RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00702
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060516

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E6, Calvary Scout, medically separated for “sleep apnea requiring CPAP”, with a disability rating of 0%.

CI CONTENTION:  The CI contended his “PTSD was not on the board”.  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 - 20060414	VARD - 20061006	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Sleep Apnea Requiring CPAP	6847	0%	Obstructive Sleep Apnea	6847	50%	20060421	
PTSD	Not Unfitting	PTSD	9411	30%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Obstructive Sleep Apnea.  According to service treatment records (STR), the CI reported a history of loud snoring and excessive daytime sleepiness.  A sleep study August 2005 revealed obstructive sleep apnea syndrome.  Continuous positive airway pressure (CPAP) was recommended and started September 2005.  The commander’s statement noted the CI was incapable of performing the duties of his specialty.  His physical condition created a burden on his platoon since he required a constant 110-volt power supply for his CPAP machine.  Without it he would not be able to sleep, creating a safety issue for the unit.  The narrative summary (NARSUM), dated February 2006, noted a normal physical exam, stable sleep apnea and compliant response to treatment.  He received a P3 profile for sleep apnea and reactive airway disease.  He had to have access to medicines, medical care, and water, electricity and filters for CPAP.  At the VA Compensation and Pension (C&P) exam, dated April 2006, performed 2 months before separation, the CI reported some difficulty falling asleep with CPAP but when he does sleep, he sleeps well.  His daytime sleepiness had improved.  

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and the VA coded the CI’s condition 6847, but the PEB assigned a 0% disability rating while the VA assigned a 50% rating due to the required CPAP machine.  The PEB determined the sleep apnea was unfitting and the CI required the use of a CPAP machine, thereby meeting the criteria for a 50% disability rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 50% for the sleep apnea condition.  

Contended PTSD Condition.  The Board’s main charge is to assess the fairness of the PEB’s determination that PTSD condition was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  

The NARSUM examination noted the CI had combat exposures during his deployment to Iraq April 2003-August 2004.  He and his wife divorced in October 2003 after she confessed to having an affair while he was away.  He began to have suicidal thoughts and fantasies about getting killed.  He volunteered for dangerous missions in the hope he would get killed.  His attitude regarding suicide changed when he witnessed a co-worker who was also going through a divorce; commit suicide by shooting himself with a rifle in September 2003. The CI became socially withdrawn and started having difficulty with sleep in June 2003.  After redeployment, he began to have decreased sleep (2-3 hours per night, nightmares regarding war experiences, fatigue, sad mood, irritability and hyper-startle response to loud noises with trembling and fast heart beating.  He had a recurring nightmare twice per month since August 2004 of a loud rocket boom, which awakens him.  Symptoms had waned and had little effect upon his occupational, interpersonal and leisure functions.  He continued to report poor sleep and stated he felt tired “all the time.” He reported a loss of appetite and “constant diarrhea.”  He took a medication for sleep.  He had not seen his children since November 2003 because his wife remarried and moved to England.  He planned to move home and live in his mom’s basement and become a teacher or a chef.  MSE was unremarkable.  Diagnosis of PTSD was rendered with a Global Assessment of Functioning (GAF) score of 60 (moderate bordering on mild symptoms, impairment.)  He received an S2 profile with no specific restrictions or limitations.

At the C&P examination for PTSD, dated April 2006, the CI reported he saw the “combat stress team” while in Iraq due to sleep disturbance.  The psychiatrist in Iraq prescribed medication for sleep.  He was taking a new medicine for sleep and sleeping better, up to 6 hours per night.  He described various combat stressors and had nightmares as described above two times a month.  He endorsed several symptoms of PTSD and depression.  He was working as a division staff member and had not missed any work due to psychiatric symptoms.  He was living with the woman he had been dating after the divorce but did not have much feeling for her.  He had several friends he talked with, cooked with and played horseshoes.  He enjoyed wood burning as a hobby.  Other than a psychiatric visit he had received no treatment since returning from Iraq.  He denied legal involvement or violent behavior.  MSE noted he could not sleep without sleep medication.  A diagnosis of PTSD and dysthymic disorder was rendered with a GAF of 78 (transient symptoms, impairment.)  

Although the CI received an S2 profile, there were no restrictions or limitations placed.  He continued to work full-time without loss of days.  His condition was not implicated in the commander’s statement and was not judged to fail retention standards.  PTSD was reviewed and considered by the Board. There was no performance based evidence from the record that the PTSD 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 PTSD contended condition and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the sleep apnea condition, the Board unanimously recommends a disability rating of 50%, coded 6847 IAW VASRD §4.96.  In the matter of the contended PTSD condition, the Board recommends no change from the PEB determination as not unfitting.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Sleep Apnea	6847	50%	
COMBINED	50%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140203, 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, AR20160005860 (PD201400702)

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 re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 50% effective the date of the individual’s original medical separation for disability with severance pay.  

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:

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

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 50% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

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:

			      
						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA