Author: JOHN J. D'ORAZIO
Last saved by: Weathers, Janice R SrA MIL USAF AFDW SAF/MRBD
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxx	 CASE:  PD 13-00197	
BRANCH OF SERVICE:  Army	 BOARD DATE:  20131115
SEPARATION DATE:  20080608			 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (68X20 / Mental Health) medically separated for anxiety disorder condition.  During a previous deployment to Iraq from September 2004 to September 2005, while on convoy, CI reported that he experienced improvised explosive blasts and saw a gunner shot by a sniper and served on body details.  The anxiety disorder condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent S3 profile and referred for a Medical Evaluation Board (MEB).  The anxiety disorder condition, characterized as anxiety disorder, NOS from MEB” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded five other conditions for PEB adjudication.  The informal PEB adjudicated anxiety as unfitting rated 10% citing criteria with likely application of Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to meet retention standards by the MTF and considered by the PEB to be not unfitting  The CI made no appeals, and was medically separated with a 10% combined Service disability rating.  

CI CONTENTION:  “ V.A. found 30% disablaing [sic]”.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The Service rating for the unfitting anxiety disorder condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the respective Service Board for Correction of Military Records. 

RATING COMPARISON:  

Service IPEB – Dated 20080418 | VA - (~2 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Anxiety Disorder, NOS | 9413 | 10% | Bipolar Disorder (also Claimed as Anxiety and PTSD | 9432 | 10%* | 20080904
Bipolar Disorder, Type II | Not Unfitting | | | |
Depression | Not Unfitting | No VA Entry
Migraine Aura | Not Unfitting | Migraine Headaches | 8100 | 10% | 20081016
Right Knee Pain Chronic | Not Unfitting | Right Knee Strain (Claimed as Right Knee Pain/Strain) | 5299-5260 | 0% | 20081016
Flat Feet | Not Unfitting | No VA Entry
No Additional MEB/PEB Entries | 0% x 1/Other x # | 20081016
Combined:  10% | Combined:  30%
Derived from VA Rating Decision (VARD) dated 20081030 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Military Disability Evaluation System has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veteran Affairs, operating under a different set of laws.

Anxiety Disorder, NOS Condition.  The narrative summary (NARSUM) notes the CI had history of depression with sad mood, crying spells, and feelings of hopelessness and helplessness following a deployment to Iraq from September 2004 to September 2005.  In Iraq he was utilized several times for convoy guarding and also for body details.  During convoys he experienced improvised explosive device (IED) blasts, and a gunner a couple of vehicles ahead of him was shot. He was experiencing marital problems when he returned and he and his wife were divorced in December 2005.  In January 2005, the CI sought psychiatric help and was started on an antidepressant.  In August 2007 the CI had neuropsychological testing because of memory concerns.  His memory was good, but testing was consistent with Post Traumatic Stress disorder (PTSD) and Bipolar II disorder.  He was evaluated by a by a psychiatrist and his medication regimen was changed from antidepressants to mood-stabilizing medications.  The MEB Behavioral Medicine consult 4 December 2007, approximately six months pre-separation, noted an AXIS I diagnosis of Anxiety Disorder, manifested by combat experiences, with nightmares, avoidance of reminders of war, estrangement from others, an exaggerated startle response and hyper-vigilance.  Impairment for military service was marked but for social and industrial adaptability was slight.  Bipolar II disorder that existed prior to service (EPTS) was also diagnosed.  The CI was noted to be improved with treatment with a favorable prognosis.  At the MEB exam 1 April 2008, approximately 2 months pre-separation, the CI reported nightmares of IED blasts and flashbacks, especially in public situations, that make him nervous.  He avoided talking about his military experiences.  He noted his depression symptoms were alleviated with medications, but he still sometimes experienced mood swings and anxiety in public situations.  The CI denied suicidal/homicidal ideations or hallucinations.  The MEB examination noted a normal mental status exam (MSE), with a normal appearance.  The CI’s affect was full and congruent with mood; he was alert and oriented; knowledge, memory and concentration were intact; insight was good and judgment was fair; his thought processes and intellectual function were normal; and there was no evidence of delusions.  The CI had two children and they were living with his ex-wife.  It was also noted that he had a girlfriend and this was a good, supportive relationship.  He had plans for the future to get a master’s degree after finishing college.  The examiner summarized that the CI was having mild to moderate symptoms of anxiety disorder which affected his occupational performance during periods of stress and required medication for control.  The diagnoses were: AXIS I - A) Anxiety disorder controlled with medication, and B) Bipolar disorder, Type II with depression, “subacute at this time”; AXIS IV - stressors were divorce and theater war action; and AXIS V - current global assessment of functioning (GAF) was 60  (GAF 60 – 51, Moderate symptoms OR moderate difficulty in social, occupational, or school functioning).  The CI was considered competent, not suicidal or homicidal, but military service separation was recommended.  Post-separation treatment notes in the record support that the CI’s symptoms of depression and anxiety improved with mood-stabilizing medications for Bipolar II Disorder.  The CI reported an overall stable mood with good energy and sleep, with occasional anxiety symptoms of nervousness and restlessness, and otherwise normal MSEs.  

At the VA Compensation and Pension (C&P) General Medical examination 9 May 2008, approximately one month pre-separation, no evidence of extreme psychological problems or PTSD was found; Bipolar II Disorder, with anxiety was found.  At the VA C&P Mental Health examination 4 September 2008, approximately three months after separation, the CI reported depression symptoms.  He reported occasional thoughts of the war stresses, but they were not intrusive thoughts and he was not having nightmares.  He reported just starting a new job, working in a psychiatric unit of a VA hospital, and that so far it was going well.  The CI reported feeling “edgy” in crowds, but was spending time with his children and girlfriend.  He reported that his more than two year relationship with his girlfriend was better since he was on mood-stabilizing medications.  The CI expressed he had short and long range occupational plans, which included completing college and getting a master’s degree in business. On the VA MSE the CI had good eye contact and appropriate behavior.  He was alert and fully oriented.  There was normal thought process and content; no hallucinations or delusions were evident or reported; his memory was good.  There was no evidence of panic attacks, obsessive or ritualistic behavior or lack of impulse control.  The VA examiner agreed with the diagnosis of Bipolar II Disorder.  The AXIS 1 diagnosis was Bipolar II disorder with occupational or social impairment due to mild or transient symptoms controlled by required medication.  The GAF was 70 (GAF 70 - 70 – 61, some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships.)  The CI’s condition was noted to have improved with medication changes and not to have worsened post-separation.  

The Board directs attention to its rating recommendation based on the above evidence. Members agreed that the preponderance of the evidence in the record did not support a diagnosis of PTSD.  The PEB adjudicated the CI’s Anxiety Disorder as unfitting and provided a disability rating of 10% coded as 9413 (Anxiety Disorder).  The VA rated Bipolar Disorder at 10% coded as 9432 (Bipolar Disorder).  The Board deliberated the rating of the CI’s mental health disorder.  The CI was diagnosed at the MEB Psychiatric Examination with Anxiety Disorder and Bipolar II Disorder, EPTS.  At the VA Mental Health C&P exam the CI was diagnosed with Bipolar II Disorder.  The difference between the PEB diagnosis at separation and at the VA diagnosis does not impact the CI’s permanent disability rating because all mental health diagnoses (except eating disorders) are rated the same, IAW VASRD General Rating Formula for Mental Disorders and only a single disability rating can be provided based on occupational and social impairment.  At both the MEB and the VA C&P exam, the CI was doing well on mood-stabilizing medication with intact personal relationships, normal mental status exams, except for mild symptoms of chronic depressed mood and occasional anxiety associated with crowds or loud noises.  At post separation treatment visits the CI reported the birth of a son and that he was actively participating in the care of the infant.  At the VA exam, the CI reported starting a new job the previous week and that it was going well.  The CI was taking college courses online while he was working.  The Board next reviewed to see if VASRD §4.129 applied in this case, and found that it did not.  The Board agreed that the CI’s mental health condition met the 10% disability rating (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, or; symptoms controlled by continuous medication) IAW VASRD §4.130 and reviewed to see if it met the higher evaluation of 30% (Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal)) and found that it did not.  There is no evidence in the record that at the time of separation the CI was experiencing any panic attacks, paranoia, memory loss, and chronic sleep impairment or had any periods of being unable to work due to mental health symptoms.  The CI’s symptoms were well controlled by medication at separation and remained stable and continued to improve post-separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the Anxiety Disorder.  

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the Anxiety Disorder, NOS and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration. 

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:  

UNFITTING CONDITION | VASRD CODE | RATING
Anxiety Disorder, NOS | 9413 | 10%
COMBINED | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130416, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			
	           xxxxxxxxxxxxxxxxxxxxxxxx, DAF
	           President
	           Physical Disability Board of Review

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx, AR20140004220 (PD201300197)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						    xxxxxxxxxxxxxxxxxxxxxxxxx
						     Deputy Assistant Secretary
						         (Army Review Boards)

PD 13-00197