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AF | PDBR | CY2012 | PD2012 01062
Original file (PD2012 01062.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD1201062
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20130619
SEPARATION DATE: 20020709


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SRA/E-4 (2A352/F-16 Production Coordinator) medically separated for obsessive compulsive disorder (OCD). The CI was first seen in July of 1998 for increased anger and recurrent dreams of killing people. He began a treatment regimen that resulted in him being diagnosed with OCD. The condition could not be adequately rehabilitated to meet the requirements of his Air Force Specialty. He was issued an S4 on his Physical Profile Serial Report and referred for a Medical Evaluation Board (MEB). The OCD condition was forwarded to the Informal Physical Evaluation Board (IPEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The IPEB adjudicated “obsessive compulsive disorder social and industrial adaptability impairment definite” as unfitting but not yet stable enough to make a final rating determination and recommended placement on the Temporary Disability Retirement List (TDRL) with a rating of 30%. The CI appealed to the Formal PEB (FPEB) and requested to remain on active duty. The FPEB stated “Unfortunately, the Board cannot sustain the IPEB's recommendation for Temporary Retirement because if the member is working fulltime, not missing any work and performing his job rather well, he is certainly not 30 percent disabled. The FPEB finds the member unfit and recommends discharge with Severance Pay with a compensable disability rating of 10 percent.” The Secretary of the Air Force Personnel Council (SAFPC) upheld the findings and recommendations of the FPEB and the CI was medically separated.


CI CONTENTION: “I was awarded Temporary retirement due to the severity of my condition. Which was withdrawn when I requested to remain on active duty. My condition has worsened over the years since leaving the military, and request to be placed on permanent retirement due to my worsening health.”


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 rating for the unfitting OCD 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 Board for Correction of Military Records.



RATING COMPARISON:

Service FPEB – Dated 20020405
 VA – based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Obsessive Compulsive Disorder
 9404 10% Obsessive Compulsive Disorder 9404 10%* STR
No Additional MEB/PEB Entries
 Other x 5 (Not Service Connected) STR
Rating: 10%
 Rating: 10%
Derived from VA Rating Decision (VA RD ) dated 200 20211 ( most proximate to date of separation [ DOS ] ).
* The CI did not report for his initial C&P Exam and was rated using the STR. The VA later increased his rating to 30% via the VARD dated 20040701 based on C&P exam date d 20031007 with the effective date 20020710 (one day after separation).


ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veteran Affairs (DVA) but not determined to be unfitting by the PEB. However the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. 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 Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on severity at the time of separation.

Obsessive Compulsive Disorder. The CI requested mental health evaluation and treatment in July 1998. At that time he complained of impaired ability to cope with stress, increased irritability, disturbing dreams and homicidal thoughts towards his wife. Those symptoms did not occur in a traumatic context and the CI was able to control his actions, without harming himself or other members of his family. The CI enrolled in therapy with good results and in January 1999 his symptoms were in complete remission, he was functioning well and psychiatric treatment was discontinued. The CI resumed psychiatric treatment a year later secondary to occurrence of intrusive thoughts (disturbing, related to his wife and daughter dying) accompanied by ritualistic behaviors (checking locks, touching objects in a specific order). He was seen by psychiatry in October 2000, diagnosed with OCD and medication treatment was initiated. The psychiatrist noted the CI was fully capable of performing current job duties but not the role of an avionics technician. Subsequent psychiatric notes evidenced a stable mood, normal mental status exam (MSE) with good work and social performance despite continuous obsession with death. There was a decompensation episode in January 2001 after a decrease in medication dose. The CI experienced transient psychotic symptoms and disturbing dreams which remitted after adjustment of antipsychotic medication. In February 2001, secondary to marital conflict and daughter illness, the CI complained of having a “nervous breakdown” described as increased anxiety and preoccupation with death. In April 2001, the CI self discontinued the antipsychotic medication and subsequently experienced exacerbation of compulsive thoughts, insomnia and difficulties concentrating. Medication regimen was reinstated with good effects (except one decompensation episode in May 2001 when the antipsychotic dose was reduced). However, with adjustment of a second medication, the CI was able to be stabilized and follow up appointment from July 2001 noted he was doing well. In September 2001, the CI complained of insomnia, agitation and increased frequency of intrusive thoughts when he had run out of medication. His wife stated he became irritable and verbally aggressive so inpatient psychiatric admission was initiated (September 24-27, 2001). Psychologic testing performed the same month evidenced mild obsessive-compulsive symptoms. Once again, the medication regimen was readdressed and in October 2001, the CI resumed his outpatient mental health treatment. Follow up notes (November 2001-June 2002) from the mental health clinic as well as life skills center noted the CI was compliant with medication, his obsessive compulsive disorder condition was well controlled, with minimal sleep disturbances and good coping skills. Due to restrictions from flight line duties and deployment a MEB was initiated. The MEB narrative summary (NARSUM) MSE performed on 10 December 2001, 7 months prior to separation noted the CI was pleasant and appropriate, well dressed and groomed. He maintained good eye contact, presented with mild psychomotor and mild increase in rate of speech (though speech had normal volume and prososdy). There was minimal dysphoric affect, without lability. No evidence of suicidal/homicidal thoughts or psychosis. Insight was described as fair; judgment was fair to good. The CI had good concentration and attention. The psychiatrist assigned a Global Assessment of Functioning of 65 denoting some mild symptoms and recommended continuation of medication regimen as well as therapy. In his memorandum for the MEB, dated 18 December 2001, the CI requested return to full duty and stated his condition was in complete control. The CI also submitted several letters of support for retention including supervisors and co-workers who all uniformly lauded his performance, dedication and ability to work with others in the team. On 5 March 2002, the IPEB recommended placement on the TDRL with a 30% rating. The CI appealed to the FPEB for return to full duty and submitted additional letters of support. A letter from a current supervisor dated 28 March 2002, who noted having supervised the CI for one year, stated:

Concerning ___'s duty performance, it is excellent. His attitude toward his job is outstanding, and he is a tireless worker. On numerous occasions, his supervisor has informed me of his willingness to work a job to completion, often times going above and beyond the normal realm of responsibility for his position. He volunteers time off-duty to support organizational programs, and is increasing his value to the Air Force by working toward his Aircraft Maintenance Technology degree. In short, he is an Airman you can trust to get the job done correctly. … his on-duty behavior has been commendable. He has "5" EPRs, and has been awarded notoriety certificates for flawless performance. If the medical review board purpose is to decide if a person can perform in his job and work with others, then the answer must unequivocally be YES!

The FPEB noted the CI’s excellent duty performance, working fulltime and not missing work, but concluded the restrictions from flight line duties and deployment rendered him unfit for continued military service. SAFPC upheld the FPEP findings. There is no VA Compensation and Pension (C&P) examination proximate to separation. A C&P examination, dated 7 October 2003, 15 months after separation, noted the CI was not taking medication and had recently sought mental health care services in September 2003. He was employed fulltime by the Federal Aviation Administration since 23 September 2002 as an air traffic control system specialist and reported missing 2 or 3 days of work due to his OCD.

The Board directs attention to its rating recommendation based on the above evidence. The Board first addressed if the tenant of §4.129 (mental disorders due to traumatic stress) were applicable. The Board determined that the OCD was not due to a “highly stressful event” as used in the VASRD, and that §4.129 are not applicable in this case. The Board noted that the IPEB recommended TDRL placement with a 30% disability rating but the CI did not agree with this decision and requested continuation on active duty. There were several letters of support written on the CI’s behalf and all mentioned exceptional work ethic and duty performance. The CI continued regular outpatient treatment and medication management with stabilization of his mental status. There were no other inpatient admissions. The CI was able to maintain his marriage, work full time and study part time. The NARSUM psychiatry examiner noted good concentration and memory, normal volume and prosody of speech, minimally restricted affect and no evidence of psychosis. Mental health notes written between January and June 2002 noted the OCD was well controlled, the CI had good coping skills, there were minimal sleep disturbances and no decompensation episodes requiring admission to the psychiatric inpatient unit. The FPEB noted the CI was capable of full employment and had an excellent work performance. According to a post-separation VA examination, the CI was employed fulltime following separation without significant impairment despite cessation of medication. Although the CI’s mental condition was considered in full remission, he was maintained on continuous medication meeting the 4.130 guidelines for a 10% rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board recommends no change in the FPEB adjudication and a permanent disability rating of 10% for the OCD 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 OCD 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, as follows:

UNFITTING CONDITION VASRD CODE RATING
Obsessive Compulsive Disorder 9404 10%
RATING 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120707, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





XXXXXXXXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review
SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews MD 20762
Dear XXXXXXXXXXXXXXXXXXXX :

          Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2012-01062.
         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.
         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,





 XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

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