RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-04402
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050831

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Helicopter Repairer, medically separated for “panic disorder with agoraphobia, with diagnosis also made of posttraumatic stress disorder [PTSD]” 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 - 20050706	VARD - 20060707	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Panic Disorder with Agoraphobia with Diagnosis of PTSD	9412	10%	Anxiety Disorder	9435	10%	20051205	
Sleep Apnea	Not Unfitting	Sleep Apnea	6847	50%	20051205	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Panic Disorder with Agoraphobia with Diagnosis of PTSD. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s mental health (MH) condition began in November 2004 several months after returning from a deployment. He began feeling anxiety and depression that progressively worsened when he was notified that his unit might redeploy to Iraq. He experienced panic attacks which lasted for a few minutes, and preferred staying home rather than going to places where “escape” was not possible. The CI attended PTSD group therapy and was diagnosed with mild PTSD in November 2004, however, a specific traumatic

event was not documented. He did not have any suicidal or homicidal ideation, or receive any emergency room (ER) or inpatient treatment for panic attacks or any other MH issue.

The 14 June 2005 MEB NARSUM psychiatric addendum, 3 months prior to separation, noted CI complaints of shakiness and shortness of breath during panic attacks, which resolved with deep breathing. In addition to panic attacks, he felt overly concerned about events happening in Iraq and spent several hours a day watching news media coverage of Middle East war. The examiner stated that the CI had some minor financial stressors, “but no occupational problems at the present time.” The mental status examination (MSE) was normal, with mild restlessness but no abnormal movements noted. The examiner assessed severe, delayed PTSD and panic disorder with acute, severe agoraphobia. A Global Assessment of Functioning (GAF) score of 65 was rendered for “some mild symptoms, generally functioning pretty well with meaningful interpersonal relationships.”

At the 5 December 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported that since separation from the military in August 2005, he had not had any panic/anxiety attacks or PTSD symptoms. When questioned specifically about PTSD symptoms, he stated that when he watched the news, he got angry because he was not there to help his “former comrades in arms.” He also stated the he had dreams about current news events even though they had no relation to his experiences while deployed. When asked to describe the traumatic event that led to his PTSD, the CI talked about his participation in a mission to pick up the body of an 18-year female soldier which was brought to his helicopter covered by an American flag. A letter found in her personal effects was from her mother telling her about shopping for a wedding dress for her next leave when she returned to the States. Upon hearing this, he felt overwhelmed and extremely sad that this “real person” was now dead. The CI reported an “exceptionally” good relationship with his wife of 8 years and 5-month old son, as well as good relationships outside of the family. He was seeking employment in helicopter maintenance/aviation, and enjoyed fishing, kayaking, being outdoors and stating active in his church where he had joined a Bible study group. He also liked to spend time with his family and go out for dinner. The MSE was completely normal, and the examiner assessed “resolved” anxiety disorder, not otherwise specified (NOS) and adjustment disorder with anxiety and depressed mood. The examiner also noted that the traumatic stressor criteria for PTSD was not satisfied in that the CI “did not experience, witness, or was confronted with an event or events that involved actual or threatened death or serious injury or threat to the physical integrity of self or others.” It was also noted that criterion A2 was not met since his response was never one of intense fear, helplessness or horror. A GAF score of 85 was rendered (absent or minimal symptoms, good functioning in all areas).

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the panic disorder 10%, coded 9412 (panic disorder and/or agoraphobia), citing “mild at this time, with ongoing treatment recommended.” The VA rated anxiety disorder 10%, coded 9435 (mood disorder, NOS), based on the C&P examination, citing VASRD §4.130 criteria for a 10% disability, and the absence of stressors and symptoms to meet criteria for a PTSD diagnosis. Panel members first 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. Although, the NARSUM examiner diagnosed PTSD, there was no mention of PTSD symptoms or a single traumatic stressor during the examination. The C&P examination also noted the absence of a traumatic stressor, and review of MH encounters indicated that although the CI had nightmares, the nature of these was not elaborated, and no traumatic stressor was ever described.

The panel next proceeded with the rating recommendation, noting a §4.130 rating is based on symptoms independent of diagnosis, and therefore all MH symptoms (panic disorder, PTSD) are considered in the rating and reflected in the recommendation. Panel members considered the absence of ER treatment or hospitalization, and the apparent stability of symptoms throughout

service and the complete absence of symptoms 3 months after separation. Although the NARSUM addendum documented “severe” panic disorder and PTSD, only mild impairment from symptoms was assessed. The commander’s statement noted that the CI was unable to deploy to a combat environment due to his PTSD and sleep apnea diagnoses, but did not mention any MH symptoms. There were no reports of chronic sleep impairment, problems with concentration, irritability, anger outbursts or problems with memory, and the MSEs were normal. The C&P examiner documented that the CI’s condition was completely resolved since he was assured of not returning to Iraq or being deployed away from his family. The examiner noted that he was involved in a wide range of activities and was generally satisfied with his life with no more than everyday problems or concerns. The panel agreed that a 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.” 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 panic disorder.

Contended PEB Condition: Sleep Apnea and PTSD. The panel’s main charge is to assess the fairness of the PEB determination that the sleep apnea was not unfitting. The sleep apnea was profiled P3, however there were no limitations for any functional activities. Comments noted no deployment to areas without access to a military treatment facility, but there were no further restrictions for performing in a training environment. The commander’s statement indicated the CI could not deploy to a combat environment with sleep apnea, but at the NARSUM examination, he reported that his symptoms were signficantly improved with use of a continuous positive airway pressure machine, and he felt stronger, more alert, and better able to maintain his physical conditioning. Performance evaluations indicated that he consistently performed “two levels above contemporaries” with excellent potential for promotion. There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation. Sleep apnea was not profiled until after the CI entered into the DES, and performance reports showed no evidence of interference of abilities to perform duties due to sleep apnea. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the sleep apnea, so no additional disability rating is recommended. As noted above, the symptoms related to the condition were considered in the rating for panic disorder IAW VASRD 4.130, and could not be recommended for an additional rating IAW VASRD 4.14 (avoidance of pyramiding). 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 panic disorder with agoraphobia and PTSD and IAW VASRD
§4.130, the panel recommends no change in the PEB adjudication. In the matter of the contended sleep apnea, 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.

The following documentary evidence was considered:

	PD-2017-04402

AR20190012255, XXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXXX

	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.