RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:XXXXXXXXXXXXXXXXXX	CASE:  PD-2017	-0485	3
BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20051017
SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Mobile Electric Power Plants Intermediate Maintenance Technician, medically separated for “panic disorder with agoraphobia” with a disability rating of 10%.
CI CONTENTION: Did not take into account issues associated with migraine headaches, tinnitus and suffering while on active duty. 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 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 - 20050708	VARD - 20061120	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Panic Disorder…	9412	10%	Panic, Anxiety, Headaches, Tachycardia, Agoraphobia, Pinealycysis, Obsessive Compulsive Disorder	
9404	
NSC	
STR	
Obsessive Compulsive
Personality Disorder	Cat II					
Common Migraine	Cat III					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Panic Disorder. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s panic disorder began in January 2003 after experiencing palpitations which progressively worsened. She was treated with psychotropic medications, which were discontinued when she became pregnant. She initially benefited from therapy and was essentially stable throughout the pregnancy (1-2 panic attacks per week), but developed baseline anxiety and worried about several factors associated with the pregnancy. After delivery, she reported an increased fear of crowds and developed agoraphobia. Medications were resumed and increased due to continued panic attacks and generalized anxiety (later noted to be attributable to obsessive compulsive personality traits). She developed depressive symptoms in the context of multiple family stressors, and while she declined an offer of inpatient treatment, she accepted a day treatment program for 5 weeks and returned to outpatient care.

The 31 May 2005 MEB NARSUM examination, 5 months prior to separation, noted CI complaints of regular episodes of palpitations, shortness of breath, fear of dying, numbness, dizziness, chest pain, chills and hot flushes. These episodes came without warning and began to affect her “ability to go to public and social functions.” She significantly improved after being removed from duty with performance evaluations noted to be “good,” and no legal or disciplinary problems, hospitalizations or suicide attempts. The mental status examination (MSE) showed an anxious mood with congruent, euthymic affect, and the examiner rendered an Axis I diagnosis of panic disorder with agoraphobia, and Axis II diagnosis of obsessive compulsive personality disorder. During the MEB examination (recorded on DD Forms 2807-1 and 2808), a week later, the MSE showed the CI to be wide eyed with an anxious affect and “fine tremors to entire body.” She reported using Paxil, Xanax and Ativan. The 20 June 2005 non-medical assessment indicated she would be a valuable asset and should be favorably endorsed for retention if medical treatment were to prove successful. 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 panic disorder 10%, coded 9412 (panic disorder), and listed “obsessive compulsive personality disorder” as a related diagnosis (Category II) contributing to the disability in this case. However, panel members noted that personality disorders are conditions not constituting physical disabilities IAW DoDI 1332.38, enclosure 5. The VA did not service connect the panic disorder, but rather combined it with other conditions under code 9404 (obsessive compulsive disorder). The panel first considered the provisions of VASRD §4.129 (mental disorders due to traumatic stress), and agreed there was no evidence of a traumatic event or stressor causing the unfitting mental health disorder, and that application of VASRD §4.129 was not appropriate in this case. The NARSUM examiner indicated the CI’s anxiety was related to an obsessive compulsive personality disorder. Therapy and medication were not helpful, but her psychiatrist noted a significant improvement in symptoms when removed from duties due to stress reduction. There were no psychiatric hospitalizations, emergency room visits, legal problems or violent behaviors. Thus, the panel majority concluded that some or all of the symptoms would be present, given her personality disorder, but only during times of significant stress, thereby meeting criteria for a 10% 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 panic disorder.

Contended PEB Condition: Common Headaches. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was not noted on limited duty forms or implicated in the non-medical assessment, and did not fail retention standards. 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 panic disorder and IAW VASRD §4.130, the panel majority recommends no change in the PEB adjudication. The single voter for dissent submitted the appended minority opinion. In the matter of the contended headaches, 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:

Minority Opinion. The minority dissents from the majority recommendation for a 10% rating of the panic disorder, premised on its opinion that the CI had significant improvement of symptoms when removed from her duties due to stress. The minority voter asserts that the CI had ongoing/unresolved occupational and social impairments with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks to more fairly support a 30% rating under the provisions of VASRD §4.130 at the time of separation.

Scant STR evidence, 8 to 12 months prior to separation, showed continued panic attacks, anxiety, suspiciousness (agoraphobia) and impaired judgment. The MSEs revealed anxious mood, psychotropic medication use, group therapy and diagnoses of panic disorder and anxiety. The MEB NARSUM documented that the CI recognized that her symptoms were not responding to several psychotropic mediations and that she would not be capable of functioning in full duty status. The MEB opined that she had received the maximum benefit of military medical treatment, which had not restored her to full duty status. There was no other STR or VA evidence, more proximate to separation, to show that ongoing/unresolved occupational and social impairment had improved.

The minority’s position is that the MEB NARSUM examination was the most comprehensive and proximate to separation, and documented the CI’s chronic Axis I panic disorder with agoraphobia, despite the maximum benefit of military medical treatment. She had not been restored to full duty status, and it is pure speculation to determine her impairment had improved without subsequent evidence of improvement.

The Secretary is respectfully requested to consider the minority recommendation that 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 the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Panic Disorder with Agoraphobia	9412	30%	

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO :
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.