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AF | PDBR | CY2013 | PD-2013-02809
Original file (PD-2013-02809.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-02809
BRANCH OF SERVICE: Army  BOARD DATE: 20150521
SEPARATION DATE: 20070503


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-5 (Motor Transport Operator) medically separated for anxiety disorder. The condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty (MOS). He was issued a permanent S3 profile and referred for a Medical Evaluation Board (MEB). The condition, characterized as “chronic posttraumatic (sic) stress disorder” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded one other condition (chroidal rupture left eye) for PEB adjudication. The Informal PEB (IPEB) adjudicated “anxiety disorder not otherwise specified” as unfitting, not compensable, with likely application of DoDI 1332.38. The remaining condition was determined to be not unfitting . The CI demand ed a Formal Hearing; a subsequent Formal PEB (FPEB) adjudicated “anxiety disorder not otherwise specified” as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). There was no ch ange to the remaining condition. The CI made no further appeals and was medically separated.


CI CONTENTION: “My condition was changed from 10% with depression to PTSD 10%”. (sic)


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 Veterans Affairs Schedule for Rating Disabilities (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 :

FPEB – Dated 20070328
 VA* - (~3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Anxiety Disorder, Not Otherwise Specified 9413 10% Adjustment Disorder with Depression and Anxiety 9440 30% 20070802
Other x 1 (Not In Scope)
 Other x 4
RATING: 10%
 RATING: 40%
*Derived from VA Rating Decision (VARD) dated 20 070913 (most proximate to date of separation (DOS)).

ANALYSIS SUMMARY:

Anxiety Disorder, Not Otherwise Specified. The service treatment records documented that the CI was referred to behavioral health (BH) in August 2006 for anger issues and possible PTSD. The FPEB noted the CI was deployed to Afghanistan from April 2005 to March 2006, and performed duties at an entry control point. His anxiety symptoms began upon re-deployment and while being re-mobilized in July 2006. Initial contact with BH on 6 September 2006 documented symptoms of anxiety with persistent worry, difficulty with breathing, rapid heartbeat, excessive sweating, depression, feelings of hopelessness, lack of pleasure, social withdrawal, and loss of interest in family and friends. Suicidal ideation was absent and there were no issues with concentration or appetite. The examiner, a nurse practitioner (NP), made the diagnosis of depression, prescribed antidepressant medications, and referred him to psychology for counseling and psychiatry for medical management. The CI was seen three times in follow up with the NP for the treatment of his depression diagnosis, which was later changed to adjustment disorder with depressed mood. At the time of his initial evaluation with psychiatry, the CI had been referred to the MEB for his eye problem. At the MEB psychiatry narrative summary (NARSUM) dated 18 December 2006, the CI reportedly described anxiety about the possibility of being injured or killed by an IED, and reported he had experienced distressing recollections of injured or killed civilians being brought to the gate. He had nightmares about dead bodies that were brought to the gate, insomnia, poor concentration, irritability, and “inability to adapt after returning from deployment.” He felt incapable of being deployed again. He reportedly was diagnosed with PTSD by a social worker. The psychiatrist noted the NARSUM was based upon evaluations conducted in August through December 2006. Mental status examination (MSE) recorded anxious mood and restricted affect. There was no evidence of psychosis or cognitive impairment. He denied suicidal and homicidal ideation, and there was no documented impairment in thinking or judgment. The examiner diagnosed PTSD, chronic, “manifested by one year history of distressing recollections (civilian casualties, fear of IED explosions), anxious and depressed mood, irritability, insomnia, nightmares, avoidance and withdrawal, alcohol abuse, and impaired work performance.” The examiner documented marked impairment for military duty; impairment for social and industrial adaptability was not assessed, and the examiner opined, the CI “displays slight signs of mental illness on examination…requires medication and psychotherapy.” A Global Assessment of Functioning (GAF) score was not documented.

The VA Compensation and Pension (C&P) mental evaluation dated 2 August 2007, 3 months after separation, documented the CI was receiving unemployment compensation and was able to shop, clean, and cook for himself. The CI reported continued symptoms of insomnia, nightmares, anger and irritability and social isolation. The examiner noted the CI had not received consistent treatment from the VA and had attended one outpatient group session prior to the C&P mental evaluation. He had been prescribed Prozac and Buspar via the VA. His MSE was normal with the exception of the CI’s report that his mood was “anxious and on edge.” The examiner noted his commander denied knowledge of a combat stressor during deployment. The CI completed the MMPI which was rendered invalid due to inconsistent responses thought to be indicative of exaggeration or malingering. It was noted that some of the CI’s responses during the evaluation were in direct contradiction to statements that he made during the interview. The examiner documented that the CI had no clear symptoms that would meet diagnostic criteria for any Axis I mental disorder, but noted that the CI had an Axis I diagnosis of adjustment disorder with depressed mood and anxiety by history and demonstrated cluster B personality features. A GAF of 75 (mild) was assessed.

The Board directed its attention to its rating recommendation based on the above evidence. As noted above the MEB forwarded the diagnosis of PTSD to the PEB and the PEB reviewed the evidence presented by the unit commander and determined there was insufficient evidence to support the PTSD diagnosis due to absence of documented stressor. The FPEB documented the commander denied any knowledge of a combat stressor during the deployment. Therefore, the PEB found the diagnosis of anxiety disorder, not otherwise specified was more appropriate than PTSD. The PEB rated the condition at 10%, coded 9413. The first question that came before the Board is whether this condition meets the §4.129 definition of “a mental disorder that develops in service as a result of a highly stressful event [that] is severe enough to bring about the veteran’s release from active military service.” All Board members agreed that the provisions of §4.129 were not applicable in this case.

The Board next acknowledged that the CI was diagnosed with PTSD and the record indicated this diagnosis was present for the first and only time while undergoing the MEB. The Board next undertook a careful review of the record in evidence and particularly the NARSUM, and concluded the evidence to support that the condition of PTSD met full DSM-IV-TR diagnostic criteria was absent. However, the Board based its rating recommendations IAW VASRD 4.130 which is independent of diagnosis. The higher rating of 30% under 4.130 requires evidence of “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks” due to such symptoms depressed mood, anxiety, suspiciousness, panic attacks, chronic sleep impairment, mild memory loss. Both the NARSUM and the C&P examinations reported unremarkable mental status examinations, and although the GAF was not recorded at the NARSUM, the examiner documented signs of mental illness were “slight”; a statement generally consistent with an assessment of mild or transient impairment. The C&P documented a GAF of 75 for mild impairment three months after separation, and noted the CI did not have a primary Axis I diagnosis at the time of the mental evaluation. The Board noted the CI had never been hospitalized psychiatrically, had not received mental health treatment in the emergency room, and there were no reported panic attacks. He had minimal participation in mental health treatment prior to separation, and was found not to have an Axis I mental disorder three months after separation, which likely reflected that his anxiety disorder was in full remission. All Board members agreed that the 30% rating was not supported by the evidence at hand and 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. 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. 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 anxiety disorder, not otherwise specified 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 anxiety disorder, not otherwise specified 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131217, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record




XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review





 SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXX , AR20150012805 (PD201302809)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application.
This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                  XXXXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary of the Army
                                                      (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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