RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2014-02572 COUNSEL: NONE HEARING DESIRED: NO APPLICANT REQUESTS THAT: His military disability evaluation of his Mental Health (MH) condition be reviewed. APPLICANT CONTENDS THAT: The AF Form 356, Findings and Recommended Disposition of USAF Physical Evaluation Board, dated 23 Feb 11 rated him at 50 percent for a compensable unfitting condition of Post- Traumatic Stress Disorder (PTSD) with Generalized Anxiety Disorder (GAD). There was a change of diagnosis on his AF Form 356 dated 25 Apr 12. The diagnosis was changed to PTSD (combat related) with a compensable disability rating of 30 percent. The applicant’s complete submission, with attachments, is at Exhibit A. STATEMENT OF FACTS: On 14 Aug 07, the applicant entered the Regular Air Force. Per Special Order ACD-01724 dated 1 Apr 11, he was placed on the Temporary Disability Retired List (TDRL) effective 24 May 11 in the grade of Senior Airman (SrA, E-4) with compensable percentage for physical disability of 50 percent for unfitting condition of PTSD with GAD. On 13 Feb 12, the applicant presented for his periodic TDRL examination as required by 10 U.S.C. § 1210. According to the AF Form 356 dated 25 Apr 12, the Informal Physical Evaluation Board (IPEB) reviewed the TDRL examination and recommended the applicant be permanently retired with a 30 percent disability for a compensable unfitting condition of PTSD (combat related). The IPEB found that his medical condition had improved since being placed on the TDRL. It appeared to have stabilized and would not likely change over the next several years. The IPEB found evidence of occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks and recommended permanent retirement with a disability rating of 30 percent In Accordance With (IAW) the Veterans Administration Schedule for Rating Disabilities (VASRD) guidelines. The PTSD is combat related as a direct result of armed conflict and engaging in hazardous service while deployed to Afghanistan; the applicant was exposed to incoming mortar fire. In a letter dated 30 Apr 12, AFPC/DPSDD informed the applicant of the IPEB’s recommendation and advised him he could agree with the recommendation, disagree and request a formal hearing of the case or disagree and submit a written rebuttal in lieu of a formal hearing. The applicant concurred with the recommended findings of the IPEB. Per Special Order ACD-02337 dated 15 May 12, he was removed from the TDRL and permanently retired effective 4 Jun 12 in the grade of SrA with a compensable percentage of 30 percent for physical disability of PTSD. On 21 Mar 12, the Department of Veterans Affairs (DVA) rated the applicant at 80 percent for service connected disabilities of PTSD, irritable bowel syndrome, painful scars, lumbar strain and right foot strain. On 30 Mar 15, SAF/MRBC provided the applicant a copy of the Physical Disability Board of Review (PDBR) Special Review Panel (SRP) evaluation which was endorsed by a MH professional as required by the Fiscal Year 15 National Defense Authorization Action (FY15 NDAA) § 521. AIR FORCE EVALUATION: The PDBR SRP recommends there be no change to the applicant’s disability and separation determination. The applicant’s case was reviewed IAW the Secretary of Defense directive for a comprehensive review of service members who were referred to a disability evaluation process between 11 Sep 11 and 30 Apr 12 and whose MH diagnoses were changed or eliminated during the process. The applicant’s case file was reviewed IAW VASRD § 4.129 and 4.130. The DVA compensation and pension psychiatric examination completed on 5 May 11, three months after the PEB to TDRL, noted he was exposed to several traumatic events while deployed to Afghanistan as a military policeman. He reported a mortar attack that hit the quarters next to his, there were wounded and at least one dead. He froze and was overtaken by anxiety when he should have been helping. In a marketplace, a gun was pointed at a colleague, it turned out that the gun would not fire but he was extremely anxious after that. Upon return from deployment, he reported feeling emotionless, anxious and having paranoid thoughts. The diagnosis was Axis I: PTSD. The psychiatrist level examiner wrote the diagnosis of PTSD was consistent with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) criteria and no other mental disorders were noted. On 12 Feb 12, the TDRL psychiatric Narrative Summary (NARSUM) noted a review of AHLTA (electronic medical records), MEB and DVA records. The NARSUM stated that since placement on TDRL, the applicant continued to seek MH services through the DVA system. He continued to have symptoms of hypervigilance, easy startle, insomnia, irritability, nervousness, trouble concentrating, mind racing, checking and re-checking of doors/locks due to worry about safety concerns, fatigue, frequent worry, headaches, muscle tension, feelings of being disconnected from others, numbness, avoidance of movies or television shows that reminded him of things similar to his prior trauma. He elected to stop taking psychiatric medication in the fall of 2011 and was trying to cope with his PTSD symptoms mostly by attending therapy. He reported no suicidal or homicidal ideations, no hallucinations, and his insight and judgment were good. The examiner noted moderate military impairment due to incessant worries and doubts which would preclude successful integration and performance in a military setting. The MH diagnoses at the examination were Axis 1: PTSD and chronic GAD. The SRP considered the appropriateness of changes in the MH diagnoses along with a disability rating recommendation IAW VASRD § 4.130 at the time of placement on the TDRL and removal from TDRL. The SRP found that the final adjudication by the IPEB did not include the GAD. The SRP determined this change was not a possible disadvantage to the applicant since PTSD is classified as an anxiety disorder and both PTSD and GAD are rated using the same VASRD general rating formula for mental disorders. The symptoms of PTSD and GAD were subsumed under the same rating since it is unreasonably speculative to attribute any particular symptom to each disorder. The SRP then proceeded to determine if there was a possible VASRD § 4.130 higher rating than 50 percent at the time of placement into TDRL. At that time, he was working in a clerical capacity without a weapon and there were no indications of inability to perform. The SRP did not find evidence supporting a higher 70 percent rating that would require findings of occupational and social impairment, with deficiencies in most areas. The SRP then considered if there was evidence for a higher rating at the time of permanent medical retirement. He continued with symptoms which did not worsen or require psychiatric medications or any psychiatric hospitalization. The general description in VASRD § 4.130 for a 30 percent rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily,” and for 50 percent is “occupational and social impairment with reduced reliability and productivity.” The TDRL examination did not cite evidence which would confirm that either reliability or productivity on the job or at school was suffering because of psychiatric symptoms. Support for the 50 percent criteria is thus overly speculative without evidence for reasonable doubt of occupational and social impairment with reduced reliability and productivity for a higher rating. A complete copy of the PDBR SRP evaluation is at Exhibit C. APPLICANT'S REVIEW OF AIR FORCE EVALUATION: He requests the Board increase his PTSD disability rating as his symptoms increased before and after the TDRL evaluation. He has ongoing anxiety while driving, has stopped visiting friends because he feels out of place and believes they are thinking badly of him because of his past failures and how he was retired from the military. He feels like a coward and is ashamed of himself because he did not do anything special when he served in the military. He froze when he was supposed to be helping individuals who were hurt in the mortar attack. He has depression and marital troubles. He has difficulty trusting his wife and his family has told him that his irritability was affecting their relationship with him because he would get angry over little things. He would randomly think or imagine life threatening scenarios and plan out how he could save someone. His psychologist told him that he was trying to find a way to make up for freezing in the past. In the fall of 2011, he stopped taking psychiatric medications because he believed it was causing additional trouble with his school and home life. He was having difficulty concentrating and functioning properly while taking the medications. However, it was extremely challenging with his PTSD symptoms. The relaxation techniques he learned in therapy sessions helped on some occasions but not with all. He has constant panic attacks and stress reactions daily that make him anxious, nervous, helpless, angry, and unable to concentrate. On 30 Jan 12, he started working at the outpatient medical records section at David Grant Medical Center, Travis AFB, CA. During the first weeks of employment, he requested his seating arrangement to be relocated to the back of the room because he felt uncomfortable having people sit or walk behind him. However, his supervisor denied the request. His PTSD symptoms continued to increase at work because of the stressful military atmosphere in the hospital, the exercises, inspections and trainings; especially the ones that reminded him of his experiences when he was deployed. He would take extra breaks when he felt stressed, depressed or had anxiety attacks. He struggled with wanting to quit his job and school due to the overwhelming stress. He secretly dealt with his issues by drinking. When confronted, he explained he was drinking a glass of wine a day because of the health benefits. On the side he would take shots of vodka and was having thoughts of suicide as he thought life would be better if he was not around. He was afraid to tell this to his psychologist and psychiatrist because he was afraid they would send him to an inpatient MH facility. After an up and down battle, he decided he needed to take psychiatric medications and started taking Venlafaxine and has felt better. On 2 May 14, he stopped working due to his PTSD symptoms caused by work stress. On this date, his father drove him to the emergency department at Sutter Solano Medical Center because he had a severe anxiety reaction with panic attacks that lasted for over 24 hours. He was prescribed Lorazepam. He provides letters from his DVA psychiatrist which state he would not be returning to work because of medical reasons. He has also requested Social Security Disability Insurance (SSI) benefits be restarted because he is no longer working due to PTSD. The applicant’s complete submission, with attachments, is at Exhibit E. THE BOARD CONCLUDES THAT: 1. The applicant has exhausted all remedies provided by existing law or regulations. 2. The application was timely filed. 3. Insufficient relevant evidence has been presented to demonstrate the existence of error or injustice. While the applicant’s response to the Air Force evaluation is noted, we were not persuaded by the evidence presented that his separation was in error or contrary to the governing Air Force instructions. The applicant's case has undergone an exhaustive review by the Physical Disability Board of Review (PDBR) Special Review Panel (SRP) and we do not find the evidence provided, sufficient to overcome their assessment of the case. Therefore, we agree with the opinion and recommendation of the PDBR SRP and adopt the rationale expressed as the basis for our conclusion that the applicant has failed to sustain his burden of proof that he has been the victim of an error or injustice. In view of the above and in the absence of evidence to the contrary, we find no basis to favorably consider the applicant’s request. THE BOARD DETERMINES THAT: The applicant be notified the evidence presented did not demonstrate the existence of material error or injustice; the application was denied without a personal appearance; and the application will only be reconsidered upon the submission of newly discovered relevant evidence not considered with this application. The following members of the Board considered AFBCMR Docket Number BC-2014-02572 in Executive Session on 13 May 15 under the provisions of AFI 36-2603: The following documentary evidence was considered: Exhibit A. DD Form 149, dated 30 Jun 13, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Memorandum, PDBR/SRP, dated 20 Jun 14. Exhibit D. Letter, SAF/MRBR, dated 26 Jun 14. Exhibit E. Letter, Applicant, 8 Jul 14, w/atchs. Exhibit F. Letter, SAF/MRBC, dated 30 Mar 15, w/atch.