive disorder, and generalized anxiety disorder, with a GAF score of 50. The examiner noted that she had difficulty establishing and maintaining effective work and social relationships, and her psychiatric symptoms caused occupational and social impairment, with reduced reliability and productivity, as evidenced by disturbance of mood and motivation, and near continuous depression and anxiety.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the anxiety disorder 10%, coded 9413 (anxiety disorder, NOS). The PEB listed somatoform disorder and obsessive-compulsive disorder as related Category II diagnoses contributing to the disability in this case. Members concluded that these additional mental health conditions could not be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding). The VA rated the  anxiety  disorder  70%,  coded  9434  (major  depressive  disorder),  based  on  the  C&P

examination, citing findings of occupational and social impairment with deficiencies in most areas. The panel agreed that at the time of separation, the §4.130 threshold for a 70% rating was just barely approached since the CI had obsessional rituals, but no other significant symptoms warranting that rating. However, she did have occupational and social impairment with reduced reliability and productivity consistent with a 50% evaluation marked by restlessness, fatigue, difficulty concentrating or remembering minor details, complaints of her mind going blank, irritability, and paranoia. She also had physical complaints to include gastrointestinal problems and muscle tension, sleep disturbance, and obsessive-compulsive symptoms, which caused marked anxiety and distress in her social, emotional, and occupational functioning. The CI was unable to function satisfactorily in the full extent of her job and experienced acute anxiety with the news of medical field training and a likely deployment. She did not experience any significant improvement in symptoms after her training was cancelled and she was placed on limited duty, and thus members agreed that her disability exceeded a 30% rating, which requires “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily).” After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 50% for the anxiety disorder, coded 9413.

BOARD FINDINGS: In the matter of the anxiety disorder, the panel recommends a disability rating of 50%, coded 9413 IAW VASRD §4.130. 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Anxiety Disorder	9413	50%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170218, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record