RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201564 SEPARATION DATE: 20040823 

BOARD DATE: 20130322 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty Soldier, SPC/E-4(31B, Military Policeman), medically 
separated for panic disorder without agoraphobia. The CI initially noted symptoms while 
stationed in Germany; however, he did not seek medical attention. He transferred to Ft. Carson 
where his symptoms worsened and he was started on Xanax, given intramuscular Valium, and 
also started on Paxil. Despite medical disagreement, the CI was deployed; however, he was 
immediately air evacuated from theater. The CI did not improve adequately with treatment to 
meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical 
fitness standards. He was issued a permanent S4 profile and referred for a Medical Evaluation 
Board (MEB). The MEB forwarded panic disorder without agoraphobia; and major depressive 
order, single episode; as medically unacceptable IAW AR 40-501. Eight other conditions, 
identified in the rating chart below, were also identified and forwarded by the MEB as meeting 
retention standards. The PEB bundled the panic disorder without agoraphobia and major 
depressive disorder, single episode into panic disorder without agoraphobia and adjudicated 
the condition as unfitting, rated 10%, with application of the Veteran’s Affairs Schedule for 
Rating Disabilities (VASRD). The eight other conditions, identified on the rating chart below, 
submitted by the MEB were adjudicated by the PEB as not unfitting. The CI made no appeals, 
and was medically separated with a 10% disability rating. 

 

 

CI CONTENTION: The CI states: “Service connection for PTSD was denied. Service connection for 
upper and lower back pain was denied. I was in accident while on duty July 7 2003 and it 
effected [sic] by back still. Service connection for irritable bowel syndrome was granted with an 
evaluation of 0 percent. Service connection for vasomotor rhinitis is granted with an evaluation 
of 0 percent.” 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44 (Enclosure 3, paragraph 5.e. (2)) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB”. The Service 
ratings for unfitting conditions will be reviewed in all cases. The conditions of PTSD; functional 
bowel disorder; recurrent upper and lower back pain; and allergic rhinitis as requested for 
consideration meet the criteria prescribed in DoDI 6040.44 for Board purview; and, are 
addressed below, in addition to a review of the Service ratings for the unfitting conditions. 
The conditions of personality disorder, NOS; chronic knee pain; residual left ankle sprain s/p 
recent ankle sprain; and gastro-esophageal reflux are not within the Board’s purview. 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 Army Board for the 
Correction of Military Records (BCMR). 

 

 

 

 

 


 

RATING COMPARISON: 

 

Service PEB – Dated 20040715 

VA (7 & 9 Mos. Post-Separation) – All Effective Date 20040824 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Panic Disorder w/o 
Agoraphobia 

9412 

10% 

Panic Disorder w/o 
Agoraphobia, MDD 

9412 

30% 

20050328 

PTSD 

Not Unfitting 

PTSD 

9411 

NSC 

20050328 

Personality Disorder, NOS 

Not Unfitting 

Personality Disorder 

9410 

NSC 

20050328 

Functional Bowel Disorder 

Not Unfitting 

Irritable Bowel Syndrome 

7319 

0% 

20050328 

Recurrent Upper and 
Lower Back Pain 

Not Unfitting 

Upper & Lower Back Pain 

5237 

NSC 

20050506 

Allergic Rhinitis 

Not Unfitting 

Vasomotor Rhinitis 

6522 

0% 

20050328 

Chronic Knee Pain 

Not Unfitting 

Right Knee Pain 

5257 

NSC 

20050506 

Residual L Ankle Sprain 
s/p Recent Ankle Sprain 

Not Unfitting 

No VA Entry 

 

 

 

Gastro-esophageal Reflux 

Not Unfitting 

Esophageal Reflux, Hiatal Hernia 

7346 

10% 

20050328 

.No Additional MEB/PEB Entries. 

0% X 2 / Not Service-Connected x 2 

20050328 

Combined: 10% 

Combined: 40% 



 

 

ANALYSIS SUMMARY: The Board acknowledges the CI’s contention that suggests service ratings 
should have been conferred for other conditions documented at the time of separation. The 
Board wishes to clarify that it is subject to the same laws for service disability entitlements as 
those under which the Disability Evaluation System (DES) operates. While the DES considers all 
of the service member's medical conditions, compensation can only be offered for those 
medical conditions that cut short a service member’s career, and then only to the degree of 
severity present at the time of final disposition. However the Department of Veteran Affairs 
(DVA), operating under a different set of laws (Title 38, United States Code), is empowered to 
compensate all service connected conditions and to periodically reevaluate conditions for the 
purpose of adjusting the disability ratings should his degree of impairment vary over time. 

 

Panic Disorder without Agoraphobia. The narrative summary (NARSUM) 30 June 2004, 
approximately two months prior to separation, notes the history of panic attacks which the CI 
reported began while in Germany. He did not seek medical attention at that time, but was 
assisted at least once by a supervisor during an attack, which resolved with approximately a half 
hour of “rest”. He was returned to the US and his attacks intensified. He was initially having 
attacks one to three times per week. The CI received treatment with medications and was 
placed on a profile. He was deployed to Iraq, contrary to a psychiatric opinion, because the 
“unit took patient based on favorable performance.” In Kuwait, after one week, he was seen in 
the clinic because he had run out of medication and was experiencing anxiety and rage. The CI 
was treated with a tranquilizer injection, but the next day he had a repeat attack, and received 
another injection. He was relieved of his arms and sent back to the US for further treatment. 
Additional diagnoses of major depressive disorder, PTSD, and personality disorder with 
borderline traits were noted. Medications were added and changed frequently, adding 
stronger medications for the anxiety. The MEB/NARSUM stated that the CI’s current status was 
symptoms of panic once or twice a week. The MEB/NARSUM exam referenced the DD2808 3 
June 2004 and noted the physical evaluation to be unremarkable. At the MEB psychiatry exam 
23 June 2004 the CI was noted to have the following symptoms: “he feels “empty” and can’t 
think, he breaths harder and faster, he has “hot flushes”, then chills, dizziness. He has a fear of 
going “crazy” or dying. The CI was having impaired sleep and nightmares, and reported having 
visual illusions and auditory hallucinations of hearing his name called. The psychiatric NARSUM 
states the CI’s duty performance was unsatisfactory due to his irritability and paranoia and it 
was necessary to remove the CI from his unit on two occasions. The MEB psychiatry exam 
noted a flat affect but “otherwise appropriate to the situation”; no delusions; oriented to place, 
but not date and time. The examiner stated the CI appeared “lost”. The CI reported a 
significant childhood history of a chaotic family life and physical and sexual abuse. He had 


trouble in elementary school with fighting, but did better in high school. He had joined the 
National Guard but had difficulty finding and holding civilian jobs, so joined the Army. The 
diagnoses were major depression, single episode; panic disorder; PTSD secondary to childhood 
traumas, existed prior to service (EPTS). The panic disorder and major depression were noted 
to be in the line of the duty, but not the PTSD. GAF estimate was 45 and noted “severe panic 
symptoms”. The recommendations stated that the CI “has been declining in his ability to 
perform as a soldier” and were unable to perform his MOS or carry a weapon due to anger and 
poor judgment. At the VA Compensation and Pension (C&P) exam psychiatric evaluation 28 
March 2005, approximately seven months after separation, the CI reported that he continued 
with episodes of rage and panic, but that they were less frequent on medication, about three 
times per month. He did report trouble concentrating. The CI reported that symptoms of 
hearing things; seeing flashes of light, feelings of being watched; and thinking he knew what 
others were thinking or that someone on television was talking to him were better since on 
medication. He reported the same family history. The CI was enrolled in college, but reported 
doing very poorly and did not think he would pass. He had a hard time concentrating and had 
to leave class due to panic attacks. The CI had not been employed since separation. He was 
married without children; the relationship had deteriorated due to his irritability. There was no 
history of violence, suicidal or homicidal ideation, or inpatient psychiatric care. At the exam the 
CI made good eye contact, related well to the examiner, but appeared mildly depressed. There 
was no evidence of impaired thought, judgment, delusions, hallucinations; no obsessive 
behavior, no impaired impulse control. Panic attacks were noted to be once per week; anxiety 
state was noted to be mild. He was oriented to person, place and time, but exhibited poor 
concentration. There was no evidence of a personality disorder. The examiner diagnosed panic 
disorder without agoraphobia and major depressive disorder (by history). GAF was estimated 
to be 48-50. The examiner opined that a complete diagnosis of PTSD was not present and felt 
the CI had few symptoms of PTSD: “His major problems are those of panic disorder, and there 
appears to be a history of major depressive disorder while in the service” ; and, “The veteran 
did have some features of psychotic thinking while he was in Iraq, and it is unclear whether this 
was possible initial presentation of a psychotic disorder which was warded off by treatment or 
whether this represented psychotic features of a major depression”. The examiner stated 
“Psychiatric symptoms are currently frequent, severity is serious, and duration has been since 
military service” and that the CI had not had any period of complete remission. The Board 
directs attention to its rating recommendation based on the above evidence. The Board 
unanimously agreed that § 4.129 did not apply. The PEB found the CI’s panic disorder to be 
unfitting and rated as 9412 (Panic Disorder) at 10%. The VA also rated as 9412 at 30%. The 
Board agreed that the CI’s panic disorder with panic attacks occurring one to two times per 
week at the time of separation exceeded the §4.130 threshold for a 10% rating. The 
deliberation settled therefore on evidence for a 30% (occupational and social impairment with 
occasional decrease in work efficiency and intermittent periods of inability to perform 
occupational tasks) versus a 50% (occupational and social impairment with reduced reliability 
and productivity) permanent rating recommendation. The Board opined that the evidence in 
the MEB/Psychiatric NARSUM of severe anxiety with panic attacks; flat affect; paranoia; 
disorientation to time; poor judgment; and impaired sleep most nearly met the 30% rating. The 
30% rating rationale is further supported by the observation that the CI had been declining in 
performance and required more and stronger medication for treatment of his anxiety. 
However, the Board adjudged that the CI’s symptoms did not meet the criteria for a 50% rating 
at the time of separation due to the CI’s improvement on appropriate medications, which 
continued post separation as indicated by the VA C&P psychiatric assessment seven months 
post separation. The CI’s condition at the VA, while still serious, had improved and panic 
attacks were less frequent (approximately one per week), with mild anxiety and mild 
depression noted. He did not display impairment of thought, speech, or judgment. He was 
fully oriented; reported no further hallucinations; and was sleeping better. After due 
deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the 
Board recommends a disability rating of 30% for the panic disorder condition. 


 

Contended PEB Conditions. The contended conditions adjudicated as not unfitting by the PEB 
were PTSD; functional bowel disorder; recurrent upper and lower back pain; and allergic 
rhinitis. The Board’s first charge with respect to these conditions is an assessment of the 
appropriateness of the PEB’s fitness adjudications. The Board’s threshold for countering fitness 
determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating 
recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. 1) 
PTSD; The MEB psychiatric NARSUM diagnosed chronic PTSD secondary to childhood physical 
and sexual abuse and sexual assault which existed prior to service.. There were no records of a 
service incurred traumatic stressor. The VA C&P psychiatric examiner did not feel a complete 
diagnosis of PTSD was present; the only symptom specific for PTSD was sleeping difficulty. 2) 
Functional Bowel Disorder; The CI had a history of bilateral intermittent abdominal pain that 
was evaluated with upper endoscopy, colonoscopy, upper GI with small bowel follow through 
and exploratory surgery including appendix removal. The diagnosis was functional abdominal 
pain. There are no STRs addressing the abdominal pain condition after September of 2002. 3) 
Recurrent Upper and Lower Back Pain; The CI was seen for upper and lower back pain 
intermittently beginning in 2000 and the last visit for back pain in the record was August of 
2003, one year prior to separation. The MEB/NARSUM noted a past history of low back pain 
treated with physical therapy and diagnosed as muscle strain. The VA C&P exam showed a 
normal gait with no weakness, spasm or tenderness of the lumbar spine. ROM of the lumber 
spine was mildly decreased without radiculopathy. 4) Allergic rhinitis; STRs show four visits for 
allergic symptoms, all in the April to June seasonal time frame, which did respond to 
antihistamines, topical eye drops, and nasal inhalers. None of these conditions were 
permanently profiled; none were implicated in the commander’s statement; and, none were 
judged to fail retention standards. All were reviewed by the action officer and considered by 
the Board. There was no indication from the record that any of these conditions significantly 
interfered with satisfactory duty performance. After due deliberation in consideration of the 
preponderance of the evidence, the Board concluded that there was insufficient cause to 
recommend a change in the PEB fitness determination for the any of the contended conditions; 
and, therefore, no additional disability ratings can be recommended. 

 

 

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 panic condition, the Board unanimously recommends a 
disability rating of 30%, coded 9412 IAW VASRD §4.130. In the matter of the contended PTSD, 
functional bowel disorder, recurrent upper and lower back pain and allergic rhinitis the Board 
unanimously recommends no change from the PEB determinations as not unfitting. There were 
no other conditions within the Board’s scope of review for consideration. 

 

 

RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as 
follows; and, that the discharge with severance pay be recharacterized to reflect permanent 
disability retirement, effective as of the date of his/her prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Panic Disorder without Agoraphobia 

9412 

30% 

COMBINED 

30% 



 

 

The following documentary evidence was considered: 


 

Exhibit A. DD Form 294, dated 20120817, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 XXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / XXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

For XXXXXXXXXXXXXXXX, AR20130006096 (PD201201564) 

 

 

1. Under the authority of Title 10, United States Code, section 1554(a), I approve the 
enclosed recommendation of the Department of Defense Physical Disability Board of 
Review (DoD PDBR) pertaining to the individual named in the subject line above to 
recharacterize the individual’s separation as a permanent disability retirement with the 
combined disability rating of 30% effective the date of the individual’s original medical 
separation for disability with severance pay. 

 

2. I direct that all the Department of the Army records of the individual concerned be 
corrected accordingly no later than 120 days from the date of this memorandum: 

 

 a. Providing a correction to the individual’s separation document showing that 
the individual was separated by reason of permanent disability retirement effective the 
date of the original medical separation for disability with severance pay. 

 

 b. Providing orders showing that the individual was retired with permanent 
disability effective the date of the original medical separation for disability with 
severance pay. 

 

 c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will 
account for recoupment of severance pay, and payment of permanent retired pay at 
30% effective the date of the original medical separation for disability with severance 
pay. 

 

 d. Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) 
and medical TRICARE retiree options. 

 

 

 

 

 

 

3. I request that a copy of the corrections and any related correspondence be provided 
to the individual concerned, counsel (if any), any Members of Congress who have 


shown interest, and to the Army Review Boards Agency with a copy of this 
memorandum without enclosures. 

 

BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl XXXXXXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)