RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02694
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040510

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Signal Support System Specialist, medically separated for “posttraumatic stress disorder (PTSD),” with a disability rating of 10%.

CI CONTENTION:  The CI contends his condition continues to worsen and negatively impacts his life.  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 – 20040317	VARD - 20040809	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	50%	20040622	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Posttraumatic Stress Disorder.  According to the service treatment records (STR) and the mental health (MH) Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed symptoms suggestive of PTSD after his Iraq deployment in 2003.  The CI initially presented to MH in November 2003 with the report of depressive symptoms, daily crying spells, hopelessness, nightmares, and flashbacks to traumatic experiences in Iraq.  He was unable to sleep secondary to nightmares.  The CI reported a good supportive marriage, but his wife and coworkers had noticed a change in him after returning from Iraq.  Despite good support and adequate treatment, the CI was not able to resolve his PTSD symptoms, and was referred to the MEB.

At the MEB NARSUM dated 24 February 2004, approximately 3 months prior to separation, the CI noted his symptoms of PTSD continued.  He had nightmares, flashbacks and was hypervigilant.  He also reported symptoms of depression.  He was prescribed medications to address his mood, anxiety and sleep issues, and his symptoms had not required inpatient treatment. The mental status examination (MSE) noted that the CI appeared anxious and hypervigilant.  He had an anxious mood and affect and no other abnormalities.  The diagnosis of PTSD was recorded, and a Global Assessment of Functioning (GAF) score of 58 for moderate symptoms and or impairment was documented.  
 
On 7 April 2004, the CI presented to outpatient psychiatry as a crisis appointment.  The CI reported he had suffered a severe panic attack which lasted 30 minutes, precipitated by a flashback to Iraq.  The CI had presented the previous week to the clinic for a panic attack which had lasted an hour.  There was no indication from the record that the CI was ever hospitalized or received treatment in the emergency room (ER) for his MH condition.

The VA Compensation and Pension (C&P) mental health examination was accomplished approximately 2 months after separation.  The CI had plans of attending college in the fall of 2004, but was not employed at the time.  The CI reportedly stated he had been hospitalized for a week in April 2004 secondary to panic attacks and PTSD symptoms; however, no admission or discharge record was in evidence.  The CI reported his relationship with his wife and child had improved, and he reportedly had panic attacks 1-2 a week, irritability, loss of interest and motivation, insomnia and fatigue.  The CI noted he had not received any treatment since discharge, but had continued to take his medications prescribed while in service.  He noted some improvement with medication, but his mood and irritability had not improved much.  The MSE was unremarkable with the exception of a dysphoric mood and constricted affect, and some impairment in concentration.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD condition at 10%, coded 9411, with the notation that the condition required psychotropic medication and psychotherapy.  The VA granted a 50% disability rating coded 9411, citing §4.130 criteria rating for the 50% disability level. 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.  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 should assign an evaluation of not less than 50% and schedule an examination within the six month period following the veteran’s discharge to determine whether a change in evaluation is warranted.  

The Board next considered the §4.130 rating at the time of constructive Temporary Disability Retirement List (TDRL) placement.  Available treatment records prior to constructive TDRL period demonstrated some impairment in occupational and social functioning; however, there was no documented evidence to support impairment in judgment or thinking.  Although the CI reported he was hospitalized in April 2004, this was not demonstrated in the STRs.  The STRs recorded 2 outpatient psychiatry visits in the month of April 2004, and neither visits documented a hospitalization.  The STR did not reflect any treatment in the ER for his reported panic attacks.  There was no evidence of suicide attempts or homicidal ideation, or a history of aggression or violence.  The Board considered the record in evidence did not support a higher than 50% rating for TDRL placement. 

The Board next determined the most appropriate fit with VASRD §4.130 criteria at the end of TDRL for its permanent rating recommendation.  There were no available records reflecting post-separation treatment with the exception of the C&P MH examination.  As noted above, the C&P examination documented continued difficulty with sleep, concentration and panic attacks.  The CI had plans to attend college in the fall of 2004; however, he was not working and he had limited social interactions.

The Board considered the absence of evidence demonstrating issues with memory, thinking, or judgment; absence of evidence of hospitalizations, and no recorded visits to the ER for MH symptoms.  He had partial response to his medication prior to separation, and had not improved significantly in the 2 months after separation.  After considerable deliberations, Board members concluded the CI’s condition was not transient and was not well controlled with medication, and therefore, was most reflective of the 30% disability level.  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 30% disability rating for the PTSD condition.

BOARD FINDINGS:  In the matter of the PTSD condition, the Board unanimously recommends a constructive 6 month TDRL rating of 50% and a 30% permanent rating 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the day prior to medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Posttraumatic Stress Disorder	9411	50%	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140527, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 AR20160013313 (PD201402694)

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 re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30%.

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 temporary disability 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 day following the six month TDRL period.
	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will [account for recoupment of severance pay, provide 50% retired pay for the constructive temporary disability retired six month period effective the date of the individual’s original medical separation and then payment of permanent disability retired pay at 30% effective the day following the constructive six month TDRL period.  
	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:

CF: 
(  ) DoD PDBR
(  ) DVA