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AF | PDBR | CY2012 | PD2012 01940
Original file (PD2012 01940.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: AIR FORCE
CASE NUMBER: PD1201940 SEPARATION DATE: 20080623
BOARD DATE: 20130319


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (2W171/Aircraft Armament System Craftsman) medically separated for a mental condition. This CI sought mental health services in June 2006 where he received alcohol and drug abuse prevention and treatment (ADAPT) and was diagnosed with mental health conditions. His condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS). He was issued permanent S1 profile, but still referred for a Medical Evaluation Board (MEB) due to his medication. The Axis I: mood disorder, not otherwise specified (NOS); social phobia; alcohol dependence, in full remission; nicotine habituation; Axis II: personality disorder, NOS; and Axis III: herniated nucleus pulposus (HNP), L4-L5; plantar fasciitis condition were forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. The PEB adjudicated mood disorder, NOS, associated with social phobia as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be Category III which is not separately unfit and compensable, ratable. The CI made no appeals, and was medically separated with a 10% disability rating


CI CONTENTION: “The Military Mental Health Professionals gave me different diagnosis. The Disability Review Board did not consider my other health related issues and only awarded 10%. The VA has given me a combined rating of 60%. All these ratings are service connected. The ratings for my bilateral hearing loss is still pending. The single rating from the USAF Board was 10% and they found me Unfit for Continued Service, but the VA awarded me a 30% rating for this single issue.” (sic). The CI attached a two page statement to his application which was reviewed by the Board and considered in its recommendations.


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 ratings for the unfitting mood disorder (encompassing personality disorder) and contended lumbar spine condition identified by the MEB, are addressed below, and, thus are within the DoDI 6040.44 defined purview of the Board. The Board will consider the contended radicular right lower extremity only in regards to rating the lumbar spine condition and is otherwise outside the scope of the Board. The bilateral hearing loss and VA service-connected right knee, left knee and tuberculosis, as per the contention, were not identified by the MEB or PEB; while the alcohol dependence and nicotine habituation are not compensable or ratable, and, thus are not within the DoDI 6040.44 defined purview of the Board. Those, and any other conditions or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records. The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected conditions continue to burden him; but, must emphasize that the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veteran Affairs (DVA), operating under a different set of laws.
RATING COMPARISON:

Service IPEB – Dated 20080320
 VA - based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Mood Disorder, NOS, Associated with Social Phobia
 9435 10% Schizo-affective D/O 9211 NSC STR
Panic D/O 9412
Personality D/O, NOS
 Cat III Bipolar Affective D/O 9432
Alcohol Dependence, in Full Remission
 Cat III No VA Entry STR
Nicotine Habituation
 Cat III No VA Entry STR
No Additional MEB/PEB Entries
 Herniated Intervertebral Disc Lumbar with Low Back Pain 5237 0% STR
Other x 4 STR
Combined: 10%
 Combined: 0%
Derived from VA Rating Decision (VARD) dated 20101004


Mood Disorder, NOS, Associated with Social Phobia Condition. The CI first presented to mental health in June 2006 with a concern of being unable to concentrate. He provided a history of alcohol abuse which led to two inpatient alcohol treatment; one was the result of a felony DUI, approximately 3 months prior to the narrative summary (NARSUM). In addition to alcohol dependence, the CI was prescribed medication for anxiety and mood symptoms. In August 2007, he underwent a psychiatric evaluation with a civilian psychiatrist who diagnosed Bipolar I disorder, with psychotic features, obsessive compulsive disorder (OCD) and generalized anxiety disorder. Psychological testing was performed that suggested over-reporting and exaggeration of symptoms. The psychologist diagnosed mood disorder NOS, social phobia, alcohol dependence in early remission, personality disorder NOS and assigned a Global Assessment of Functioning (GAF) of 70. The service treatment record (STR) demonstrated no evidence of intensive mental health treatment, no history of mental health hospitalization, no ER visits for mental health, no episodes of psychosis and no evidence of active suicidal thoughts. The permanent profile, 24 April 2007, indicated no restrictions and the previous profile of S4 was reduced to S1. The commander’s statement, 29 February 2008, indicated the CI was not working in his AFS because his personality disorder and repeated alcohol use led to suspension of his security clearance. “He could reasonably be expected to perform adequately in duties which do not require a security clearance or access to weapons, munitions and aircraft except when under temporary, situational stress.” Also noted are frequent absences from work due to medical appointments. At the NARSUM (conducted by treating psychiatrist), 10 October 2007, 8 months prior to separation, the CI did not voice any concerns, but stated, “I just went crazy.” The examiner indicated the MEB was necessary due to antipsychotic medication restrictions. On mental status examination (MSE) the CI made good eye contact, had normal speech pattern, normal motor activity, affect was mildly anxious, no evidence of a thought disorder, no suicidal or homicidal thoughts; insight, judgment, and impulse were intact. The psychiatrist assigned a GAF of 70; diagnosed mood disorder NOS, with marked impairment for further military duty; social phobia with minimal impairment for further military duty and personality disorder NOS. The psychiatrist rated the mood disorder as “marked because DoD regulations and AF implementation of those regulations prohibit use of several categories of medications that treat mood disorders.” A NARSUM addendum, 17 November 2007, 7 months prior to separation, was conducted over the telephone and recorded: a GAF of 70; noted the CI was attending the mandatory weekly alcohol and drug abuse prevention and treatment program; he was alert, oriented and had no suicidal or homicidal ideation. However, the CI was non-attendant for the VA Compensation & Pension (C&P) examination.

The Board directs its attention to the rating recommendation based on the evidence just described. The PEB rated the CI’s conditions at 10% with code 9435. The VA determined the CI’s conditions not service-connected; and, therefore, did not rate the conditions. The CI was evaluated on 15 February 2011, more than 3 years after separation, by the VA and assigned a 10% rating for mood disorder NOS.

The Board first unanimously agreed that VASRD §4.129 was inapplicable due to an absence of a highly stressful causative event. The Board noted two assigned GAFs of 70, mild impairment, and the STR demonstrated no evidence of hospitalizations due to mental condition, no episodes of suicidal ideations or psychosis, and no evidence of occupational or social impairment based on mood symptoms. At the time of separation the Board agreed that the §4.130 threshold for a 50% rating (occupational and social impairment with reduced reliability and productivity) was not approached. The deliberation settled on arguments for a 10% versus a 30% permanent rating recommendation. The Board considered the criteria for a rating of 30%, which requires “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.” The STR demonstrated no evidence of the CI receiving letters of counseling, reprimands or article 15. The CI was never hospitalized psychiatrically, or seen in the ER for mental health issues. The commander statement stated “He could reasonably be expected to perform adequately in duties which do not require a security clearance or access to weapons, munitions and aircraft except when under temporary, situational stress.” The Board noted with interest that his permanent profile for psychiatry was reduced from S4 to S1, a year prior to separation and was not changed. At the VA examination, dated 15 February 2011, 3 years after separation, the CI indicated he was no longer taking psychotropic medication and denied legal or problematic consequences of alcohol. The psychologist indicated the CI had been working full time for 1 to 2 years. A mild impairment in functioning was assessed, and a 10% rating was assigned. The 30% rating is difficult to support given that there is no documentation that mood symptoms interfered with daily functioning, and there was no evidence of occupational or social impairment at the time of the VA exam more than 3 years after separation. The 10% description, “occupational and social impairment due to mild or transient symptoms which decrease work efficiency only during periods of significant stress, or; symptoms controlled by continuous medication,” more accurately reflects the CI’s condition at separation. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the mood disorder NOS condition.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that lumber spine was not unfitting. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (Resolution of reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. The lumber spine condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards. The condition was reviewed by the action officer and considered by the Board. There was no performance based evidence from the record that the lumber spine condition 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 lumber spine contended condition and so no additional disability rating is 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 mood disorder condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended lumbar spine condition, the Board unanimously recommends no change from the PEB determination as not unfitting. 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
Mood Disorder, NOS, Associated with Social Phobia 9435 10%
COMBINED 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20121127, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




                  XXXXXXXXXXXXXXXXXXXX, DAF
                  Acting Director
                  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-2012-01940.
         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,





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

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