RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02864
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060630

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

CI CONTENTION:  The CI requests that all conditions be considered.  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 on 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 - 20060510	VARD - 20061201	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Stress Disorder…	9411	10%	Posttraumatic Stress Disorder 	9411	50%	20060902	
Chronic Left Hip Pain	Not Unfitting	Left Low Back Muscular Strain… claimed as a Left Hip Disability and Low Back Strain	5237	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Posttraumatic Stress Disorder (PTSD).  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 returning from his Iraqi deployment in 2005.  The NARSUM documented several traumatic experiences during his deployment, and noted that his symptoms gradually increased over time.  He had difficulty with sleep, combat related dreams, intrusive memories of several combat related incidents, and flashbacks.  He noted he avoided public spaces, and reported other symptoms consistent with the diagnosis of PTSD.  The CI was prescribed psychotropic medication to treat his symptoms, and noted that although he achieved more hours of sleep, his sleep had not been refreshing.  There was no documentation of panic attacks, significant irritability, problems with memory or concentration, abnormal behaviors, violence, hospitalizations, suicidal or homicidal ideation, or visits to the emergency room (ER) related to MH.  Despite treatment, the CI continued to have significant PTSD and mood symptoms, and was therefore, referred to the MEB.  The MEB NARSUM examination on 27 March 2006, (3 months prior to separation), the mental status exam (MSE) recorded a depressed mood and anxious affect and no other abnormalities.  The examiner noted that treatment of the CI’s condition had either been ineffective or was limited by side effects.  It was noted that he had impairment in duty due to his increasing symptoms.  The diagnosis of PTSD was recorded as the sole diagnosis, and a Global Assessment of Functioning (GAF) score of 40 (some impairment in reality testing or communication, or major impairment in several areas).  

At the VA Compensation and Pension (C&P) mental exam in September 2006, performed approximately 2 months after separation, the CI reported daily anxiety and slept only a few hours, but denied that his limited sleep interfered with functioning.  He reported panic attacks with agoraphobia; and although road rage was reported, he denied a history of violent behaviors.  He was socially isolated, and his emotional numbness had caused problems in his marriage.  The CI was unemployed, and noted he had been married for 11 years, but his wife had threatened to leave him if he continued to abuse alcohol.  The MSE was unremarkable with the exception of constricted affect.  The diagnoses of PTSD, chronic, obsessive-compulsive disorder and panic disorder with agoraphobia were documented, and a GAF of 45 (serious symptoms and or impairment) was recorded.  His prognosis was assessed as fair to good.  

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 outpatient treatment.  The VA granted a 50% disability rating coded 9411, based on the findings of the C&P exam.  The Board considered whether the provisions of VASRD §4.129 (Mental disorders due to traumatic stress) was applicable.  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 6-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 separation.  Available treatment records at the time of constructive Temporary Disability Retired List (TDRL) placement demonstrated some impairment in occupational and social functioning; however, there was no documented evidence to support impairment in thinking or judgment.  The NARSUM and C&P exam both recorded absence of history of psychiatric hospitalization and no documented history of suicide attempts or homicidal ideation, or visits to the ER for MH issues.  Both the NARSUM and C&P exam documented essentially normal MSEs with the exception of mood and affect.  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.  The C&P exam was the sole source document in the post-TDRL period.  That examination documented findings consistent with the 30% disability level (panic attacks, sleep disturbance, road rage, isolative behaviors, avoidance behaviors, marital problems).  After due deliberation, and in consideration of all the evidence and VASRD §4.3 (reasonable doubt), the Board recommended a 50% disability rating at TDRL placement and a permanent 30% disability for the PTSD condition.

Contended PEB Conditions:  Chronic Left Hip Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  There were no other conditions within the Board’s scope of review for consideration.  

BOARD FINDINGS:  In the matter of the PTSD condition, the Board unanimously recommends an initial TDRL rating of 50% in retroactive compliance with VASRD §4.129 as DOD directed; and a 30% permanent rating IAW VASRD §4.130.  In the matter of the contended chronic left hip condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 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 20140607, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160011081, 

Dear:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD 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 re-characterize your separation as a disability retirement with the combined disability rating of 30%.  Enclosed is a copy of the Board's recommendation and record of proceedings for your information.

The constructive TDRL period and the re-characterization of your separation as a disability retirement 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 30% disability retired pay effective the date following the constructive six month TDRL period, minus the amount of severance pay you were previously paid at separation.

The accepted DoD 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 and will provide information on your retirement benefits.  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),.

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

Sincerely,