RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	   CASE:  PD-2014-00581
BRANCH OF SERVICE:  Army 	Separation date: 20071022

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantryman, medically separated for “posttraumatic stress disorder (PTSD),” with a disability rating of 10%.  

CI CONTENTION:  The CI makes no contentions.  His complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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:  

SERVICE PEB – 20070925	VARD - 20080429	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Stress Disorder	9411	10%	Post-Traumatic Stress Disorder (Claimed as Bipolar Disorder, Personality Disorder, Chronic PTSD, Depressive Disorder, Insomnia)	9411	30%	2008116	
COMBIEND RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

PTSD Condition.  According to the service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI’s first presentation of mental health problems occurred during his first deployment to Iraq.  He was evaluated by mental health in Baghdad on 23 June 2007 where he reported he had experienced traumatic events that led to feelings of guilt.  He noted he began cutting and burning himself, and had daily mood swings.  He also reported a childhood history of cutting and burning acts he reportedly performed to relieve stress or tension.  In addition, he and wife were having marital problems, and his wife informed him one week prior, that she wanted a divorce.  He was very angry with his wife.  The CI indicated that he was diagnosed as a teenager by a psychiatrist as having bipolar disorder, and was prescribed a mood stabilizing antipsychotic medication which he took for about 18 months.  He stopped the medication 6 months before entering the military.  The NARSUM was accomplished in August 2007, 2 months prior to separation.  The CI reported that he began cutting and burning himself in April 2007 while in Iraq.  He was distressed because of the death of a fellow soldier and blamed himself for his death.  He was prescribed medication; however, due to lack of significant improvement, he was sent to Germany where he was hospitalized for about 3 days before returning to U.S.  The examiner noted his current medications included an antidepressant and a mood stabilizer in the form of an antipsychotic.  The CI reported he experienced nightmares, and he did not like being around crowds.  He noted that he had improved “about 40 to 50%.”  He denied suicidal or homicidal thoughts, and reported frequent mood swings.  The diagnoses of bipolar disorder, existing prior to service (EPTS); and PTSD were recorded. 

The VA Compensation and Pension (C&P) mental examination was accomplished 3 months after separation.  The CI noted he was diagnosed with PTSD and had bipolar disorder since childhood.  The examiner noted that the CI had “no difficulty going any place and being around people,” but noted he avoided crowds, was easily startled, and had dreams of his traumatic experience.  With the exception of chronic sleep disturbance, current PTSD symptoms were not clearly recorded or identified.  The CI had remained married and noted that the relationship was stable.  He was working, and had good relations with his supervisor and his co-workers.  He had worked for 2 months, and had not lost any time from work. The examiner noted PTSD stressors occurred late March 2007, and that the diagnostic criteria for PTSD were met.  The mental status examination (MSE) was unremarkable, except mood and affect was noted as flat.  Suicidal and homicidal ideation was absent, and the CI denied panic attacks.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD condition at 10% for symptoms requiring continuous medication, coded 9411, and acknowledged that the CI had a history of bipolar disorder prior to service.  As noted above, the condition of bipolar disorder was documented as EPTS in the service treatment record and the NARSUM, and was recorded by the MEB as a condition that was diagnosed and treated prior to service.  Regardless of the diagnosis, 4.130 rating is based on symptoms independent of diagnosis, therefore, all mental health symptoms were considered in the rating.  The VA granted a 30% disability rating coded 9411.  

The PEB rating, as described above, was derived from DoDI 1332.39 and preceded the promulgation of the National Defense Authorization Act (NDAA) 2008 mandate for DoD adherence to Veterans’ Administration Schedule for Rating Disabilities (VASRD) §4.129.  The Board, IAW DoDI 6040.44 and DoD guidance (which applies current VASRD §4.129 to all Board cases as appropriate), must consider if the definition of §4.129 is met for any psychiatric condition resulting in medical separation; i.e., “a mental disorder that develops in service as a result of a highly stressful event.”  If the Board judges that application of §4.129 is appropriate, it will recommend a minimum 50% rating for a retroactive 6-month period on the Temporary Disability Retired List (TDRL).  The Board must then determine the most appropriate fit with VASRD 4.130 criteria at 6 months for its permanent rating recommendation, based on the facts in evidence which are most probative for that interval.  The Board noted the PEB documented that 10A/C (combat-related) was awarded, and PTSD was related to conflict in Iraq.  Therefore, all Board members agreed the provisions of §4.129 were applicable in this case.  The higher 70% rating criteria requires evidence of “Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.  Available treatment records prior to constructive TDRL period demonstrated some impairment in occupational and social functioning; however, no documented evidence to support impairment in judgment or thinking.  There were no psychiatric hospitalizations, no recorded visit to the emergency room (ER) for mental health issues, no reports of panic attacks and no evidence of suicidal or homicidal ideation.  Although the NARSUM did not record an MSE, at the last psychiatry outpatient visit in early August 2007, it was noted that his mood and affect was abnormal; however, all other aspects were normal.  The Board considered the record in evidence did not support a higher than 50% rating for TDRL placement. The Board concluded there was insufficient reasonable doubt (IAW VASRD §4.3) for recommending a 70% TDRL placement rating.  The Board next determined the most appropriate fit with VASRD §4.130 criteria at the end of TDRL for its permanent rating recommendation.  The Board deliberated the evidence for the 50%, 30% and 10% disability rating.  The 50% disability rating requires evidence of “Occupational and social impairment with reduced reliability and productivity due to symptoms such as: flat affect, panic attacks more than once a week, difficulty in understanding complex commands, impaired short and long-term memory and impairment in judgment and thinking…”  The C&P examination was the only source document for consideration.  That examination documented a stable marriage and employment.  He was taking medication with noted good response, and he had not required hospitalization or ER treatment.  The CI noted he had not lost any time from work in the 2 months of employment and his relationships were good with his supervisor and co-workers.  He reported difficulty with sleep.  The MSE was unremarkable. The record consistently documented absence of suicidal ideation (SI) and homicidal ideation (HI); no impairment in judgment or thinking, no recorded panic attacks, or visits to the emergency room related to SI or HI.  Although the CI reported chronic sleep disturbance, there was no evidence that his chronic sleep impairment interfered with the CI’s ability to work; he lost no time from work.  He noted he had good response to his medication.  In addition, there was no evidence of issues with memory, thinking, or judgment.  The evidence demonstrated the CI’s condition was stable at the time of separation, and his disability was most reflective of the 10% level for “symptoms controlled by continuous medication.”  After due deliberation, and in consideration of all the evidence and VASRD §4.3 (reasonable doubt), the Board recommends a 50% disability rating at TDRL placement and a permanent 10% disability rating for the PTSD condition.

Contended PEB Condition. The Board’s main charge is to assess the fairness of the PEB’s determination that the borderline personality disorder was not unfitting.  Personality disorder is not a physical disability and is not ratable IAW DoDI 1332.38.  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 contended conditions and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the PTSD condition, the Board recommends a disability rating of 50%, coded 9411 for the TDRL interval and a permanent disability rating of 10%, coded 9411 IAW VASRD §4.130.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Post-Traumatic Stress Disorder	9411	50%	10%	
COMBINED	50%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140114, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXX, AR20160008270 (PD201400581)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to  constructively place the individual on the Temporary Disability Retired List (TDRL) at 
50% disability for six months effective the date of the individual’s original medical separation for disability with severance pay and then following this six month period no recharacterization of the individual’s separation or modification of the permanent disability rating of 10%.

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum as follows:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of temporary disability effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was separated with a permanent combined rating of 10% effective the day following the six month TDRL period with no recharacterization of the individual’s separation.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will provide 50% retired pay for the constructive temporary disability retired six month period effective the date of the individual’s original medical separation and adjusting severance pay as necessary to account for the additional TDRL time in service.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA