RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03734
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070626

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

CI CONTENTION:  The CI requested that all her medical records be evaluated, including VA records.  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 - 20070508	VARD - 20080405	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Generalized Anxiety Disorder	9400	10%	Generalized Anxiety Disorder	9400	50%	20070926	
Personality Disorder	Cat III	Personality Disorder	9499-9416	NSC	20070926	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Generalized Anxiety Disorder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI began treatment for her mental health (MH) disorder in January 2007.  The anxiety was characterized by insomnia with early awakenings, recurrent upset stomach, sweaty palms and anxiety attacks with hyperventilation occurring two to three times per day.  She admitted to excessive anxiety about general life issues.  She had anxiety attacks up to five times per day.  There was no history of MH hospitalizations or emergency room visits.

The 17 March 2007 MEB NARSUM examination, 3 months prior to separation, noted symptoms of problematic sleep, decreased but improving interest, social isolation, guilt, chronic psychomotor agitation and decreased energy, concentration  and appetite.  She reported decreased anxiety attacks to 1-2 per week and improved mood.  She attended a weekly anxiety group and took anti-depression and anti-anxiety medications.  She also endorsed many symptoms of obsessive-compulsive (OC) personality disorder, including making lists of daily to do items and having to have things a certain way.  She was rigid about rules and instructions and had checking rituals.  She was a self-described neat freak and admitted to needing to be in control and having lots of reassurance.  Her depression symptoms resolved after starting anti-depression medication.  She was able to maintain her primary duties although she had to get rid of many of her additional duties and decrease social outings.  Physical examination showed an anxious mood and effect of limited range and moderate intensity.  She denied suicidal ideation.  Axis I diagnoses of generalized anxiety disorder and OC disorder and Axis II diagnosis of personality disorder were rendered with a Global Assessment of Functioning (GAF) score of 55 (moderate symptoms, impairment.)  The examiner noted the CI had a predisposition for anxiety that had resulted in development of severe anxiety.  

The 20 June 2007 Life Skills follow-up visit noted the CI had significant lessening of obsessive worry.  She had found a job as a medical technician and planned to return to school.  Her GAF score was 70 (mild symptoms, impairment.)  At the 26 September 2007 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported several OC symptoms.  She frequently checked doors, cleaned, picked up and ordered.  She worried about everything and was often indecisive.  She cleaned for an hour before going to work and then cleaned another 2 hours after she returned from work.  She has up to five panic attacks per day and up to five each week, probably caused by closed-in crowds.  Depression symptoms recurred when her husband ended the marriage.  She remained indecisive, extremely anxious and worried excessively with poor sleep.  
 
She continued treatment after separation with a primary care provider in the private sector.  Her anti-depression medication was changed, but she still took anti-anxiety medication as needed.  She was working as an office clerk at a department store as well as a cashier at another store.  These were both part-time jobs.  She was also taking two on-line classes to become a registered dietician and she did okay in those classes.  She was living with her sister’s family.  She had no social life and had one friend.  She exercised, ran several miles, read daily and baby sat her niece and nephew.  Physical examination showed high anxiety, high tension and a hard time relaxing.  She sat on the edge of her chair without sitting back and relaxing.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MH disorder 10%, coded 9400 (generalized anxiety disorder).  The VA rated the MH disorder 50%, coded 9400, based on the C&P examination, citing evidence of occupational and social impairment with reduced reliability and productivity due to symptoms of panic, but she was doing her job well.  Application of VASRD §4.129 was considered by the panel, 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 10% assigned by the PEB.  

The §4.130 criteria for a 10% rating requires “symptoms controlled by continuous medication” and a 30% rating requires “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  The NARSUM examination noted the CI continued to have symptoms of anxiety, including OC traits but her anti-depression medication resolved her depression.  She had no hospitalizations or emergency room visits.  She remained a good worker and had found a new job.  The examiner noted her disability for social and industrial impairment was mild.  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 MH disorder.  

Contended PEB Condition:  Personality Disorder.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The personality disorder is a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending it as unfitting.  After due deliberation, and in consideration of the preponderance of evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the anxiety disorder and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  In the matter of the contended personality disorder, the panel agrees it cannot recommend it for additional disability rating.  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 20170410, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03734.

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,

		

							

Attachment:
Record of Proceedings