RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03017
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041019

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

CI CONTENTION:  He was given a higher rating for his condition(s) 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 - 20070816	VARD - 20041122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Stress Disorder	9411	10%	Post-Traumatic Stress Disorder	9411	50%	20040806	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

PTSD Condition.  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 Iraqi deployment in 2004.  The CI initially presented to MH in April 2004 with the report of nightmares related to combat, irritability, emotional distancing, and passive suicidal thoughts (SI).  He also noted that he had begun drinking alcohol to treat his symptoms.  On 6 May 2004, he was admitted to the hospital after he expressed suicidal ideations (SI) with the plan of crashing his car.  The discharge summary dated 13 May 2004 noted that the CI returned from deployment on 2 April 2004, and since he returned he felt depressed, had cried all the time; had problems controlling his emotions, and was unable to concentrate.  He stated he could not relax, or make any decisions.  He had dreams about the fellow British soldier who was blown up by a grenade, as well as dreams about combat events and other events he witnessed during deployment.  He had problems with sleep, energy and motivation.  The CI spent a week on the inpatient unit where he was treated with talk therapy and medication.  At the time of discharge, his mental status examination (MSE) was unremarkable with the exception of anxious mood.  Discharge diagnoses included PTSD, acute onset, alcohol abuse, in remission; and alcohol dependence, in remission.  A Global Assessment of Functioning (GAF) score of 70-75 (mild impairment/mild symptoms) was recorded.  On 1 June 2004, the CI presented to the emergency room (ER) with the report that he felt depressed because of the recent break-up with his girlfriend.  He also had drank a significant amount of alcohol, but denied SI.  It was noted that he had not taken his medication in 2 days.  Despite treatment, the CI continued to have significant anxiety symptoms, including the report of panic attacks in June 2004, and was therefore, referred to the MEB.

The MEB NARSUM examination on 1 July 2004, approximately (4 months prior to separation), the CI noted he had panic attacks, daytime anxiety, flashbacks of combat experiences, and nightmares.  The MSE recorded an anxious and depressed mood with anxious affect and no other abnormalities.  The diagnosis of PTSD, chronic, treated, with partial improvement, was recorded as the sole diagnosis.  At the VA Compensation and Pension (C&P) in August 2004, a mental examination was performed 2 months before separation.  The CI reported symptoms of PTSD, crying spells, and panic attacks.  He also noted he had problems with sleep and irritability and concentration.  He was somewhat isolative from others, and no longer went out or enjoyed the things he used to.  MSE recorded anxious and sad mood with constricted affect.  All other aspects of the examination were unremarkable.  He denied SI and homicidal ideation (HI).  The CI was still taking his psychotropic medication with noted improvement in the 2 months prior.  The diagnoses of PTSD and alcohol abuse, in remission was documented, and a GAF of 60 (cusp of moderate and mild) was recorded.

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, and invoked the provisions of §4.129 described below as the reason for the 50% evaluation.  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 constructive Temporary Disability Retired List (TDRL) placement.  Available treatment records demonstrated some impairment in occupational and social functioning; however, there was no documented evidence to support impairment in judgment or thinking.  The NARSUM and C&P examination both recorded history of one psychiatric hospitalization related to PTSD and mood symptoms.  There was no evidence of suicide attempts or homicidal ideation, or visits to the ER for MH issues.  There was no evidence of a legal history at the time of constructive TDRL.  Both the NARSUM and C&P examination documented essentially normal MSEs with the exception of anxious and or sad mood.  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; however, the Board considered the last two treatment entries, both in the month of September 2004, and the C&P examination.  As noted above, the C&P examination documented continued difficulty with sleep, concentration and panic attacks.  Treatment entry dated 2 September 2004, 7 weeks before separation, recorded a telephone call from the CI that indicated he had increased anxiety and occasional panic attacks, and needed a refill of his anti-anxiety medication.  On 30 September 2004, less than 1 month before separation, the CI was seen by the psychiatrist and was doing well.  His MSE was unremarkable.  Board members concluded the CI’s condition was stable at the time of separation, and his disability was most reflective of the 10% level for “symptoms controlled by continuous medication.”  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 10% disability for the condition of PTSD.

BOARD FINDINGS:  In the matter of the posttraumatic stress disorder condition, the Board unanimously recommends an initial TDRL rating of 50% in retroactive compliance with VASRD §4.129 as DOD directed; and a 10% 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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Posttraumatic Stress Disorder	9411	50%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140617, 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 XXXXXXXXXXXXXXXXXX AR20160011100  (PD201403017)

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 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:
( ) DoD PDBR
( ) OVA