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AF | PDBR | CY2013 | PD-2013-02727
Original file (PD-2013-02727.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02727    
BRANCH OF SERVICE: AIR FORCE    BOARD DATE: 20150529
SEPARATION DATE: 20071126                


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Air Traffic Control) medically separated for panic disorder with agoraphobia. The mental health condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS). He was issued an S4 profile and referred for a Medical Evaluation Board (MEB). “Panic Disorder w/agoraphobia” and “personality disorder, NOS [not otherwise specified],” were forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB adjudicated “panic disorder with agoraphobia” as unfitting, rated 10%, citing application of Department of Defense and Veterans Affairs Schedule for Rating Disabilities (VASRD) guidelines. The personality disorder was determined to be a C ategory III condition (conditions that are not separately unfitting and not compensable or ratable ) . The CI made no appeals and was medically separated.


CI CONTENTION: He was given a higher rating for his condition by the VA. His complete submission is at Exhibit A.


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


RATING COMPARISON :

Service IPEB – Dated 20070912
 VA* - (8 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Panic Disorder with Agoraphobia 9412 10% Anxiety Disorder NOS with Panic Attacks 9412 50% 20080710
Personality Disorder Category III
Other MEB/PEB Conditions x 0 (Not In Scope)
 Other x 0
Rating: 10%
 Rating: 50%
* Derived from VA Rating Decision (VA RD ) dated 200 81006 (most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Panic Disorder with Agoraphobia. The CI was first seen on 16 October 2006 for chest pain and palpitations and thought that this might be secondary to stress from the unexpected recent death of his father from a heart attack. A cardiac evaluation was normal. He was treated with medications and counseling, but his symptoms persisted. On 2 January 2007, he overdosed on medications and alcohol after talking to his mother and then feeling “intolerable” grief over his father’s death. He reported that he had not wanted to die, but was hospitalized for suicidal ideation for 6 days for counseling and observation. He verbalized that he would only improve in his symptoms if he were returned home; entry into the PEB process was therefore recommended. Over the next few months his symptoms improved somewhat with continued medications and counseling, but did increase during the stress associated with the impending death of his wife’s grandfather. On 30 May 2007, he was permanently disqualified from air traffic control duties secondary to the need for long term counseling and medications (not permissible). The narrative summary (NARSUM) was dated 6 June 2007, 5 months prior to separation. It noted that the inpatient psychiatrist believed that while the CI had a panic disorder, an adjustment disorder secondary to the loss of his father and an underlying personality disorder were more problematic. Unit leadership had been advised to hold the CI accountable for his behavior. There was a growing concern that his “symptom pattern was more suggestive of poor coping strategies and immature personality components,” an assessment with which the CI did not concur. In May, it was determined that his personality disorder was aggravating the treatment of the anxiety disorder. He endorsed a family history of depression and anxiety. On examination, his mood was dysphoric (a sense of unease or dissatisfaction). His affect was subdued, insight poor, with judgment and impulse control fair. Cognition was intact. His personality disorder was thought to aggravate the anxiety disorder and to interfere with treatment. He was again admitted on 14 June 2007, for 4 days, following a car accident involving friends and family with the death of the driver’s girlfriend. This was also around the time of his father’s birthday and Father’s day. An email from the PEB physician dated 12 September 2007 noted that the psychiatrist opined that the majority of the impairment was from the personality disorder and that the anxiety disorder was mild.

At the VA Compensation and Pension (C&P) examination performed 8 months after separation, the CI reported that he had a good relationship with his spouse, mother and younger brother. He had several friends, but his wife did not care for them as they treated him as if he were still single. He had run out of his medications and was not taking any at the time he was seen. He reported that he had a “real high stress level” and “has always worried about things, even since childhood.” He functioned okay prior to his father’s death. He had financial concerns and worried that he was not contributing enough. The mental status examination was remarkable for a flat affect and depressed mood. Thought content, judgment, and insight were intact. He reported panic attacks three times a week and that he would not drive at night due to these. His recent memory was mildly impaired. He had been employed, but quit after a few weeks when he had a panic attack at work around the time his mother had surgery. He was diagnosed with an anxiety disorder and the personality disorder determination was deferred. He was also noted to have maladaptive personality traits which “may be contributing to his current constellation of symptoms.” His symptoms were thought to be transient or mild (description of a 10% rating).

The Board directed attention to its rating recommendation based on the above evidence. The Board first considered the application of VASRD §4.129 (mental disorders due to traumatic stress) which was applied by the VA but not the PEB. It noted that the stressful event was not secondary to trauma, but rather secondary to the loss of a parent who died of natural causes. The Board determined that this did not meet the intent of VASRD §4.129. In addition, the PEB noted that the primary problem for the individual was the personality disorder which aggravated the anxiety disorder. Finally, the VA examiner noted that the CI endorsed a history of mental health issues prior to the loss of his father although his symptoms worsened afterwards. The PEB rated the anxiety disorder at 10%, coded 9412 (panic disorder and/or agoraphobia). The VA also rated the anxiety at 10%, coded 9412, but applied VASRD §4.129 to rate the CI at 50% from 27 November 2007 (date of separation) until 10 July 2008 (date of the C&P exam). The Board considered the definition of both the 30% rating “o ccupational and social impairment with occasional decrease in work e fficiency and intermittent periods of inability to perform occupational tasks although generally functioning satisfactorily, with routine behavior, self- care, and conversation normal” and a 10% rating “o ccupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication . ” The Board determined the description for a 10% rating best described the disability in evidence at separation. It noted that the VA later raised the rating back to 50% effective 17 November 2008 based on post-separation evidence. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the panic disorder with agoraphobia condition. Also, in accordance with DoDI 1332.38 E5.1.2.9.2., a personality disorder is not a physical disability and is, therefore, not ratable.


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 disorder with agoraphobia condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication. The personality disorder is appropriately adjudicated as a Category III condition and not ratable. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination, as follows:


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131216, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762
XXXXXXXXXXXXXXXXX

Dear XXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2013-02727 .

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,







XXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR

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