RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05509
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20060510

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Honor Guard, medically separated for “generalized anxiety disorder” with a combined disability rating of 10% (30% less 20% for aggravating/contributory factors).  

CI CONTENTION:  “Review all conditions.  Review fairness of original rating that was reduced from 30 to 10%.”  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 - 20060327	VARD – 20060920	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Generalized Anxiety Disorder 	9400	30%-20%	Generalized Anxiety Disorder with a History of Insomnia	9400	0%	20060823	
Alcohol Dependence with Physiologic Dependence	Category III					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Generalized Anxiety Disorder (GAD).  According to the service treatment record and MEB psychiatry narrative summary (NARSUM), the CI was initially seen in behavioral health in July 2005 following a DUI where he then underwent partial hospitalization for alcohol dependence, was diagnosed with anxiety disorder not otherwise specified (NOS) and treated with psychoactive medications.  The CI had had years of symptoms of mild worry with full symptom of anxiety not manifesting until after service entry; alcohol had been a fairly successful means to reduce the anxiety.  Symptoms included anxiety, sense of restless tension, distractibility, headache, gastrointestinal discomfort, irritability, and difficulty initiating and maintaining sleep.  There were no panic attacks or depressive or post-traumatic stress disorder (PTSD) symptoms.  In December 2005 after alcohol use, the CI had an altercation and was hospitalized through the emergency department for homicidal/suicidal ideations.  The diagnosis was changed to GAD and medications were changed and increased.  
The 24 February 2006 MEB NARSUM psychiatry consult, 3 months prior to separation, noted complaints of anxiety.  The mental status examination (MSE) showed mood was described as anxious and stressed with affect constricted to moderately dysphoric; psychomotor activity was generally reduced, eye contact was fair to poor and cooperation was fair.  There were no delusions, hallucinations, suicidal ideation, or other symptoms suggestive of psychosis, speech disturbance, objective cognitive impairment, or other abnormality.  Medications were Zoloft with Trazadone at bedtime for his GAD and Campral (for alcohol use).  The diagnoses were GAD “as evidenced by pervasive sense of worry, social withdrawal, muscle tension, and difficulty sleeping, which pre-existed alcohol dependence,” with marked military impairment and mild-definite social/industrial impairment; and alcohol dependence with physiologic dependence, in early full remission, with marked military impairment and definite social/industrial impairment.  Of note, the 2001 enlistment history and physical (DD Form 2808 and 2807-1) had no abnormal findings or indication of mental health symptoms prior treatment.  

At the 23 August 2006 VA Compensation and Pension (C&P) mental disorder examination, 3 months after separation, the CI reported no current psychiatric symptoms or complaints aside from “I get a little nervous in crowded places."  He denied abuse of alcohol or drugs.  The CI continued to take medication (Lexapro) which was provided to him at discharge.  He indicated no scheduled future mental health appointments and was considering whether to continue with medications and/or psychiatric treatment.  MSE was normal.  The diagnosis was GAD by history, in remission.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the GAD 30% with a 20% deduction for aggravating/contributory factors, coded 9400 (GAD).  The VA rated the GAD 0%,  based on the C&P examination, citing no symptoms of anxiety and the disorder appeared to be in remission with no or minimal impact on social or occupational functioning or to require continuous medication.

The panel 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 condition, and that application of VASRD §4.129 was not appropriate in this case.  Considering rating IAW VASRD §4.130, the panel agreed that no rating higher than the 30% adjudicated by the PEB was warranted by the evidence of record.  There was no evidence of a pre-existing mental health disorder or treatment to support any VASRD-compliant deduction of the 30% rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the GAD, coded 9400, with no deduction.  

Contended PEB Condition:  Alcohol Dependence with Physiologic Dependence.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was a Category III condition that is not separately unfitting and not compensable or ratable.  IAW DoDI 1332.38, the alcohol dependence with physiologic dependence is a condition not constituting a physical disability, therefore, the panel has no basis for recommending it as unfitting.  After due deliberation, and in consideration of the preponderance of the evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the generalized anxiety disorder the panel recommends a disability rating of 30%, coded 9400 IAW VASRD §4.130.  In the matter of the contended alcohol dependence with physiologic dependence, 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.  

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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Generalized Anxiety Disorder	9400	30%	

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05509.

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 in accordance with 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 the 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 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 90 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, in such a case, failure to render an election will result in automatic enrollment by law.