RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2018-00547
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20021210

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an Air National Guard O4, Communications & Information Officer, medically separated from the Temporary Disability Retired List (TDRL) for “somatoform disorder, not otherwise specified (NOS)” with a disability rating of 10%. 

CI CONTENTION:  He received a higher rating by the VA for the somatoform disorder.  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 - 20020718	VARD - 20030130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Somatoform Disorder NOS	9421	10%	Somatoform Disorder	9499-9421	50%	20021203	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Somatoform Disorder, NOS.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s somatoform disorder was diagnosed in 2000 after an initial onset of panic attacks in 1996, followed by multiple somatic complaints of unknown etiology.  The CI was separated and placed on the TDRL on 7 November 2000.

The 20 March 2002 TDRL NARSUM examination, 9 months prior to TDRL removal, noted complaints of panic attacks with multiple somatic issues that included chest, head, and back pain.  Documentation of panic attack frequency was not in evidence, but the CI noted he had become isolated for fear of an attack in public. He had not pursued mental health (MH) treatment since TDRL placement and indicated that he was unable to find a job.  He reported a good relationship with his spouse.  The mental status examination (MSE) was unremarkable with the exception of anxious and mildly dysphoric mood and congruent affect.  Cognitive function was intact, judgment was not impaired, and suicidal/homicidal ideation was absent.

On 18 September 2002, 3 months before TDRL removal, the CI presented to the emergency room (ER) with chest pain so severe that it caused him to double over.  He also reported associated dizziness and shaking as well as blacking out with the inability to see for about 30 seconds.  A complete work-up ruled out a heart attack and he received medication for anxiety. He was discharged from the ER and noted to be “almost” symptom free.

At the 3 December 2002 VA Compensation and Pension (C&P) mental disorder examination, 1 week prior to TDRL removal, the CI reported continued somatic symptoms of various frequencies and that he avoided social situations for fear of having attacks.  He was unemployed but did not state that he was unable to work due to an MH condition.  He spent his time performing home maintenance duties, compiling resumes on his computer, reading, and going to movies.  He was not undergoing MH treatment, and there was no record of the number or frequency of panic attacks.  The MSE was unremarkable with the exception of anxious mood.  There was no evidence of disturbance of thinking, suicidal ideation, problems with memory or concentration, or chronic sleep impairment.  The examiner provided no opinion related to the CI’s employability.  

The panel directed attention to its rating recommendation based on the above evidence.  The CI was removed from TDRL with a permanent disability disposition of separation with severance pay at 10%.  The PEB cited mild social and industrial impairment (if he had pursued care).  The VA rated the somatoform disorder 50%, analogously coded 9499-9421 (somatization disorder), 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; short and long term memory impairment (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment and abstract thinking; motivation and mood disturbances; difficulty in establishing and maintaining effective work and social relationships.

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 MH condition, and that application of VASRD §4.129 was not appropriate in this case.  Panel members next considered a rating recommendation under VARSD §4.130, and noted the TDRL removal examination documented a report of sudden onset of severe pain associated with limited symptom panic attacks that.  There was no record of frequency of such attacks, which were self-limiting and did not require ER visits.  While the CI was unemployed, there was no indication that he was unable to work.  Although the C&P examination noted one ER visit for a panic attack, there were no evidence of panic attacks occurring once a week or more to justify a 30% disability rating.  Panel members agreed that, at the time of TDRL removal, the CI’s condition met criteria for a 10% rating 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 somatoform disorder at TDRL removal.

BOARD FINDINGS:  In the matter of the somatoform disorder and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication at the time of TDRL removal.  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
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2018-00547.

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.