RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD1301079
BRANCH OF SERVICE:  Army	BOARD DATE:  20140416
SEPARATION DATE:  20040921

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSG/E-6 (11B/Infantry) medically separated for general anxiety disorder (GAD).  The CI entered active duty on 1 February 1989.  There were no combat related deployments or combat related personal awards in the record of evidence.  The CI was psychiatrically hospitalized in March 2004 for approximately 3 weeks as he was exhibiting highly anxious behavior due to his thought processes regarding the well-being of his wife and two children.  His mental health (MH) condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty.  He was issued a permanent S3 profile and referred for a Medical Evaluation Board (MEB).  The diagnosis of “general anxiety disorder” was consistent between the MEB psychiatric narrative summary (NARSUM) and the MEB.  The same diagnosis was referred by the MEB to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The PEB adjudicated GAD as unfitting, rated 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “A very low % was given when in fact conditions were worst.”[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.  In addition, the CI was notified by the Army that his case may eligible for review of the military disability evaluation of his MH condition in accordance with Secretary of Defense directive for a comprehensive review of Service members who were referred to a disability evaluation process between 11 September 2001 and 30 April 2012 and whose MH diagnoses were changed during that process.  The CI is also eligible for PDBR review of other conditions evaluated by the PEB and has elected review by the PDBR.  As such, the CI’s contention regarding the rating for his unfitting GAD is addressed below.  No additional conditions are within the DoDI 6040.44 defined purview of the Board.  In accordance with Secretary of Defense directive for a comprehensive review of MH diagnoses that were changed during the Disability Evaluation System process, the applicant’s case file was reviewed regarding diagnosis change, fitness determination, and rating of unfitting MH diagnoses in accordance with the VASRD §4.129 and §4.130.  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 Board for Correction of Military Records (BCMR).

RATING COMPARISON:

Service IPEB – Dated 20040622	VA - (3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
General Anxiety Disorder	9400	10%	Generalized Anxiety Disorder	9400	10%	20041209	
No Additional MEB/PEB Entries	Other x 11	20041206	
Combined:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20050425 (most proximate to date of separation [DOS]).
* VARD 20100625 increased DC 9400 from 10% to 70% effective 21 January 2010.  The CI was reevaluated in 2013; that VARD is not in evidence.

ANALYSIS SUMMARY:

General Anxiety Disorder.  Prior to an acute presentation, the CI was a stellar performer.  The final performance evaluation in his record covered the period from July to October 2003.  He was noted to be an exemplary performer and immediate promotion was recommended.  The CI was hospitalized 24 March 2004 after learning that he was due to deploy to Iraq.  He and his active duty spouse had only been together for 5 months and were working on obtaining a joint domicile for over a year.  He was thought to be suicidal by his wife and command after driving to the hospital at a high rate of speed and presenting in acute crisis thinking that he was dying.  He reported that when he was deployed to Hungary from April to September 2003, he had vivid nightmares that something horrible had happened to his wife and two children (from a prior marriage).  While he had seen fellow soldiers killed (not in combat), he denied any stress from this.  He reported that his symptoms had recently worsened and that he needed to keep them under constant observation.  He was discharged on 15 April 2004 on psychotropic medications and MEB recommended.  The MH NARSUM was dictated on 31 March 2004, while the CI was hospitalized.  It noted that he and his current wife had been married for 3 years.  On examination, he was anxious and his affect varied from tearful to euphoric.  He was diagnosed with GAD, narcissistic and histrionic personality traits.  A Global Assessment of Functioning (GAF) of 55 was assigned (indicative of moderate symptoms or impairment).  At the VA Compensation and Pension (C&P) examination performed 3 months after separation, the CI reported that in 2000, his unit deployed to Kosovo from Germany.  He reported that he saw lots of killing and dead bodies.  He also reported that he was assigned to teach Iraqi military in 2003 while he was deployed to Germany for 8 months.  He related that the Kosovo experience was the more traumatic.  He endorsed nightmares, flashbacks, insomnia, depression and worry since the Kosovo deployment.  He stated that he tried to keep these feelings to himself.  He felt nervous, restless, irritable and worried about the safety of his wife and children.  He also endorsed nightmares, flashbacks, poor sleep, avoidance and isolation.  On examination, he was nervous and tense with a constricted affect.  He was diagnosed with both GAD and posttraumatic stress disorder (PTSD).  His GAF was rated as 50-60, from the upper limit of serious symptoms or impairment to the upper limit for moderate symptoms or impairment.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both coded the condition 9400 (GAD) and rated it at 10%.  The Board considered the appropriateness of changes in the MH diagnoses, PEB fitness determination and if unfitting, whether the provisions of VASRD §4.129 were applicable and a disability rating recommendation in accordance with VASRD §4.130.  Office of the Under Secretary of Defense memorandum dated 17 July 2009 states:  "Therefore, as a matter of policy, the PDBR and all three BCMRs will apply VASRD Section 4.129 to PTSD unfitting conditions for applicants discharged after September 11, 2001, and in such cases, where a grant of relief is appropriate, assign a disability rating of not less than 50% for PTSD unfitting conditions for an initial period of 6 months following separation, with subsequent fitness and PTSD ratings based on the applicable evidence.”  The Board considered the criteria for diagnosis according to the Diagnostic and Statistical Manual for Mental Disorders IV TR including: the evidence for the stressor (criterion A), re-experiencing of the event (criterion B), persistent avoidance of stimuli associated with the trauma (criterion C), hyper-arousal (criterion D), duration and onset (criterion E), presence of clinically significant distress or impairment in social, occupational or other important area of functioning (criterion F).  The Board first considered the diagnosis.  It noted that the applicant was diagnosed with GAD by both the PEB and by the VA.  While the VA C&P examiner also diagnosed PTSD, after separation, the VA rater observed that the CI was first noted to have symptoms secondary to impending separation from his family and did not attribute his symptoms to a traumatic experience.  The Board determined that the GAD diagnosis should remain as the unfitting diagnosis at separation.  The Board also determined that no MH diagnoses were changed to the applicant's possible disadvantage in the disability evaluation process.  This applicant therefore did not meet the inclusion criteria in the Terms of Reference of the MH Review Project.  

The Board then considered if the provisions of VASRD §4.129 were applicable.  It noted that the CI became symptomatic in the context of imminent separation from his family, not secondary to previous traumatic experiences.  While these were later reported, the index event for the GAD manifestation was related to the prospect of future deployment, not due to past deployment experiences.  The Board determined that VASRD §4.129 was not applicable.  It then considered the rating IAW VASRD §4.130.  The performance of the CI was stellar prior to the onset of anxiety related to a future deployment and family separation.  There was no evidence of delusions, hallucinations, emergency room visits, abnormal behavior, grooming deficits, cognitive impairment, suicidal or homicidal ideation (although a concern of his wife) or impaired speech.  He was on psychotropic medications.  The description for a 30% disability 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, with routine behavior, self-care, and conversation normal.)”  The evidence does not support that the CI met this level of disability.  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 GAD condition.

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 GAD condition 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130725, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review
SAMR-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 XXXXXXXXXXXXXXXXXX, AR20140014458 (PD201301079)

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						     XXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary
						         (Army Review Boards)