RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXX		BRANCH OF SERVICE: ARMY
CASE NUMBER:  PD0900130		COMPONENT: ARNG
BOARD DATE: 20091217		SEPARATION DATE: 20060221
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SUMMARY OF CASE:  This covered individual (CI) was a Guard NCO (Infantry) medically separated from the Army in 2006 after 24 years of combined service (12 years active).  The medical basis for the separation was a cervical condition and hearing loss.  He was medically evacuated from a 2003 OIF deployment for a non-reducible inguinal hernia, which was satisfactorily corrected out of theater.  He had chronic neck pain which was exacerbated by Kevlar during deployment and diagnosed as C5-6 degenerative disc disease after his return.  An audiometry exam demonstrated significant hearing loss, but no detailed history of this condition is in evidence.  It is unclear from the records and chronology as to exactly what condition precipitated his entry into an initial MEB process at Ft. Stewart, GA.  There is over a two year span from OIF evacuation to Formal PEB.  He was referred from Ft. Stewart to a Community Based Healthcare Organization (CBHCO) in Florida.  Most of his MEB evaluation occurred at the Naval Hospital, Pensacola, FL and appeared to be centered on evaluation and treatment for PTSD. There are NARSUM’s from the CBHCO and from Psychiatry, Pensacola.  In Pensacola he was additionally evaluated for obstructive sleep apnea (OSA), and all of his MEB addendums emanated from there.  His PTSD was tied to OIF as well as prior Navy service during the Gulf War.  His MEB DA 3947 from Ft. Stewart listed PTSD, hearing loss and the cervical condition as medically unacceptable.  It listed medically acceptable conditions of agoraphobia, ‘partner relational problems’ and nicotine dependence (all secondary Axis I diagnoses on the Pensacola psychiatric NARSUM).  An Informal PEB found the cervical condition and hearing loss to be unfitting, rated 10% and 0% respectively.  PTSD and the remaining DA 3947 conditions were found to be not unfitting.  A Formal PEB yielded the same fitness adjudications, but a 0% cervical rating.  OSA was presented at the Formal PEB as well and adjudicated as not unfitting.  The CI was separated at 0% disability.  These findings were upheld on appeal to the ABMCR.
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CI CONTENTION:  The CI states: ‘I was rated for the least qualifying diagnosis (hearing/neck pain) when by instruction all diagnosis while on active duty were to be addressed and rated.’  The CI further states that the Army miscalculated his retirement pay erroneously stated that he had waived his retirement and discounted some of his combat experiences as related to the PTSD condition.  It is noted that this Board is only empowered to review his disability ratings and fitness adjudications.

RATING COMPARISON:

Service PEB	VA (9 Mo. after Separation)	
Condition	Code	Rating	Date	Condition	Code	Rating	Exam	Effective	
 Subjective Neck Pain …	5299 - 5237	0%	20060110	Cervical Degenerative Disc … C5-6	5242	10%	20061203	20060222	
Bilateral Hearing Loss 	6100	0%	20060110	Bilateral Hearing Loss	6100	10%	20061113	20060222	
Chronic and Intermittent PTSD …	Not Unfitting.	20060110	PTSD	9411	50%	20061114	20060222	
Agoraphobia …	Not Unfitting.	20060110	Not coded or rated.	20061203	20060222	
Partner Relational Problems 	Not Unfitting.	20060110	Not coded or rated.	20061203	20060222	
Nicotine Dependence 	Not Unfitting.	20060110	Not coded or rated.	20061203	20060222	
No Additional DA 3947 Entries.	Non-PEB  X  5 / NSC X 10	20061203	20060222	
TOTAL Combined: 0%	TOTAL Combined (Includes Non-PEB Conditions):  80%                                                                          	
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ANALYSIS SUMMARY:

Cervical Condition.  The orthopedic addendum notes onset of cervical pain during OIF, exacerbated by Kevlar.  Although an MRI showed some mild disc bulging at three levels, there was no evidence of any VASRD-ratable radiculopathies in this case.  The range-of-motion (ROM) documented in the orthopedic addendum, as noted in the chart below, was the only formal goniometric exam in the service record.  There were some relevant detailed ROM exams performed by Physical Therapy (P.T.), as quoted in the chart below; but, there was no stipulation that they were derived from goniometry and they did not encompass the full set of ROM measurements required for formal VASRD rating.  The VA rating examination occurred ~9 months after separation.  None of the exams noted abnormal contour, and both goniometry exams noted pain as the end-point of measurement.  All relevant determinants of the Board rating recommendation are summarized in the table below.

Cervical
ROM	MEB
11/18/05	VA C&P Exam
12/3/06	P.T. Comments
1/17/06	P.T. Comments
2/15/06	
Flex	10⁰	35⁰	Right rotation decreased 50%.  All others WNL.	Cervical flex and ext WNL. R rotation 45 degrees. L rotation 60 degrees.	
Combined	100⁰	250⁰			

Both the formal and Informal PEB ratings for the cervical condition invoked the USAPDA pain policy.  It is noted that the 10⁰ flexion documented in the orthopedic addendum, as the sole determinant, would result in a 30% rating IAW VASRD §4.71a.  This is in contrast to the VA examination which was accurately rated at 10% per §4.71a.  The record documents that the cervical condition was responding favorably to P.T. after the MEB examination, however, and the P.T. exams noted above were proximal to separation.  The Board concluded that reasonable doubt did not favor the CI in recommending a 30% rating based on the single MEB examination.  All evidence considered, the Board recommends a 10% rating for the cervical condition.  The 5299 coding prefix applied by the PEB was unnecessary and the pathology is more accurately reflected by the 5242 ‘degenerative spine disease’ code applied by the VA.  The Board prefers the 5242 code.

Hearing Loss.  PEB rating of the hearing condition was IAW VASRD §4.85, except that the speech discrimination component was derived from ‘word recognition’ scores on the MEB audiometry report (90% for the right ear, 100% for the left ear).  VASRD §4.85 (a) stipulates that the examination for hearing impairment ‘must include a controlled speech discrimination test (Maryland CNC)’.  Although the puretone detection across all decibel ranges was similar in the MEB and VA audiometry exams, the VA obtained Maryland CNC speech discrimination scores of 82% for the right ear and 80% for the left ear.  This was the difference between the PEB 0% and VA 10% ratings.  Given that the probative value of the speech discrimination measurements by the MEB is compromised, reasonable doubt would favor the CI in relying on the VA audiometry exam for deriving a rating recommendation under §4.85.  This was a subject of some deliberation by the Board, but the final recommendation was a 10% rating for the hearing condition.  

PTSD.  The Board struggled with a difficult decision regarding the fitness adjudication for PTSD in this case.  The Informal PEB, Formal PEB and ABMCR decisions were carefully reviewed in light of lengthy statements, contentions and rebuttals in evidence from the CI.  The latter were sometimes characterized by angry language and accusations, but the Board remained mindful of the psychological backdrop for this factor.  The Board is also aware that there were genuine shortcomings in the management of returning Guard and Reserve casualties during this early period of OIF ramp-up.

The exact timing and context for the diagnosis of PTSD and its emergence as a significant MEB issue is not precisely elucidated in the record.  It is evident that it was not a medical condition contributing to the OIF evacuation or overtly manifest until after initial surgical management of the hernia condition at Landstuhl and transfer to Ft. Stewart.  Only the cervical condition, hearing issue and post-op inguinal pain were noted in the CBHCO Case Manager’s intake note in Florida.  These notes reflect a mental health referral to Pensacola soon afterwards.  Later psychiatric entries describe hostility directed at social workers and mental health personnel at Ft. Stewart, but record of these encounters are not in evidence.  It does appear that PTSD surfaced as the pre-eminent condition during a lengthy CBHCO period, as the NARSUM written by the CHBCO Medical Director was directed only at PTSD.  Regarding the latter, this stated ‘Clearly, he fails retention standards and should be boarded.  His condition should be considered chronic and stable.’  The MEB DA 3947, listing the cervical and hearing conditions, is signed by the same provider.  Because of the length of his MEB evaluation, there are two NARSUM’s from the psychiatrist at Pensacola.  The updated one added an Axis I diagnosis of atypical depression to Axis I PTSD and included the secondary Axis I diagnoses noted in the summary.  Only PTSD was opined to be medically unacceptable IAW AR 40-501.  The NARSUM documented a history of prior PTSD stressors and symptoms going back to Navy service in the Gulf War era.  It specifically stated, ‘chronic and intermittent Posttraumatic Stress Disorder most likely over the last 20 years.  However, after Operation Iraqi Freedom, he had a marked exacerbation in his symptoms over the last one and a half years.’  Regarding degree of impairment, the following is excerpted:

It is further the opinion of the Board that the patient's psychiatric condition presently manifests itself by severe interference with social adaptability which was characterized by extreme levels of anger and aggression and by moderate interference with civilian industrial adaptability due to the interpersonal difficulties, as well as disassociated association and memory problems.

In addition to the two NARSUM’s, there is a detailed MEB addendum from the same psychiatrist in response to a written PEB request for clarifications regarding PTSD.  Several of the inquiries and responses are relevant to fitness adjudication.  The PEB cited the CI’s civilian employment as an aircraft inspector at Raytheon in regards to meeting retention standards.  The reply was that the CI stated he could not return to the job because his concentration was impaired and his supervisor was looking for an alternative position for him.  Of note, VA records document that the CI remained employed in the same position for over two years after separation.  The PEB’s letter also cited an email from the CI’s platoon leader that ‘denies any evidence of significant combat stressors or PTSD symptoms during deployment’.  The psychiatrist’s reply referenced the CI’s account that there was little direct contact with the platoon leader and opined that the platoon leader was not qualified to judge whether there were manifestations of fear response or other indications of PTSD.  The platoon leader’s statement is a major source of contention for the CI.  It is referenced and the contents are dissected and refuted in most of his written statements.  Various exposures to combat stressors are repeatedly detailed by the CI, although their confirmation is not significantly relevant to fitness determination.  A Combat Infantry Badge award confirms that the CI’s unit was engaged in active hostilities, and the presence of Criterion A stressors supporting a psychiatrist-confirmed diagnosis of PTSD is conceded.  Only the resulting severity of psychiatric impairment is germane to the Board’s recommendation regarding fitness.  Additionally the MEB psychiatrist responded to a statement in the PEB’s letter that ‘Apparently PTSD has not interfered with duty’.  The reply referenced a statement by the CI that he did not ‘feel like I am capable of leading my squad’ and that ‘he no longer feels comfortable carrying a weapon’.  The addendum did not express a direct opinion as to whether the CI’s personal judgments were valid.  Regarding his current functioning at work (issuing flight gear at Whiting Naval Air Station), the addendum stated that he had experienced some interpersonal clashes and restraint with dealing with student pilots of Middle Eastern descent.  It also stated that he ‘tends to be a workaholic’ as a symptom of PTSD.  The CI’s specific difficulties were reiterated as follows.

He has marked disturbance of sleep with nightmares, insomnia, acting out violently during sleep, leading to daytime fatigue and poor concentration.  He has irritability with verbal outbursts.  He has frequent intrusive thoughts of past traumas.  He is unable to multitask and has difficulty following complex commands.  He has difficulty with task completion.  He has significant symptoms of hyperarousal and avoidance.  In addition, he has depressive symptoms which include anergy, amotivation, decreased libido, and increased carbohydrate craving ... His deficits due to posttraumatic stress disorder will prevent him from further successful service in the Army National Guard.

The initial Pensacola psychiatrist retired and the CI saw another psychiatrist in that department after the Informal PEB ruling.  The second psychiatrist conducted his own interview and provided a detailed clinical note.  It is not designated as a MEB document in the record, but presumably was prepared for and available to the Formal PEB.  It is referenced in the CI’s ABMCR appeal and addressed in that record of proceedings.  The second psychiatric note details essentially the same history and current symptoms as earlier evaluations.  It states that the CI was not working and unable to return to his civilian job.  That conflicts with earlier information regarding his military duties at Whiting Field and subsequent VA records regarding continued civilian employment at the Raytheon position.  This document does not express a direct opinion regarding military fitness and does not provide a formal rendering of degree of impairment.  The salient portion of the second psychiatrist’s opinion is summarized in the following excerpt.

It is my opinion that [CI’s name] clearly meets criteria for PTSD and that it is causing significant impairment in multiple aspects of his life.  It is likely that he will continue to have this impairment or some amount of impairment for most of his life. As the Board did state in their letter, he has had chronic PTSD symptoms over the last 20 years.  However, these symptoms have greatly been exacerbated by his deployment to Iraq.

The second psychiatrist arranged a visit for the CI with an Army psychiatrist at Ft. Gordon, GA for a ‘third opinion’.  That evaluation took place after the Formal PEB and two weeks prior to separation, possibly in preparation for a USAPDA appeal which did not materialize.  It was not referenced in the ABMCR proceedings.  It is relevant to the Board’s period of review and is excerpted below.

Medical records reviewed. The patient has been referred to the medical processing system with a diagnosis of PTSD.  His case is currently being adjudicated by the PDA. The supporting documentation by [names of both Pensacola psychiatrists] was reviewed as well as the findings of the PEB.  Of note is the fact that neither the PDA nor PEB has requested the current evaluation.  It would appear that the reported medical condition (PTSD) has been disapproved for disability purposes for two reasons: 1) no one from the patient's chain-of-command will substantiate his account of events during deployment and 2) the patient (by his own report) had similar difficulties after the Gulf War and remained fully functional in both his civilian and military roles.  He reports being angry with the military for not awarding him disability beyond severance pay.  Given these obstacles, he was advised that a ‘third opinion’ would be unlikely to help his cause.  He related that he understood this.  With regard to the historical data and present symptom constellation as reported by the patient, the undersigned notes that his case is atypical for PTSD.  Although he endorses a relative cornucopia of symptoms, the timing and setting in which his difficulties occur is inconsistent with that routinely seen in PTSD.  Rather he appears to have a longer-standing history of strained interpersonal relationships occurring in a variety of contexts which appears to be driving the need to retain symptoms and suggests that a broader understanding be sought in his care.  He discounts the interventions to date (both counseling and medication) as being ineffective in alleviating these long-standing difficulties.  Yet, he does not seem to be relating this information to his caregivers.  The probability that other agendas are at play in this case is most likely.

This note, as well, did not render a formal opinion regarding fitness or degree of impairment.  The relevance of this psychiatrist’s impression lies not with the skepticism regarding the diagnosis, nor was his opinion followed up by subsequent VA providers.  It does, however, go to fitness in that it raises the question of other psychological factors at play impacting on total psychiatric impairment.  To the extent that any of these other factors were reflected as impairment to performance, the Board cannot lay all of it on the doorstep of PTSD as unfitting.  To the extent that ‘other agendas’ were in play, it goes to the probative value of the preceding psychiatric opinions which were explicitly premised on the accuracy of subjective input.  The Board can neither entirely endorse nor entirely discount this single psychiatric opinion, but it belongs on the scale in weighing the impact of PTSD (in and of itself) on fitness.

Two significant determinants of fitness, as considered in the PEB’s and ABCMR’s decisions, are the Commander’s statement and the physical profile.  The Commander’s statement is fairly brief and in questionnaire format.  The Commander’s reply to the question regarding soldier’s ability to perform military duties states, ‘No, unable to hear and walk & carry on mission as a squad leader.’  A similarly worded response below that one added ‘unable to carry, walk, run to carry on mission.’  There was no direct statement, positive or negative, regarding mental capability.  The Commander’s statement noted PTSD as one of the ‘medical conditions affecting this soldier’s duty’.  It also circled ‘no’ to ‘able to carry and fire individual assigned weapon’.  The latter was presumably an assumption, since it was not taken from the physical profile.  The last physical profile was dated four months prior to the PEB, and was the first one with a psychiatric profile (S3).  It included PTSD in addition to the neck and hearing profiles already in place.  It specifically did not proscribe carrying a weapon.  The final psychiatric NARSUM, however, did recommend ‘that he not handle weapons due to his marked increased startle response’.  The lack of detail in the Commander’s statement was not significantly supplemented by the NCO evaluations.  The only one in evidence reflects his performance during OIF and noted that he met standards for mental fitness.  On the other hand, there are no negative reports in the record that reflect poorly on his performance in the Whiting assignment or otherwise.

The Army’s rationale for finding the CI fit as regards to PTSD is summarized in the following two excerpts.  First, the Formal PEB’s DA 199:

[PTSD] not unfitting, not rated.  The soldier is reported to have chronic and intermittent PTSD most likely over the last 20 years.  The psychiatrist notes four airplane crashes during U.S. Navy service from 1981-1993 and an airplane crash in 2001 on an aircraft he had inspected in his civilian employment.  He has been employed by Raytheon/Vertex/L3 Communications Company from 1998 to the time of mobilization performing preflight daily turnaround inspections on aircraft.  During his deployment [Name], soldier's in-theater platoon leader reports (e-mail of 20 SEP 05) that the level of engagement was minimal, no one in the unit was hurt, and the soldier never acted fearful or concerned about the common experiences they shared.  There is no evidence that PTSD interfered with civilian employment or with the soldier's deployment.  Nor is there evidence that his PTSD was aggravated by stressors during deployment.  The psychiatrist makes the additional diagnoses of agoraphobia, without panic disorder and depressive disorder, not otherwise specified.  While many of the soldier's symptoms are consistent with these diagnoses, the psychiatrist indicates that both are medically acceptable.  At the formal PEB, Psychiatric Addendum dated 15 DEC 05 was presented which reiterated the information presented in earlier psychiatric statements without corroboration of soldier's reported stressors.

Secondly, excerpts from the ABCMR:

Although the applicant contends that his PTSD was not properly considered by the PEB, there is no evidence to show that this condition rendered him unfit to perform his military duties.  It is acknowledged that evidence of record shows the MEB reported the applicant as having PTSD.  However, the physical disability evaluation system evaluates Soldiers based on their ability/inability to perform their military duties.  There is no evidence that PTSD interfered with the applicant's military duties.  His commander noted that he could not perform duty because he could not hear or carry, walk, or run, not because he was mentally incapable of performing his duties.  The applicant's physical profile did not prohibit him from carrying his assigned weapon.  Usually, Soldiers with a disabling mental disorder are prohibited from carrying a weapon. ... The fact that the applicant has been diagnosed with PTSD is not in question, nor was the fact that a psychiatrist on 12 October 2005 recommended assignment limitations for him, which included not operating government vehicles, handling weapons, explosives or classified material, nor returning to a combat zone.  However, none of the evidence, including a later evaluation by a psychiatrist, shows that his PTSD was determined to be medically unacceptable prior to his discharge and, as a result, he was not rated by the Army for PTSD.

The ABMCR’s mandated standards for its decisions are ‘probable error or injustice’ and ‘accordance with the laws and regulations’ as regards to the PEB adjudication.  The Board bases its recommendations regarding fitness on the ‘more likely than not’ principle.  The Board considered the following conclusions in a protracted deliberation regarding this decision.

Favoring a recommendation for no recharacterization of the PEB adjudication:

•	The Informal PEB’s fitness adjudication was affirmed by both a Formal PEB and ACBMR review. 

•	The record is clear that PTSD emerged in a clinically relevant way only during the MEB period.  The CI had already completed ±20 years of combined service, including the OIF deployment, with no evidence of impairment from PTSD.  His NCO evaluation is a good example.

•	The CI’s performance at Whiting NAS suggests fitness, not unfitness.  The ‘workaholic’ comment strengthens that impression.

•	The civilian employment in a demanding position throughout the MEB and for two years after separation is a strong argument for fitness.

•	The points made in the ‘third’ psychiatric opinion have at least some validity.  This ‘spreads’ any unfitness beyond just PTSD (albeit impossible to apportion psychiatric symptoms).  It also casts a shade of doubt on the probative value of opinions supported only by subjective history.
  
•	There is a suggestion of ‘anti-PEB’ bias in the Pensacola psychiatric opinions, as reflected in tone and wording.  The updated NARSUM prior to the PDA query is not nearly as adamant regarding severity and impairment.

Favoring a recommendation of PTSD as a separately unfitting condition:

•	The CHBCO NARSUM is taken as a concurrence with the two psychiatric opinions.

•	The primary NARSUM in this case states an unambiguous and adamant opinion that PTSD was unfitting, citing specific limitations and concluding that it would not allow the CI to resume Guard service.  This is mitigated only by the possible probative value and bias issues discussed above.  The Board remains mindful that it the domain of the PEB, not the MEB, to determine fitness.

•	A second psychiatric opinion is supportive of the first, although not as explicit regarding impairment and fitness.

•	The Commander’s statement is cursory and not good support for the PEB or ABMCR arguments.  Likewise, it does not make a good case that the CI was unfit. 

•	The physical profile permitting weapon access is not good support for the PEB or ABMCR arguments, since it is refuted by direct physician statements to the contrary.  This is an especially relevant issue in light of the MOS.

•	The PEB statement on the DA 199 that PTSD was not aggravated by OIF is in frank contradiction to two submitted medical opinions. 

•	The platoon leader’s statement, independently of its accuracy, does not go to fitness at separation and is therefore of little relevance.  

After careful consideration of these numerous competing issues, the Board opined that the weight of evidence favoring the CI’s petition met the Board’s threshold for a favorable recommendation.  Granting that there may have been no ‘probable error or injustice’ in the PEB adjudication, the weight of medical opinions contrary to its adjudication was not overcome by the ambiguous evidence referenced in the Commander’s statement and physical profile.  More likely than not, the diagnosed PTSD condition would have rendered the CI unfit for further duty in his MOS.  

After arriving at a recommendation of adding PTSD as an unfitting condition for separation rating, the Board turned its attention to rating recommendation.  It must apply an initial TDRL rating of 50% in retroactive compliance with VASRD §4.129 as DOD directed, and determine a permanent rating recommendation at six months IAW VASRD §4.130.  The most proximate psychiatric re-evaluation was the initial VA psychiatric rating examination performed at 9 months after separation, and was the primary basis for the Board’s permanent rating recommendation.  The CI’s symptoms at this time remained typical of PTSD, moderately severe and constant.  He was employed in the aircraft inspector position discussed above, but related work-related issues to the examiner.  He stated that he was constantly re-checking his work because of concentration problems and that he was sometimes calling in sick after sleepless nights.  The examiner noted that his employer was accommodating his limitations.  His marriage was intact, but strained.  Social activities were restricted.  He was being treated with three psychotherapeutic medications.  Global functioning was rated in the moderately to seriously impaired range (GAF = 50).  The VA rating based on this exam was 50%, connoting ‘occupational and social impairment with reduced reliability and productivity’.  He manifested none of the ‘due to’ descriptors enumerated in §4.130 for the 100% rating and only 2 of the 9 enumerated for 70%.  He met 5 of 9 descriptors for the 50% rating, and his impairment was accurately encompassed in the general description for that rating as cited above.  The severity of his impairment exceeded the ‘occasional’ and ‘intermittent’ qualifiers in the general description for the 30% rating.  The Board is therefore in agreement with the 50% rating conferred by the VA based on their psychiatric rating examination performed nine months after separation, and recommends 50% as the permanent PTSD rating in this case.

Other Conditions.  The only additional conditions compensated by the VA from the initial rating examination were Obstructive Sleep Apnea (OSA), tinnitus and gastric reflux (GERD).  The post-operative inguinal hernia condition was rated 0%.  The additional Axis I conditions on the MEB DA 3947 were appropriately adjudicated as not unfitting and, regardless, any impairment would be subsumed in the PTSD rating.  OSA was a late diagnosis in the MEB process, and did not appear on the MEB’s DA 3947.  It was discussed at the Formal PEB, however, and designated as not unfitting on that DA 199.  It was not covered in the physical profile or Commander’s statement.  Especially considering that it was not clinically apparent during all prior military service and most of the MEB period, there is not reasonable doubt in the CI’s favor supporting recharacterization of the PEB fitness adjudication for the OSA condition.  GERD was mentioned only in the CBHCO NARSUM, but not in the MEB physical or on the DA 3947.  The CI was on a low dose acid-reducing medication and there is no evidence of any active symptoms at separation.  There is no reasonable foundation for Board recommendation of an unfitting GERD condition.  Tinnitus was not evidenced in the DES packet and therefore not subject to Board recommendation regarding fitness, nor is there any suggestion that it would be unfitting.  None of the CI’s other incidental medical conditions noted in the service or VA records were relevant for Board consideration regarding fitness.

The Board, therefore, has no reasonable basis for recommending any additional unfitting conditions for separation rating.
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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.  As discussed above, PEB reliance on the USAPDA pain policy for rating the cervical condition was operant in this case and the condition was adjudicated independently of that policy by the Board.  In the matter of the cervical condition, the Board unanimously recommends a rating of 10% coded 5242 IAW VASRD §4.71a.  In the matter of the bilateral hearing loss condition, the Board voted 2:1 to recommend a rating of 10% coded 6100 IAW VASRD §4.85.  The single voter for dissent (who recommended no recharacterization of the 0% rating determined by the PEB) did not elect to submit a minority opinion.  In the matter of the PTSD condition, the Board unanimously recommends that it be added as an additionally unfitting condition for separation rating.  Regarding PTSD, the Board unanimously recommends an initial TDRL rating of 50% in retroactive compliance with VASRD §4.129 as DOD directed; and a 50% permanent rating at 6 months IAW VASRD §4.130.  In the matter of obstructive sleep apnea, tinnitus, gastroesophageal reflux disease and all of the CI’s other medical conditions; the Board unanimously agrees that it cannot recommend any findings of unfit for additional rating at separation.
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RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows; TDRL at 60% for 6 months following CI’s prior medical separation (PTSD at minimum of 50% IAW §4.129 and DoD direction) and then a permanent combined 60% disability retirement as below.

UNFITTING CONDITION	VASRD CODE	TDRL RATING	PERMANENT
RATING	
Post-Traumatic Stress Disorder	9411	50%	50%	
Cervical Degenerative Disc Disease	5242	10%	10%	
Bilateral Hearing Loss	6100	10%	10%	
COMBINED	60%	60%	
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The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20090205, w/atchs.
Exhibit B.  Service Treatment Record.
Exhibit C.  Department of Veterans' Affairs Treatment Record.

We note the applicant asks the Board for specific correction of records and specified consequential entitlements. By law the Board authority is limited to making recommendation on correcting disability determinations. The actual correction of records and consequential entitlement determinations is the responsibility of the applicable Secretary and Accounting service.  The applicant's request will of course remain with the application as it is processed.