RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03162
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051209

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Vehicle Operator Craftsman, medically separated for “dysthymia” with a disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 - 20051027	VARD - 20060508	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Dysthymia	9433	10%	Dysthymia	9433	30%	20060404	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Dysthymia.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s dysthymia (chronic depression) began as early as April 2002 when he voluntarily reported for psychological treatment.  In May 2002 he presented for medication management for a known history of mood swings and personality issues.  The mood swings occurred on a daily basis along with increased irritability, frustration and episodes of feeling “down.”  Treatment consisted of Celexa (antidepressant) and psychotherapy was recommended.  At visits in November 2004 it was noted that he was taken off profile to attend a course, but instead underwent physical conditioning for deployment.  Prozac (antidepressant) replaced the Celexa.  In June 2005, the CI indicated he had not taken medication for at least 4 months.  On examination he appeared alert and fully oriented with an intact memory. His mood was “at my best” and affect was bright, appropriate and non-labile.  Thought processes were logical and goal directed.  Content was focused on the future.  Judgment was adequate and insight was improved.  Speech was normal in rate, rhythm and volume, and kinetics were normal.  There was no evidence of delusions, hallucinations or suicidal or homicidal ideation.  General Assessment of Functioning (GAF) score was 70 (some mild symptoms).  There was no new prescription and he was cleared for deployment.  The CI resumed Prozac at the end of June 2005, but on 2 July 2005 reported a feeling of anxiety, dread and being afraid, but with no specific fear while in pre-deployment training.  At a life skills support center visit on 4 July 2005, the CI was seen for anxiety and depression.  He reported he recently experienced his first panic attack.  The psychologist recommended the Prozac be switched to a medication with stronger anxiolytic properties, and a day later, it was replaced by Paxil (antidepressant).  

A 20 July 2005 MEB NARSUM psychiatry intake examination, 5 months prior to separation, noted the CI suffered extreme stress with convoy operations that lead to several panic attacks and subsequent demoralization with an intent to end his life.  He was admitted to the hospital and felt excessive guilt about not being able to complete his deployment training.  A mental status examination (MSE) revealed good eye contact and the CI was cooperative, attentive and seemed frank in his demeanor.  Speech was voluble (talkative).  His mood was depressed and affect was mood congruent and appropriate.  Thought process was linear and logical and thought content was devoid of any psychotic symptoms with no ideas of self-harm or violent intent.  Judgment was adequate.  His GAF score was 55 (moderate symptoms).  Military impairment was moderate and social industrial impairment was considerable.  Celexa was continued and Ambien was prescribed for insomnia.  

At a psychiatry visit on 18 August 2005, some improvement in depression was noted, but he had continued symptoms of anxiety.  Celexa was continued.  The August 2005 commander’s statement indicated the CI’s condition did not affect his ability to satisfy duty requirements.  He was working in his primary AFSC and was able to work full shifts.  His condition precluded deployment to certain world-wide locations, but he was motivated to work around his condition.  The commander recommended retention and considered cross-training in a less demanding career field.  The  23 September 2005 MEB addendum, less than 3 months prior to separation, noted a much improvement mood, but the CI continued to have low grade depression and low energy as well as some symptoms of anxiety including increased heart rate, nervousness and jumpiness with noises.  The MSE revealed improvement in depression, but continued symptoms of anxiety.  His GAF score was 55.    He was noted to have considerable social and industrial impairment and moderate military impairment.  

At the 4 April 2006 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported panic attacks, stress, anxiety, worry, low energy, sleep disturbance, intrusive thoughts, self-doubt and short temper.  The MSE revealed the CI to be clean and cooperative.  Psychomotor activity and speech were unremarkable.  Affect was appropriate and mood was anxious.  Attention and orientation were intact to person, time and place.  Thought process was logical and goal directed and thought content was unremarkable.  He had no delusions.  He understood the outcome of his behavior, had average intelligence and understood he had a problem.  He had moderate sleep impairment but no inappropriate behavior.  He had mild obsessive and ritualistic behavior in the context of a general anxiety presentation.  His most recent panic attack was within the last month, his impulse control was good with no episodes of violence.  He had occasional suicidal thoughts but no homicidal thoughts.  His memory was normal.  He denied hallucinations, but reported experiences within his belief system.  He was capable of completing daily living activities with assistance of his wife due to agoraphobic behaviors.  He was employed doing survey work, although he quit a prior job due to panic attacks.  His GAF score was 55.  The examiner noted the CI had mild decreased efficiency and productivity, moderate decreased reliability and the inability to perform work tasks during periods of stress.  Additionally, he had impaired work, family and other relationships that were moderate and frequent.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the dysthymia 10%, coded 9433 (dysthymia).  The VA rated the dysthymia 30%, coded 9433, based on the C&P examination, citing “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care and conversation normal).”  The panel first considered whether the provisions of VASRD §4.129 (mental disorders due to traumatic stress) were applicable in this case.  However, the panel agreed there was no traumatic event that caused the unfitting mental health condition.  Therefore, application of VASRD §4.129 was not applicable in this case.  

The panel then considered whether the evidence at the time of separation supported a rating higher than the 10% PEB rating.  The higher rating of 30% requires evidence of “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to  such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events).”  The MEB addendum revealed some improvement in depression.  The psychiatry examiner indicated considerable social/industrial impairment and moderate military impairment.  The CI did have a depressed mood, anxiety and panic attacks and was being treated for sleep impairment; however, he had no memory loss.  Although the commander indicated the CI was doing his job, he could not be deployed and needed continuous medication.  More importantly, the CI developed anxiety symptoms when he was not taking any medication.  With medication he improved sufficiently such that he was able to work as noted by the post-separation VA examination, although he did indicate that he had to quit a prior job due to panic attacks.  Clearly, stress exacerbated his long term dysthymia such that he had a decrease in work efficiency.  Despite having a depressed mood, anxiety, panic attacks and sleep impairment, the symptoms seemed to be mild and transient during periods of significant stress, and the symptoms were controlled by continuous medication.  Therefore, the panel agreed that a 10% rating, as assigned by the PEB, was appropriate.  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 dysthymia.  

BOARD FINDINGS:  In the matter of the dysthymia 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:

SAF/MRB

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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-2017-03162.

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.