RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXX	CASE:  PD-2017-04453
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050726

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Mental Health Service Journeyman, medically separated for “dysthymic disorder” with a disability rating of 10%.   

CI CONTENTION:  The CI made no specific contention.  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 - 20050606	VARD - 20060126	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Dysthymic Disorder	9433	10%	Dysthymic Disorder 	9433	50%	20051121	
COMBINED RATING:  10%		COMBINED RATING OF ALL VA CONDITIONS:  80% 	

ANALYSIS SUMMARY:  

Dysthymic Disorder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI was hospitalized 14 April 2005 after taking 8 pills of Fiorcet and Midrin and making self-inflicted superficial cuts on her wrists and thighs.  The hospitalization was the CI's first inpatient care.  She had been evaluated by a psychiatrist in August 2003 and diagnosed with dysthymia and started on Zoloft.  In February 2005, she was started on Effexor for continued depressive symptoms.  The CI described periods in early teens of both anorexia nervosa symptoms and obsessive/compulsive symptoms, which she overcame on her own.  

The 30 April 2005 MEB NARSUM examination, 3 months prior to separation, noted complaints of depression.  At the mental status examination the CI was dressed in civilian clothes and well groomed.  Her psychomotor activity was increased, with shaking of her feet and some wringing of her hands.  Her eye contact was good and her speech was spontaneous and of regular rate, rhythm and volume.  She described her mood as "better” and appeared euthymic, with congruent affect and normal intensity.  She was alert and oriented and her intellectual functioning was average (based by vocabulary and complexity of concepts).  Her thought process was logical, coherent and goal-directed; she demonstrated no loose associations or flight of ideas.  Her thought content was negative for auditory or visual hallucinations.  The provider concluded the CI met the criteria for dysthymia and personality disorder not otherwise specified.  

At the 21 November 2005 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported insomnia, anxiety, hives, lack of motivation and isolative feelings.  The CI complained that her ability to perform daily functions during remission/partial remission was impaired and she was hopeless, fatigued with insomnia and had poor concentration.  Mental status examination showed a reliable historian.  Orientation was within normal limits.  Appearance and hygiene were not appropriate and she showed signs of neglect, but grooming was good.  Behavior was not appropriate with findings of anxiety and shaking legs almost continuously.  Affect and mood were abnormal with depressed mood, although depression did not affect her ability to function independently and effectively.  Her communication and speech were within normal limits.  She stated panic attacks occurred as often as four times per month, each lasting 15 minutes.  The attacks consisted of skin burning, dyspnea, tachycardia and feelings of impending doom.  There was no delusion or hallucination history and none observed.  Obsessional rituals included cleaning house, weighing, hand washing and stalking.  Thought processes were appropriate and abstract thinking was normal.  Judgment was impaired and described as poor secondary to anxiety and obsessive symptoms.  Memory was mildly impaired, such as forgetting names, directions and recent events.  Suicidal ideation was present, including urges to overdose or cut on self.  Homicidal ideation was absent.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the dysthymic disorder 30%, coded 9433 (dysthymic disorder), then subtracted 20% for aggravating or contributory factors (comorbid personality disorder) for a rating of 10%, citing that without the non-compensable personality disorder, the social and industrial impairment would be mild.  The VA rated the dysthymic disorder 50% coded 9433, based on the C&P examination, citing occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands and memory impairment.  

The panel gave greater probative value to the NARSUM examination due to the ability of the provider to observe the CI over time while hospitalized and as an outpatient.  The panel noted the VASRD rules do not support decreasing a rating due to the presence of a non-ratable condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the dysthymic disorder, coded 9433.  

BOARD FINDINGS:  In the matter of the dysthymic disorder, the panel recommends a disability rating of 30%, coded 9433 IAW VASRD §4.130.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Dysthymic Disorder	9433	30%	

The following documentary evidence was considered:

SAF/MRB

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04453.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.