RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-03600 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20081106

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Journalist, medically separated for “bilateral breast pain,” with a disability rating of 0%.

CI CONTENTION: “I was told PTSD from a sexual assault was my fault. I was tested again and again and told I have a borderline personality disorder.” The CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 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 - 20080722	VARD - 20100908	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Breast Pain	7628-7626	0%	No VA Examination Proximate to Separation in Evidence	
Anxiety Disorder	Not a Ratable Condition		
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 50%	
	
ANALYSIS SUMMARY:

Bilateral Breast Pain. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bilateral breast pain began in May 2007 after a left breast tender mass developed. The CI ended up being medically evacuated from Kuwait and an ultrasound of the left breast confirmed the mass and a breast lumpectomy was done in June 2007. Biopsy of the excised mass concluded the diagnosis of benign fibrocystic disease.

The 4 January 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 10 months prior to separation, revealed bilateral breast diffuse tenderness, no masses, dimpling, or signs of inflammation, and normal nipples bilaterally. A small surgical scar was noted in left breast. Clear liquid could be expressed from the left nipple. During the 29 February 2008 MEB NARSUM examination, 8 months prior to separation, the CI reported chronic breast pain, left greater than right. Pain was worse when wearing combat gear, a bra, or whenever there was pressure against the breast. Medication reduced the pain level significantly. The NARSUM noted the physical examination took place on 4 January and recorded the same information as the DD Forms 2807- 1 and 2808.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bilateral breast pain condition 0%, analogously coded 7628-7626 (benign neoplasms of the gynecological system or breast - surgery of breast), citing bilateral breast wide local excision without significant alteration of size or form. The panel noted the higher rating of 30% is warranted (one or both breasts) if following simple mastectomy or wide local excision there is significant alteration of breast size or form. Panel members agreed the rating adjudicated by the PEB was supported as they found no evidence of alteration in breast size or form after the lumpectomy to support the 30% 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 bilateral breast pain condition.

Contended PEB Condition: Anxiety Disorder. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The PEB cited the anxiety disorder was not ratable because the primary diagnosis was personality disorder. A review of the STR showed the CI reported she was sexually assaulted in April 2005. On a 7 May 2005 Pre- Deployment Health Assessment (PDHA) the CI reported she was in “very good” health, had no medical problems, but had sought counseling or care for mental health (MH) during the past year. There was no elaboration on the PDHA in the prompt section for “Please list your concerns.” There was no indication the CI was referred to MH after reporting she had received counseling, and the examiner’s final disposition noted the CI was deployable.

In October 2007, the CI entered the DES for the condition of breast pain. The panel noted the MH condition was not on the 22 October 2007 permanent profile recommending MEB due to the breast pain, or at the time of the January 2008 MEB H&P examination, when the CI entered the DES. At that time, anxiety disorder was listed on the MEB Proceedings, but it was “not medically disqualifying.” The panel further noted the psychiatry NARSUM dated February 2008 also recorded anxiety disorder as not medically disqualifying. This was also documented in the March 2008 MEB NARSUM; instead it documented borderline traits on Axis II. The April 2008 commander’s statement noted the CI did not consistently follow instructions and required prompting from cadre and friends; however, it was noted she communicated effectively with others, was able to relate civilly to supervisors and co-workers, able to respond appropriately to changes in routine, and able to make basic work-related decisions. Although the CI was not able to perform her assigned military occupational specialty duties, it was noted she performed alternate duty well.

The May 2008 psychiatry addendum stated the anxiety disorder was medically disqualifying, but the primary diagnosis was a personality disorder -- a major contributing factor in her anxiety disorder diagnosis. The psychiatrist opined the anxiety disorder was medically disqualifying because “her emotional dysfunction precludes her from working in a primarily male dominated military environment.” In June 2008, an additional profile was written listing a MH condition of “anxiety disorder.” Although the CI stated she felt uncomfortable in an environment dominated by males, there was no evidence she was unable to perform her duties due to MH issues. The CI performed her occupational duties during deployment until being medically evacuated for bilateral breast pain.         There was no MH condition profiled prior to entering the DES, and no

objective performance evidence that the MH condition interfered with duty. Panel members concluded there was not a preponderance of evidence showing the anxiety disorder solely would have caused the CI to be referred into the DES or be found unfit. There was no performance- based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the bilateral breast condition and IAW VASRD §4.116, the panel recommends no change in the PEB adjudication. In the matter of the contended anxiety disorder, the panel recommends no change from the PEB determination 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.

PD-2017-03600 

AR20190010063, XXXXXXXXXXXXXXXXX 
	
Dear XXXXXXXXXXXXXX

	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.

PD-2017-03600