RECORD OF PROCEEDINGS

PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXX BRANCH OF SERVICE: Air force

CASE NUMBER: PD1100185 SEPARATION DATE: 20020610

BOARD DATE: 20111220

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty TSgt/E-6 (1W031, Weather Forecaster Specialist) medically separated for an anxiety disorder. The condition began in 1999. He did not respond adequately to treatment and was unable to perform within his Air Force specialty (AFS). He was issued an S4 profile and underwent a Medical Evaluation Board (MEB). Anxiety disorder was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AFI 48-123. No other conditions appeared on the MEB’s submission, and no other conditions with fitness implications were identified in the Disability Evaluation System (DES) file. The Informal PEB (IPEB) adjudicated the anxiety condition as unfitting, rated 10% IAW with the Veterans Administration Schedule for Rating Disabilities (VASRD). This finding was upheld by a Formal PEB (FPEB) and the CI was medically separated with a 10% disability rating.

CI CONTENTION: The CI states: “On June 10, 2002, I was discharged from the Air Force. The Medical Evaluation Board assigned a 10% disability rating. The 10% rating was given despite having been diagnosed, in Feb '99, by Capt. K---, Chief, Mental Health Services at Barksdale AFB, with Severe Social Phobia, and in Feb '02 by Col. S---, M.D., Chief of Psychiatry at Fort Jackson, SC, with Anxiety Disorder and a GAF of 60. Dr. S--- stated, "impairment should be considered as in the line of duty and impairment for social and industrial adaptability is definite." The IPEB's findings stated "anxiety disorder, not otherwise specified. Definite social and industrial adaptability impairment" and "member is unfit because of physical disability," yet they only granted a 10% disability rating and stated this was lAW DoD and VASRD guidelines. The FPEB confirmed the findings of the IPEB. These findings do not accurately reflect the professional medical opinions of the military doctors or the DoD and VASRD guidelines. The diagnosis/statements of Doctors K--- and S---, the VASRD, and DoD guidelines reflect that a minimum disability rating of 50% is appropriate, accurate, and fair. A 10% rating would apply where the symptoms were "mild or transient" and able to 'maintain adequate job and social adjustment.' This does not coincide with Doctor K---'s or Dr. S---'s diagnosis, as can be seen in the attached documents, of "severe social phobia," "considerable social and industrial impairment," and "definite." The Doctor's did not describe my symptoms as "mild or transient," they were at the very least moderate and they impacted my ability to perform my job under normal everyday conditions. This is not reflected by the 10% rating, but is instead in-line with the 50% rating. Subsequent to the FPEB's decision, I was told by Col. S--- that had I been in the Army, I would have received a minimum 50% rating. I'm not looking for a handout, just a fair reconsideration of the previous decisions lAW the guidelines. In my 8+ years since leaving the Air Force, I've continued to struggle with these same issues.” No conditions other than anxiety disorder are contended or noted in this application.

RATING COMPARISON:

ANALYSIS SUMMARY: The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on severity at the time of separation. It must also judge the fairness of PEB fitness adjudications based on the fitness consequences of conditions as they existed at the time of separation. The Board notes the significant interval (21 months) between the date of separation and the Department of Veterans’ Affairs (VA) evaluation. DoDI 6040.44, under which the Board operates, specifies a 12 month interval for special consideration to VA findings. The 12 month window specified in DoDI 6040.44 is appropriate for rating comparisons but not for new developments after separation. This does not mean that the VA information was disregarded, as it was a valuable source for clinical information and opinions relevant to the Board’s evaluation. In matters germane to the severity and disability at the time of separation, however, the information in the service record was assigned proportionately more probative value as a basis for the Board’s rating recommendations.

Anxiety Disorder Condition. The CI’s symptoms first appeared as a result of the stress of recruiting duty in 1999. Despite treatment with counseling and medication, his symptoms persisted and he was retrained into weather forecasting. During the several months of weather forecasting technical school training, he experienced no symptoms. However, the stresses of the new forecasting job again resulted in feelings of intense anxiety despite therapy and two psychotropic medications. The narrative summary (NARSUM) psychiatrist (26 October 2001) reported that restlessness, fearfulness, crying, diminished concentration and depressive symptoms remitted when he was taken out of forecasting and placed in administrative duties. Panic attacks were not mentioned. No social impairment was noted and family relationships were close and supportive. Mental status exam (MSE) revealed normal orientation, speech and thought processes, and no psychomotor disturbance. There was no evidence of hallucinations and affect did not appear anxious. Memory was intact. The assessment was anxiety disorder manifested by job-related anxiety symptoms. The global assessment of functioning (GAF) was 60, connoting moderate symptoms or impairment. The highest GAF in the past year was 70 (mild symptoms or impairment). The examiner stated that the symptoms seemed to be specific to certain types of duty stress, but that it was possible he could perform satisfactorily in an environment such as the postal service, where he previously worked and had no such difficulties. The commander’s letter, dated 31 January 2002, stated that he had the ability to absorb a small set of data and properly interpret it, but the challenges of quickly absorbing and interpreting larger data sets resulted in stress levels that prevented him from functioning normally in weather forecasting. The commander recommended the CI for cross training, and noted he was a reliable, hard working member. An updated psychiatric NARSUM exam dated 14 January 2002 documented the same findings and assessment. A follow-up mental health outpatient note 7 February 2002 indicated the CI was doing well and had no recurrence of anxiety. A 25 March 2002 recorded the CI continued to feel “reasonably well,” was disappointed regarding the PEB adjudication. There was mild restriction of affect, but the MSE was otherwise normal. A follow up appointment for 22 April 2002 was scheduled, but the documentation from that appointment is not in the file. The Board noted an updated physical profile dated 22 April 2002 changing the CI’s profile to S1, with no restrictions noting “Previous Life Skills issue”; “return to duty.” There was no further evidence until the VA compensation and pension (C&P) examination 21 months after separation (22 March 2004). At that examination, the CI’s symptoms were better and he was receiving no treatment for anxiety. He avoided work that would put him in a stressful situation. He was working as an airport security screener for 17 months and reported that his job was going well. He denied depression symptoms. Panic attacks were not mentioned. He would often awaken at night but had no difficulty going back to sleep. Although he sometimes got “a little anxious,” it soon passed; he had not experienced that for a while. There were no hallucinations and no suicidal or homicidal ideations. The assessment was “minimal present anxiety…likely to be currently subclinical.” The assigned GAF of 60 seemed incongruent with the described clinical picture. Psychological testing revealed borderline elevation in social introversion and depression scores, but the results were consistent with the patient reports of things “going fairly well.” The Board discussed the rating recommendation based on the evidence just described. The Board notes that IAW §4.126, “…the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination.” Therefore, while a GAF score at the time of an examination is one factor in assessing the overall level of disability, it must be placed in the context of “all the evidence of record.” The CI’s symptoms and relevant impairment only occurred in highly specific and avoidable situations, and thus did not reflect the meaning inherent in the next higher 30% rating (‘occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks’). A GAF score of 70 during the prior year was an additional indicator that the CI’s condition was mild in the absence of a specific, highly stressful work environment (recruiting and weather forecasting). The Board noted that despite his symptoms, the CI attained a promotion in rank and a satisfactory performance report for the period 1 November 2000 to 31 October 2001. Mental health clinic entries following the MEB documented mild symptoms. The C&P examination documented satisfactory stable employment beginning approximately four months after separation and continuing to the time of the C&P examination. Although 21 months after separation, the C&P examination reflected symptoms similar to the mental health clinic encounters noted prior to separation and indicates the CI’s condition remained generally stable through the time of separation to the time of the C&P examination. While there may have been minor impairment of social functioning (social introversion) and the CI had significant difficulty with certain kinds of jobs, he needed no treatment for his disorder and clearly had no difficulty in his occupation at the time of the C&P exam. This was predicted by the NARSUM psychiatrist who suggested that he could perform satisfactorily in a different job environment. All Board members agreed that the descriptor under the 10% rating (“…transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress”) accurately depicted the CI’s condition. All evidence considered, there is not reasonable doubt in the CI’s favor supporting a change from the PEB’s rating decision for the anxiety disorder condition.

Remaining Conditions. No other conditions were noted in the NARSUM, identified by the CI on the MEB physical, or found elsewhere in the DES file. The Board does not have the authority under DoDI 6040.44 to render fitness or rating recommendations for any conditions not considered by the DES. The Board thus has no basis for recommending any additional unfitting conditions for separation rating.

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 condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication. The Board unanimously agrees that there were no other conditions eligible for Board consideration which could be recommended as additionally unfitting for rating at separation.

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 20110322, w/atchs

Exhibit B. Service Treatment Record

Exhibit C. Department of Veterans' Affairs Treatment Record

XXXXX

President

Physical Disability Board of Review

SAF/MRB

1500 West Perimeter Road, Suite 3700

Joint Base Andrews MD 20762

Dear XXXXX :

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2011-00185

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 re-characterization or modification of your separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXX

Director