RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02746
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Computer Systems Craftsman, medically separated for “dysthymic disorder” with a disability rating of 10%.  

CI CONTENTION:  “Please review all conditions.”  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 - 20090415	VARD - 20080111	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Dysthymic Disorder	9433	10%	Anxiety Disorder	9413	30%	20070723	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40% 	

ANALYSIS SUMMARY:  

Dysthymic Disorder.  According to service treatment record and MEB narrative summary (NARSUM), the CI’s mental health (MH) disorder began in 2005 with sleep problems, lack of motivation, chronic lack of energy, hopelessness, poor concentration and lack of sex drive.  There was no history of suicidal or violent behavior and no history of inpatient psychiatric care.  The CI was treated in the emergency room once in 2005, (4 years before separation) for a panic attack.

At the 16 December 2008 MEB NARSUM examination, 6 months prior to separation, the CI indicated a primary concern that his mood state limited social role functioning.  The CI had a history of intermittent treatment with an antidepressant medication since 2005.  It was noted that his treatment was primarily at the local VA since July 2007, and he was being treated for dysthymia.  The examiner referenced a July 2007 VA Compensation and Pension (C&P) examination, 23 months prior to separation that noted the CI’s problems began in 2000 after his wife left him.  They had been married for 6 months.  He had been unhappy and depressed half of the time since then.  In late 2004 and early 2005 he was placed on an antidepressant, and took it initially for about 3-6 months and then a second trial of the medication for about 4 months.  He reported the medication had helped his depression and his sleep.  The psychiatrist diagnosed dysthymic disorder and anxiety disorder not otherwise specified.  The NARSUM examiner summarized the C&P examination noting the CI had brief treatment in 2005, 2006 and 2007, and overall impression was that his symptoms were well controlled with medication and not duty impacting.  

At the time of the NARSUM, the CI was being treated with an antidepressant medication, as well as medication for insomnia and restless leg syndrome (sleep disorder that interferes with initiation and maintenance of sleep).  The CI denied symptoms of anxiety including PTSD, mood swings, irritability, and psychotic symptoms.  He admitted to social isolation; however, details were not supplied.  The CI had been in and out of MH treatment.   The NARSUM noted the absence of treatment in 2008 with return to treatment in January 2009.  At the time of the NARSUM, he was taking Zoloft.  Mental status examination (MSE) was unremarkable with the exception of a “bad” mood.  The diagnosis of dysthymic disorder was recorded with a Global Assessment of Functioning (GAF) Score of 65 for mild symptoms and or impairment.  The examiner stated that the CI denied any current symptoms.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MH disorder 10%, coded 9433 (dysthymic disorder).  The VA rated the MH disorder 30%, coded 9413, (anxiety disorder, not otherwise specified), based on the C&P examination 23 months before separation.  Panel members agreed that the provisions of VASRD §4.129 for a “mental disorder that develops in service as a result of a highly stressful event” were not applicable in this case.

The panel next proceeded with the rating recommendation.  The panel considered the absence of emergency room treatment, hospitalization and apparent stability of symptoms in the absence of consistent medication therapy during the 12 months before separation.  The NARSUM examination documented a stable and mild condition.  The commander’s statement, 5 months before separation, indicated the CI’s condition had had no impact on his ability to perform the duties of his MOS.  There was no mention of difficulties with supervisors or co-workers and no indication that the MH symptoms had impacted duty performance.  It was noted that the CI would not be available for possible training opportunities and overseas deployments due to profile restrictions.  Panel members agreed, the 10% rating and no higher was justified for “occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication.”  After due deliberation, considering all of 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 dysthymic disorder.  

BOARD FINDINGS:  In the matter of the dysthymic 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 20170424, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02746.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

						Sincerely,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings