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.