From: To:

IN   REPLY   REFER  TO:

20 Feb 20

Director, Secretary of the Navy Council of Review Boards 
PD-2017-02071

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 13 Feb 19

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

2.	On 12 February 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-02071
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20070622

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Global Command and Control System Common Operational Picture/Maritime Operator, medically separated for “panic disorder with agoraphobia” with disability rating of 10%

CI CONTENTION:	His  mental  disability  continues  to  worsen  and  affects  his  ability to hold employment.  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 - 20070430	VARD - 20070904	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Panic Disorder with Agoraphobia	9412	10%	Anxiety Disorder, NOS with Depressive Disorder	9434-9412	50%	20070522	
Depressive Disorder, Not Otherwise Specified [NOS]	Cat II					
Post Ablative Primary Hypothyroidism Status Post Radio Iodine Ablation for Graves’ Disease	Cat III	
Hypothyroidism Secondary to Graves' Disease	
7903	
10%	
20070522	
Hypothyroidism Secondary to Previous Treatment for Graves’ Disease	Cat III					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

Panic Disorder with Agoraphobia. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI initially experienced anxiety, fear and heart palpitations in March 2006. He was prescribed an anti-anxiety medication in January 2007, but was afraid to take it until a visit to the emergency room for a panic attack on 21 January 2007. At a mental health visit on 23 January 2007, he described feeling stressed at work and was discouraged due to concerns with not being able to be promoted. He also reported some symptoms of depression and that he drank large amounts of coffee and several sodas every day. The provider noted that he was diagnosed with hyperthyroidism at age 15 due to Graves’ disease, underwent radio iodine thyroid ablation at 17, and took thyroid medication (Synthroid).

The 8 March 2007 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of anxiety attacks which were triggered by reminders of death, being in the shower, while driving and sometimes for no reason. He was anxious in small spaces and when he was alone, and reported fearing future attacks and avoided thoughts that might precipitate an attack. He also felt sadness and symptoms of depression over the previous 7 months. Medications include Zoloft (anti-depression), Synthroid, which was recently increased, and a sleep aide. Mental status examination (MSE) showed anxiety, especially when discussing somatic concerns, and the fear something was wrong with him, but his mood was “better.” Axis I diagnoses included panic disorder with agoraphobia (mild to moderate impairment), hypochondriasis and depressive disorder NOS (mild impairment). An Axis III diagnosis of hypothyroidism due to previous treatment was also listed. A Global Assessment of Functioning (GAF) score of 51-60, (moderate symptoms) was rendered, and the examiner noted some symptoms existed prior to service, but were never formally diagnosed. The April 2007 non-medical assessment noted the CI was away from current duties an average of 8 hours per week.

At the 22 May 2007 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported a year-long history of symptoms as described above, but also including sweaty palms, a sense of dread and not wanting to go outside, and an inability to be alone. He also reported symptoms of depression but no suicidal ideation, and had not required hospitalization. He experienced moderately severe panic attacks twice a week, and he still drank a large cappuccino every day, but able to drive and function for the most part. Medications remained the same and he had attended some therapy classes. He still did not like to go out much but had a job and a girlfriend. He lost an estimated 26 days from work in the past year and he felt his performance was not as good as it could be due to anxiety at work. At the MSE, the  CI reported he was depressed and anxious, but denied suicidal ideation. Even though he had difficulty sleeping sometimes, it did not interfere with daytime activities.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the panic disorder 10%, coded 9412 (panic disorder and/or agoraphobia), and listed depressive disorder, NOS as a related diagnosis (Category II) contributing to the disability in this case. The panel concluded that the depressive disorder could be reasonably justified as separately unfitting; nor would a separate rating be achievable without violation of VASRD §4.14 (avoidance of pyramiding). Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for mental health conditions. The VA rated anxiety disorder, NOS with depressive disorder 50%, coded 9434-9412 (major depressive disorder-panic disorder), based on the C&P examination, citing depressed mood, crying spells, a sense of being a failure, anxiety characterized by sweaty palms, a sense of dread…panic attacks about twice a week, and sleep impairment and requiring continuous medication.

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 CI reported ongoing panic attacks at least weekly, depression and anxiety but he was able to function, work and having a girlfriend. He continued to take his medication which resulted in improvement of symptoms. The panel concluded the symptoms were mild and most closely met criteria for a 10% rating. 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 panic disorder.

Contended PEB Conditions: Post Ablative Primary Hypothyroidism Status Post Radio Iodine Ablation for Graves’ Disease…; Hypothyroidism Secondary to Previous Treatment for Grave’s Disease. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. Although the conditions were noted on limited duty forms, none were implicated in the non-medical assessment or failed retention standards. There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the panic disorder with agoraphobia and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication. In the matter of the contended thyroid condition, the panel recommends no change from the PEB determinations as not unfitting. 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 20170227, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record