RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03143
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050503

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Aircraft Structural Maintenance Apprentice, medically separated for “anxiety disorder” with a disability rating of 10%.   

CI CONTENTION:  “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 - 20050321	VARD - 20051121	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder	9413	10%	Generalized Anxiety Disorder with Panic Attacks	9400	50%	20050722	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Anxiety Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI self-referred her anxiety disorder for behavioral health care when she developed anxiety and body image concerns.  During specialty mental health treatment, she revealed more intensive issues with panic attacks and severe occupational problems.  Her treatment consisted of individual psychotherapy, cognitive skills training, and medication evaluation and management.  She had multiple trips to the emergency room (ER) for panic symptoms, typically which occurred during work.  

The 24 January 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of strong general anxiety symptoms, and at times, debilitating panic episodes.  She reported regular sleep problems, panic attacks, constant worry, an inability to apply healthy coping strategies, and poor overall response to treatment.  She was treated with anti-depression and anti-anxiety medication, and took the latter on an as needed basis, but sometimes as often as daily; she also took a sleep aide.  The CI made multiple ER trips for panic symptoms, typically occurring while at work despite accommodating schedule modifications for her problems and stress.  She was convinced her problems stemmed from her being a poor fit with the military environment and struggled with occupational related anxiety and poor adaptation to her career field.  Mental status examination (MSE) showed mild anxiety and depressed mood.  A diagnosis of “anxiety disorder NOS with intermittent situational panic attacks, occupational problems and partner relational problems” was rendered with a Global Assessment of Functioning (GAF) score of 55 (moderate symptoms, impairment).  The examiner stated that she had a significantly debilitating anxiety disorder manifested in inadequate coping and recurrent occupational and social dysfunction.  

At the 22 June 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported severe episodes of anxiety sometimes times associated with panic attacks.   She awoke tense, feeling “tightly wound,” and that she could not function normally during the day fearing an anxiety attack at her workplace where she was a part-time waitress.  She also described daily periods of depression, interwoven with her anxiety, and that she was not involved in activities and leisure pursuits because of her job, home responsibilities and fragile emotional status.  The CI stated she was briefly hospitalized for anxiety, panic attacks and related somatic symptoms in 2005 after she could not recall how she drove home one day and found herself unable to talk.  She took anti-anxiety and anti-depression medication and remained in outpatient psychotherapy treatment.  She was enrolled in an online college program, socialized with her husband and his friends, and had missed less than 1 week of work in the past year due to anxiety, depression or fatigue.  Psychological testing showed severe depression and the MSE revealed anxiety, elated mood, easy distraction, fatigue, sleep impairment, panic attacks and mildly impaired memory.  A diagnosis of generalized anxiety disorder was rendered with a GAF score of 59 (moderate symptoms, impairment).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the anxiety condition 10%, coded 9413 (anxiety disorder, NOS) citing mild social and industrial impairment.  The VA rated the condition 50%, coded 9400 (generalized anxiety disorder) based on the STR and C&P examination, citing reduced reliability and productivity.  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 if there was evidence for a §4.130 rating higher than the assigned 10%.  The §4.130 criteria for a 10% rating includes “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,” while a 30% rating stipulates “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  A 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  Members noted that while the NARSUM examination documented anxiety and panic attacks with multiple interventions, the CI felt her problems stemmed from a poor fit with the military and had no motivation for adjustment focused treatment; the provider rated her social and industrial impairment as “mild.”  The C&P examination noted the CI worked part-time with occasional absences, was enrolled in an online college program, and socialized with her husband and friends.  Therefore, the panel agreed the condition most closely met criteria for 10% disability.  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 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 20170330, 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-2017-03143.

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