RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00805
BRANCH OF SERVICE:  Army 	Seperation date:  20080314

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Infantryman) medically separated for posttraumatic stress disorder (PTSD).  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.   He was issued a permanent S3 profile and referred for a Medical Evaluation Board (MEB).  The “post traumatic stress disorder….” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “posttraumatic stress disorder…”as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  The CI contends that his VA rating 2 years post-separation was higher than his Service disability rating.  The 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:  

IPEB – Dated 20080219	VA* - Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	10%	*STR	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 5	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20080930 (most proximate to date of separation (DOS)).  *CI Failed to report for C&P dated 20080728.  

ANALYSIS SUMMARY:  

PTSD Condition.  According to service treatment records (STR), the CI deployed to Iraq twice: April 2003-April 2004 and December 2005-November 2006.  Post Deployment Health Assessment (PDHA) May 2004 documented his report of seeing someone wounded, killed, or dead, engagement in direct combat where he discharged his weapon, and a feeling of great danger of being killed and some depression in previous weeks.  At Post Deployment Health Reassessment (PDHRA) in March 2007, he reported nightmares, avoidance, hypervigilance or detached feelings, depression and loss of interest over the previous month.  After both assessments, he denied an intention to seek counseling or care for mental health issues.  A Non-Commissioned Officer Report, dated in June 2007, resulted in ratings of 2 (successful) and 1, (superior) with a recommendation for promotion.  Social work referred him for psychiatric evaluation August 2007 because he reported nightmares, night sweats, depressed mood, and sleep of about 3-4 hours daily.  He was easily angered and irritated by soldiers he was training.  He completed an anger management group and was treated with a medication for sleep and a medication for depression.  Psychological testing revealed moderate depression and anxiety, consistent with diagnosis of PTSD.  He had ongoing problems at work and was threatened with disciplinary action due to his tardiness to work.  He was later reassigned to the Warrior Transition Unit to receive more intensive treatment.  He felt irritable and negative with worries about his future and job possibilities.  

At the narrative summary (NARSUM), the CI noted ongoing problems with insomnia and daytime fatigue.  He reported increased ruminations about Iraq since inception of treatment and he did not complete a PTSD group since it made him angry.  Medications were changed to include three medicines for depression.  He reported a history of ADHD at 14 treated with medication.  The CI was getting divorced and was involved in a custody case for his daughter.  Mental status exam (MSE) showed irritable mood and affect.  A diagnosis of PTSD was rendered with a Global Assessment of Functioning (GAF) of 65 (mild impairment, symptoms.)  The commander’s statement of January 2008, noted the CI’s medication made him drowsy.  He could not be assigned overnight duty since he needed eight hours uninterrupted sleep.  His symptoms worsened with recall of his deployments.  He had difficulty managing anger and maintaining composure.  He had limited ability to train soldiers.

The CI failed to report for Compensation and Pension (C&P) exam in Jul 2008.  The most recent C&P for PTSD is dated 7 March 2011, 3 years after separation.  At that time the CI reported he had an initial assessment for outpatient PTSD treatment on 22 April 2008 but did not attend any further appointments.  He stated he could not cope with VA crowds and did not want to attend group therapy.  He had not received other treatment since separation.  He reported his biggest symptom was increased irritability and detachment.  He had poor sleep, helplessness, and passive suicidal ideation after return from his contractor job in Kuwait in December 2010.  He quit the job due to PTSD symptoms and had trouble finding employment since then.  He had limited contact with his child and ex-wife, a stressed relationship with his girlfriend, and two close friends.  He enjoyed riding motorcycles and playing pool.  MSE showed a flat affect and anxious mood.  A diagnosis of PTSD was rendered with a GAF of 55 (moderate impairment, symptoms.)

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB and the VA rated the PTSD condition at 10%, coded 9411.  The Board, IAW DoDI 6040.44 and DoD guidance (which applies current VASRD 4.129 to all Board cases as appropriate), agrees that the stipulations of §4.129 are met in this case; and, will thus recommend a minimum 50% rating for a retroactive 6-month period on the Temporary Disability Retired List (TDRL).  The Board next considered if a rating higher than 50% was warranted at the time of entry on the constructional TDRL period.  The next higher 70% rating requires “occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood”.  Board members agreed however that these criteria were not approached, and therefore a rating higher than 50% was not supported. The Board must then determine the most appropriate fit with VASRD 4.130 criteria at 6 months for its permanent rating recommendation.

The most proximate source of comprehensive evidence on which to base the permanent rating recommendation in this case is the NARSUM examination performed 15 months before separation.  The C&P exam provided some historical context.  There was no other relevant VA outpatient or civilian provider evidence providing psychiatric details during the 6-month interval.  The CI did not receive treatment after separation but was able to work and even went to Kuwait as a contractor.  He eventually left due to PTSD symptoms and would have 3-4 mixed drinks per night to calm himself.  He was not working a year after his return.  He had a girlfriend, two close friends, and activities he enjoyed.  Board members therefore concluded that the 10% rating most accurately depicted the condition at the time of removal from TDRL.  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 6 months of constructive TDRL and a 10% permanent rating thereafter for the PTSD 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 PTSD condition, the Board unanimously recommends a disability rating of 50%, coded 9411 IAW VASRD §4.129 for 6 months from the time of discharge consistent with a constructive period of TDRL and then a permanent separation rating of 10% IAW VASRD §4.130.  There were no other conditions within the Board’s scope of review for consideration.  

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified to reflect a 6-month period on TDRL with a disability rating of 50% (PTSD at 50% IAW §4.129 and DoD direction), and then medically separated with a disability rating of 10%)

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
PTSD	9411	50%	10%	
RATING	50%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140218, 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 XXXXXXXXXXXXXXXXXXXXXX, AR20160002393 (PD201400805)

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:

Enclosures

CF: 
(  ) DoD PDBR
(  ) DVA