RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01764
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Military Policeman, medically separated for “posttraumatic stress disorder,” with a disability rating of 0%.

CI CONTENTION:  His is permanently disabled for his condition by the VA.  The CI’s 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 based upon a 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 - 20040929	VARD –20041130	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Stress Disorder 	9411	0%	Posttraumatic Stress Disorder	9411	50%	20041115	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Posttraumatic Stress Disorder (PTSD).  According to the Medical Evaluation Board (MEB) narrative summary (NARSUM), dated 9 September 2004 (3 month before separation), the CI deployed to Iraq from 2003-2004 and suffered a series of traumatic combat events.  He felt stressed and developed hypervigilance bordering on paranoia.  His wife had an affair and the couple divorced, adding to his stress.  Visits to the chaplain were helpful but after redeployment, he experienced decreased sleep and traumatic nightmares.  He developed “flashbacks” triggered by watching news coverage of violence in Iraq.  He visited the emergency room in May 2004 (7 weeks after his return from Iraq) due to nightmares and hearing the voice of a deceased friend killed in Iraq.  He was anxious and slightly tearful.  A diagnosis of sleep disorder due to PTSD was rendered and he was referred to mental health.  A May 2004 medication profile showed that the CI was prescribed medications for nightmares, sleep, depression and anxiety with no evidence of refills.  The examiner noted that he refused medication but engaged in individual counseling and participated in a stress therapy group. The CI had occupational difficulties with his unit and received an Article 15 as a result of an incident while deployed to Cuba.  He had a long history of suboptimal duty performance throughout his military career and a chronic and pervasive conflictual style.  The mental status exam (MSE) noted a somewhat anxious affect associated with a sense of urgency.  He described his mood in terms of “having a lot of stress” with his unit.  An Axis I diagnosis of PTSD and Axis II diagnosis of narcissistic and antisocial personality traits were rendered with a Global Assessment of Functioning (GAF) of 70 (mild symptoms, impairment.)  The commander noted he was unable to perform his duties because his profile limited the hours he worked.  

At the VA Compensation and Pension (C&P) examination on 15 November 2004 (1 month before separation), the CI reported that his psychotropic medications were helpful, but that he had run out of his prescriptions the previous week.  He denied hospitalizations but reported trouble sleeping, nightmares, a great deal of anxiety and worry, frequent depression, and that he was anti-social.  He wanted to become a physical therapist, and since discharge, had enjoyed working as a personal trainer 9-10 hours a day.  He was not dating because he did not trust women since his divorce.  His only recreation was “working out.” He reported a high level of anxiety, nearly nightly nightmares of incidents in Iraq, hearing the voice of a soldier friend who was killed at times, and two flashbacks, the last of which was in May 2004.  He denied suicidal ideation.  A diagnosis of PTSD was rendered with a GAF of 60 (moderate bordering on mild symptoms, impairment.)  The examiner noted his symptoms appeared related to his exposure to traumatic events while in the military. 

At a 25 July 2005 VA examination, referenced by the 2005 VA rating decision narrative, the CI reported nightmares, anxiety, avoidance and withdrawal from others, difficulty being around people of possible Arab descent, trouble trusting people, and guilt regarding “killings in Iraq.”  He had taken some college courses, was living with his parents, and was not working.  He had a good relationship with his parents and daughter but limited social interaction outside his family.  He denied legal involvement.  The CI’s main activity was working out and he reported some obsessive behaviors regarding exercise and that he was “fanatical” about his diet.  He reported panic attacks once or twice a month and intrusive thoughts but denied suicidal ideation.  The examiner noted that the CI had good memory and MSE showed that he was somewhat hyperactive and anxious.  A diagnosis of PTSD was rendered with a GAF of 50-55 (moderate symptoms, impairment.)

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 9411 code (PTSD) citing that the CI did not require medication,   was receiving psychotherapy treatment and had antisocial and narcissistic personality traits.  The VA assigned a 50% rating, also coded 9411, based on the VA C&P examination 1 month before separation, citing “occupational and social impairment with reduced reliability and productivity.”  In accordance with VASRD §4.129, when a mental disorder that develops in Service as a result of a highly stressful event is severe enough to bring about the CI’s release from active military service, the rating agency shall assign an evaluation of not less than 50% and schedule an examination within the 6-month period following the Veteran’s discharge to determine whether a change in evaluation is warranted.  The Board first considered whether the provisions of VASRD §4.129 were applicable in this case.  Noting the association of combat experiences impacting the CI’s current symptoms and PEB documentation that PTSD was a direct result of armed conflict in Iraq, all Board members agreed that the §4.129 criteria applied.

The Board then considered if there was evidence for a §4.130 rating higher than 50% at the time of TDRL placement and members unanimously agreed criteria were not met for a 70% rating and that the minimum 50% initial TDRL rating was warranted.  
The Board next determined the most appropriate fit with VASRD §4.130 criteria at the end of TDRL for its permanent rating recommendation.  The 15 November 2004 VA C&P evaluation (1 month after TDRL placement) indicated the CI’s prescriptions were helpful but that he had been out of medication for a week.  He enjoyed being a personal trainer at a gym and worked 9-10 hour days.  He reported trouble with sleep, depression, and anxiety.  At the 25 July 2005 VA examination (8 months after separation), the CI reported anxiety with panic attacks 1-2 times a month, nightmares, avoidance, social isolation, distrust and guilt.  He was not working but taking college classes, and had moved in with his parents.  He had good relationships with them and with his daughter.  He exercised obsessively and kept a strict diet.  The 30% rating criteria for §4.130 requires “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal) due to symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).”  After careful review of the evidence, the Board majority concluded that the CI’s PTSD symptoms did not rise to the 30% rating threshold at the time of permanent separation.  After due deliberation, considering of all the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 50% at TDRL placement and a permanent 10% disability rating for the PTSD condition, coded 9411.

BOARD FINDINGS:  In the matter of the PTSD condition, the Board majority recommends a disability rating of 50%, coded 9411, IAW VASRD §4.129 and §4.130, for the TDRL interval and a permanent disability rating of 10%, coded 9411, IAW VASRD §4.130.  The single voter for dissent recommended permanent disability retirement and did not elect to submit a minority opinion.  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:  

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

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140423, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160010647, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability
Board of Review (000 PDBR) to constructively place you on the Temporary Disability
Retired List (TDRL) at 50% disability for six months effective the date of your original
medical separation for disability with severance pay and then following this six month
period no recharacterization of your separation or modification of the permanent
disability rating of 10%. Enclosed is a copy of the Board's recommendation and record
of proceedings for your information.

The constructive TDRL period will result in an adjustment to your pay providing
you 50% retired pay for six months from the date of your original medical separation
and then no recharacterization of your separation or modification of the permanent
disability rating of 10% following the constructive six month TDRL period.

The accepted 000 PDBR recommendation has been forwarded to the Army
Physical Disability Agency for required correction of records and then to the U.S.
Defense Finance and Accounting Service to make the necessary adjustment to your
pay and allowances. These agencies will provide you with official notification by mail as
soon as the directed corrections have been made. Due to the large number of cases in
process, please be advised that it may be several months before you receive
notification that the corrections are completed and pay adjusted. Inquiry concerning
your correction of records should be addressed to the U.S. Army Physical Disability
Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXX.

A copy of this decision has also been provided to the Department of Veterans
Affairs and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXX.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Deputy Assistant Secretary of the Army

Enclosure