RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01424
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Military Police, medically separated for “major depressive episode, single episode, in remission,” rated at 10%.    

CI CONTENTION:  He was given a higher rating for his condition by the VA.  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 - 20070420	VARD - 20071219   	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Episode…	9434	10%	Post Traumatic Stress Disorder with Depressive Features	9411	50%	20071022 	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

Major Depression. Service treatment records (STR) noted the CI was deployed to Iraq twice: from March 2003-March 2004 and February 2005-January 2006.  There were combat exposures during both deployments and he received a Combat Action Badge after the first deployment.  He was seen by behavioral health in Iraq for 2 months after the death of his platoon leader who was killed by a sniper.  He also witnessed multiple dead bodies.  The second tour was hard for him emotionally.  After redeployment he was referred to behavioral health in July 2006 due to his report of difficulties with concentration, short-term memory, low energy, irritability, depressed mood and insomnia.  He received individual supportive therapy and medication for depression.  He was removed from training and assigned to an administrative function.
The Medical Evaluation Board (MEB) DD Form 2808, Report of Medical Examination, dated February 2007, listed diagnoses of posttraumatic stress disorder (PTSD), depression, anxiety, and insomnia.  The CI had noted on the DD Form 2807 he had received these diagnoses.

The narrative summary (NARSUM), dated in April 2007, noted the CI had been followed for 8 months by behavioral health since August 2005.  He continued to take the medication for depression and had positive clinical results.  He had done well in a protected environment and symptoms had remitted.  The CI’s mental status exam (MSE) was unremarkable; he denied suicidal or homicidal ideation.  The psychiatric examiner, who was his treating psychiatrist, noted he had shown some symptoms of PTSD though there had been no active symptoms since he began treatment.  His condition had responded more like a clinical depression that PTSD.  There was no history of hospitalization or self-harm.  A diagnosis of major depressive disorder (MDD) was rendered with a Global Assessment of Functioning (GAF) score of 65 (mild impairment, symptoms.) up from 45 (serious impairment) at the start of treatment 8 months previously.  He received an S3 profile.  The commander noted the CI was not able to complete a course due to medical issues with sleeping disorders and PTSD…”has been very productive providing direct assistance…an outstanding NCO with unlimited potential for future growth.”

The VA Compensation and Pension (C&P) examination performed 5 months after separation, documented his outpatient mental health records and indicated that he had been diagnosed and treated for PTSD.  The CI reported symptoms of PTSD, including nightmares and flashbacks.  The examiner opined that his depressive symptoms remained in relative remission, but his PTSD symptoms were increasing and it would appear that PTSD was his primary diagnosis with depressive features.  He continued to take medication for depression.  He had been unemployed until he began working for the past 3 weeks in a detention center.  He was living with his ex-wife, their two daughters, and his wife’s new husband.  MSE showed a mildly depressed mood, difficulty falling and staying asleep, and mild difficulty with recent memory.  A diagnosis of PTSD was rendered with a GAF score of 45 (serious symptoms, impairment.)  The VARD assigned a disability rating of 50%.

Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for mental health conditions.  The Board considered if application of VASRD §4.129 with a 6 month (50% minimum) period on the TDRL was indicated in this case.  Board members agreed that the provisions of VASRD §4.129 were applicable in this case due to the combat traumas impacting symptoms.  The Board then considered if there was evidence for a §4.130 rating higher than the §4.129 minimum mandated 50% at time of TDRL placement.  The Board agreed that the §4.130 criteria for a rating higher than 50% were not met near the time of separation, and therefore the minimum 50% initial TDRL rating is applicable.

The most proximate source of comprehensive evidence on which to base the permanent rating recommendation 6 months after placement on TDRL was the VA C&P examination performed in October 2007, 5 months after separation.  No private provider or VA notes were in evidence in the record.  The Board considered if there was evidence for a §4.130 rating higher than 10% at time of TDRL removal.  The C&P exam rendered a diagnosis of PTSD with a GAF of 45; a sharp decline from the last previously recorded GAF of 65 with no explanation offered.  The Board noted the CI was living with several people, including his children’s stepfather, and was employed in a detention center, situations that many would find stressful.  His MSE showed mild difficulty with sleep, memory and mild depression.  Based on the above evidence, the Board agreed that he met disability rating criteria of 10%.  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 MDD condition at permanent disposition.  

BOARD FINDINGS:  In the matter of the MDD condition and IAW VASRD §4.130, the Board recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, 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	
Major Depressive Episode	9434	50%	10%	
RATING	50%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140314, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB
DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY
251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

xxxxxxxxx

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, AR20160006063 (PD201401424)

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 (000 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 recharacterize the individual's separation as a permanent disability retirement with the
combined 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:
000 PDBR
OVA