RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02040
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080923

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

CI CONTENTION:  Review requested of the mental health conditions as well as conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) along with their unfitting mental health condition.  

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 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.  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 - 20080617	VARD - 20081203	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder, NOS	9413	10%	Anxiety Disorder, NOS	9413	30%	20081016	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Anxiety Disorder, Not Otherwise Specified (NOS).  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s anxiety disorder began while deployed from October 2006-January 2007.  He denied a specific trauma, but described several “near misses” and tracers flying by his head, and that he would “hear things” while walking in the dark.  He also reported “something about the dark” that bothered him upon redeployment and felt anxious, insecure and afraid.  During a primary care visit in February 2007, the CI complained of difficulty sleeping and the provider prescribed him a sleep aid and referred him to mental health (MH) due to post traumatic stress disorder (PTSD) symptoms.  He did not seek MH treatment due to his “ego,” and despite the sleep aid, still had insomnia as well as nightmares 5-6 times a week.  He continued to experience fear of the dark, nightmares, and feeling “overwhelmed and boxed in” in crowds, but denied full panic attacks.  

The 17 October 2008 MEB NARSUM examination, 11 months prior to separation, documented that in December 2007, the CI became angry, upset and started crying while talking about Iraq.  After emergency room treatment, he was put on watch and started therapy with a psychiatrist.  During the 1 February 2008 MEB psychiatric evaluation, the provider diagnosed delayed PTSD and determined that because he had only been on medication for 2 weeks, re-evaluation would be required after a trial of treatment.  

At the 19 March 2008 MEB NARSUM MH addendum examination, 6 months before separation, the CI reported “fear of the dark” with only slightly improved symptoms since treatment began.  He slept only 3-4 hours per night and had nightmares 3-4 times per week of being chased or of falling.  He sometimes woke up sweating or with his heart pounding and vacillated between irritability and depression; he had only occasional flashbacks, triggered by seeing a man treated for a gunshot wound.  The CI was unable to do anything that occurred at night, even when at home, and became vigilant when he believed he heard noises after dark.  He reported decreased energy and concentration, and feared getting so angry he would be uncontrollable and hurt someone.  He was taking Depakote (anti-convulsion, mood stabilizer), Zoloft (anti-depression), Ativan (anti-anxiety), and Restoril (sleep).  The mental status examination (MSE) revealed that he was fidgety and often apologetic with initially mildly pressured speech which calmed slightly during the interview.  Mood varied between depressed and irritable, but he was future oriented.  Affect was anxious, apologetic and blunted without smiling, and he tapped his right leg throughout the interview; insight and judgment were fair.  The examiner opined that medications had not relieved his symptoms and that he was “between mildly and definitely impaired” due to his anxieties.  A diagnosis of anxiety disorder, NOS, “manifested by PTSD-like symptoms” was rendered, but the psychiatrist determined that diagnostic criteria 1 and 2 for PTSD were not met.  

At the 16 October 2008 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported he stopped medication after being discharged because he felt it made him sick after taking it.  He felt paranoid in public, and was irritable, hyper vigilant and avoided crowds, but denied psychiatric hospitalizations or suicide attempts.  He was unemployed since he decided to stay home with the kids, but he did volunteer one hour per week as a fireman.  His marriage was good and his leisurely pursuits included playing golf, woodworking, hunting and fishing.  The MSE was essentially unremarkable, except for reports of hypnagogic hallucinations (occur prior to sleep) of his bed floating around.  A diagnosis of anxiety disorder, NOS was rendered with a Global Assessment of Functioning score of 80 (minimal symptoms).  

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), citing occupational and social impairment due to mild or transient symptoms which were controlled by medication.  The VA rated the anxiety disorder condition 30%, also coded 9413, based on the C&P examination, citing occupational/social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  

Application of VASRD §4.129 is considered by the panel 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 then considered whether there was evidence for a §4.130 rating higher than the 10% assigned by the PEB.  The C&P examination was most proximate to separation and noted an unremarkable MSE.  Additionally, the CI reported no medication use, good relationships, and partaking in some leisure interests and volunteer work.   Thus, the panel agreed that a 10% rating, but no higher, was warranted.  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.  

BOARD FINDINGS:  In the matter of the anxiety disorder 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 20170221, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       

Enclosure