RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01329
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20050902

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Security Forces Journeyman, medically separated for “panic disorder with agoraphobia associated with generalized anxiety disorder” which was determined to have existed prior to service (EPTS) with some service aggravation. The PEB rated the disorder 30%, then deducted 20% for EPTS for a final disability rating of 10%.  

CI CONTENTION:  He was given a higher rating for his condition by the VA.  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 - 20050712	VARD - 20060411	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Panic Disorder with Agoraphobia Associated with Generalized Anxiety Disorder	9412	30%
-20%
10%	Generalized Anxiety Disorder, Panic Disorder, Bilateral Chondromalacia with Patellofemoral Pain Syndrome and Migraines	9400	50%	20060213	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Panic Disorder with Agoraphobia Associated with Generalized Anxiety Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI reported onset of anxiety symptoms several months after joining the military in 2002.  Anxiety episodes were described as mild and infrequent but increased in severity to insomnia, panic attacks, and generalized anxiety.  The CI sought treatment in late 2003.  There was no history of treatment in the emergency room or hospitalization related to his mental health condition.  

The 4 May 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of insomnia, anxiety, excessive sweating, nervousness, irritability, feeling of panic, increased heart rate, and a sense of impending doom.  Panic attacks occurred 3-4 times a week which lasted up to several hours.  The CI denied any mental health treatment prior to service, but reported taking an antidepressant medication at age 14 due to migraine headaches.  The CI also endorsed a childhood history of hydrophobia (fear of water).  The mental status examination was unremarkable except for an anxious mood and restricted affect.  His speech was slow and monotone.  The examiner rendered diagnoses of panic disorder with agoraphobia and generalized anxiety disorder; indicating neither was EPTS.  Additionally, a specific phobia (hydrophobia) was diagnosed which was noted to be EPTS.  The Global Assessment of Functioning (GAF) score was 70 for mild symptoms.  The commander’s statement dated 14 June 2005 stated the CI could not perform his duties due to anxiety disorder and medication.  The commander stated the CI is unable to carry his duty weapon due to medication.  During a life skills evaluation on 23 June 2005, 2 months before separation, the CI reported less anxiety this week.  He was still taking psychotropic medication due to anxiety.  The mental status examination was essentially normal.  The examiner assessed the CI’s anxiety and panic problems were fairly well controlled.  Panic disorder with agoraphobia and generalized anxiety disorder were diagnosed with a GAF score of 75 (mild/transient symptoms).  

At the 13 February 2006 VA Compensation and Pension (C&P) mental disorders examination, 5 months after separation, the CI reported constant anxiety and panic attacks that occurred weekly, and mild sleep problems.  The CI continued to take psychotropic medication and indicated a fair response to treatment.  He was still receiving individual psychiatric therapy and was employed as a full time security guard.  The mental status examination was relatively unremarkable, noting absence of memory, thinking, or judgment problems and no suicidal or homicidal ideation.  The CI was suspicious towards the examiner with an anxious mood and affect, and showed mild psychomotor activity (hand wringing).  The CI was diagnosed with general anxiety disorder and panic disorder, and the GAF score was 50 (severe symptoms).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the mental health condition 30%, then deducted 20% for EPTS factors, coded 9412 (panic disorder and/or agoraphobia).  The VA rated the mental health condition 50%, coded 9400 (generalized anxiety disorder), based on the C&P examination, citing the rating was a prestabilization rating.  

Members first deliberated if the PEB’s EPTS deduction should be applied.  The CI’s entry physical examination, dated 26 February 2002, did not document a mental health diagnosis or history.  The CI denied receiving any mental health treatment prior to service.  The only documented EPTS evidence was cited in the MEB NARSUM as the CI reporting a longstanding fear of water (hydrophobia).  Although the CI may have had an EPTS hydrophobia condition, the panel agreed the CI’s mental health impairment at service entry was 0%.  Additionally, the panel agreed that the PEB did not present clear and unmistakable evidence, based upon well-established medical principles, that any of the CI’s mental health diagnoses were not permanently aggravated beyond natural progression.  Thus, the panel concluded that the EPTS deduction should not be applied.  
The panel then considered if VASRD §4.129 (military separation due to a highly stressful event) was applicable.  All members agreed that neither the STR nor VA evidence showed the CI’s mental health condition was caused by a highly stressful event.
The panel next deliberated the mental health rating IAW VASRD §4.130 at separation.  The MEB NARSUM documented the CI benefitted from medication; however, his panic attacks were fairly resistant to medication and continued to occur on a weekly basis.  The NARSUM noted the CI’s anxiety caused chronic insomnia which resulted in a moderate military impairment; however, the NARSUM GAF score reflected mild symptoms.  During a life skills evaluation 2 months prior to separation, the CI’s mental health symptoms seemed to be improving with an essentially normal mental status examination and GAF score of 75.  At the VA examination the CI reported mild insomnia and weekly panic attacks.  He still required psychotropic medication and therapy.  The GAF score was in the severe range.  The VA examiner noted the CI had decreased occupational and social functioning only during periods of stress and that the severity was mild or transient.  The panel also considered the absence of documented psychiatric hospitalizations, emergency room visits, and suicidal/homicidal ideation.  Members agreed that the VASRD §4.130 criteria for a 50% rating (reduced reliability and productivity) was not met.  After a careful review of the evidence, the panel determined the CI’s mental health symptoms were not controlled by medication, he still required individual psychiatric therapy but was fully employed.  Hence the 30% rating defined as “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks” best reflected the CI’s mental health condition at separation.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the panic disorder, coded 9412.  

BOARD FINDINGS:  In the matter of the panic disorder, the panel recommends a disability rating of 30%, coded 9412 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	
Panic Disorder with Agoraphobia Associated with Generalized Anxiety Disorder	9412	30%	

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews,  MD  20762

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01329.

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 your separation be re-characterized to reflect disability retirement, rather than 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 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 the aforementioned 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 (210) 565-2273 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.