RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-05492
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060523

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Command Post Journeyman, medically separated for “circadian rhythm sleep disorder (CRSD)” with a disability rating of 0%.  

CI CONTENTION:  “Initial VA rating for mood disorder above 20% with 12 months of separation, rated 30%, appealed to 50%.”  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 FPEB - 20060222	VARD - 20070829	
Condition	Code	Rating	Condition	Code	Rating	Exam	
CRSD	8199-8108	0%	Adjustment Disorder with Depressed Mood	9440	30%	20070829	
Mood Disorder NOS	Cat II					
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

CRSD.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s CRSD began in August 2005 when she reported a history of difficulty switching her sleep schedule related to shift work.  The CI reported working day shift for an extended period of time with no difficulty with insomnia, mood or depressive symptoms.  However, a new schedule with numerous changes resulted in difficulty falling and staying asleep, tiredness, and lack of energy when awake.  She reported mood disturbance and anxiety resulting from poor sleep.  Several treatments were tried with little benefit and significant side effects.  

The undated MEB NARSUM examination prior to separation noted no complaints of a sleep disorder since she was not working shifts.  Impairment only occurred when she was working shifts.  Mental status examination (MSE) showed a euthymic mood with congruent affect.  She became anxious and tearful at one point when discussing her difficulties with sleep at her last base.  The examination was otherwise within normal limits.  Diagnoses of CRSD, shift work-type, no impairment for social and industrial adaptability, and mood disorder not otherwise specified (NOS) in the context of her primary sleep disorder were rendered.  The Global Assessment of Functioning (GAF) score was 85 (absent or minimal symptoms/impairment).  The 30 March 2006 Secretary of the Air Force memo in response to the CI’s rebuttal noted the 0% disability rating is assigned when the medical condition “does not rise to the minimum level of severity ratable for the applicable medical conditions, as listed in the VARSD, yet, is believed to be unfitting.”

The 17 July 2007 VA Compensation and Pension (C&P) examination, 14 months post separation, noted the CI reported problems of initiating sleep and middle insomnia.  In addition, she reported anger, agitation, low energy, and a depressed mood as often as five times a month.  The effect was she did not want to be bothered with people, isolated herself, and sometimes did not like being around crowds.  She was a full-time student and worked as a realtor for the past year and a half.  Her relationship with her supervisor was good, she had no legal problems since leaving military service, had not been admitted to a hospital, and had not been receiving any treatment for her psychiatric condition.  MSE was unremarkable.  A diagnosis of adjustment disorder with depressed mood was rendered for the claimed condition of CRSD with a GAF score of 60 (moderate bordering on mild symptoms, impairment).  Symptoms did not interfere with social/occupational functioning or require continuous medication.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the sleep condition 0%, analogously coded 8199-8108 (narcolepsy) citing no civilian social and industrial adaptability impairment.  The PEB also listed mood disorder as a related Category II condition that can be unfitting but was not currently compensable or ratable.  The VA rated the adjustment disorder with depressed mood condition 30%, coded 9440 (chronic adjustment disorder) based on the C&P examination, citing a GAF score of 60. 

The PEB rated CRSD analogously to narcolepsy, which is rated according to the VASRD rating scale for minor seizure disorders.  The panel noted a 10% rating disability requires confirmation of the disorder with a history of sleep disturbance.  The NARSUM examination noted the CI’s sleep condition occurred only in the context of shift work but CRSD is a clinical diagnosis, not subject to confirmation in the context of the petit mal rating.  Her GAF score indicated minimal or no symptoms.  Panel members agreed the condition was unfitting but did not meet criteria for a rating higher than 0% under the analogous 8199-8108 code.  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 sleep condition.  

Contended PEB Condition:  Mood Disorder.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  This condition was not profiled or implicated in the commander’s statement, 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 ratings are recommended.  

BOARD FINDINGS:  In the matter of the sleep condition and IAW VASRD §4.124, the panel recommends no change in the PEB adjudication.  In the matter of the contended mood disorder not otherwise specified, the panel recommends no change from the PEB determinations 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.  

SAF/MRB

Dear XXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05492.

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 rating modification or re-characterization 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 modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.