RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03018
BRANCH OF SERVICE:  Coast Guard 	SEPARATION DATE:  20050428

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

CI CONTENTION:  The CI requests consideration of all conditions.  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 - 20050315	VARD - 20060718	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	Panic (Anxiety) Disorder	9412**	10%	20051007	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Posttraumatic Stress Disorder (PTSD).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) mental health (MH) examination, the CI reported a preservice history of repeated sexual assault from ages 5-11 by her step grandfather, and a high school history of anorexia.  She also reportedly stated that she was evaluated by a psychiatrist at the age of 19 and was diagnosed with borderline personality disorder.  In June 2003 (~3 yrs. of service), the CI reported that she had attended a restaurant with several other service members in celebration of her 21st birthday when somebody slipped her a date-rape drug called GHB.  She was rendered unconscious.  She indicated that she did not remember what had occurred, but recalled waking up in the emergency room.  She stated that from what she could gather from her girlfriend, she was found on the bathroom floor passed out, and when a blood test was performed, she tested positive for GHB.  The NARSUM noted the CI stated she felt depressed since the birthday party until she began school in November 2003.  Her depression returned while at her new unit in Maine, around May 2004.  She would periodically feel very anxious, sometimes awakening with panic attacks.  There was no indication that the CI received any outpatient treatment prior to 2005, and there was no evidence that a MH condition was profiled.

At the MEB MH consultation dated 1 January 2005, approximately 5 months prior to separation, the CI reported she “felt very violated” and “didn’t know who I could trust” following the alleged drugging incident.  She believed that the official and civil inquiry into her alleged drugging and harassment complaints was superficial.  The CI also noted that she frequently had nightmares of being attacked by her mother (with whom she had bad relations).  She noted chronic sleep problems and poor energy.  For reasons undisclosed, the CI was expecting to be discharged in February 2005, but when told she would be delayed for a year, she took an overdose of her medication.  She was discovered by a friend, and taken to the hospital.  Other stressors in this time frame included both her mother and grandmother having sustained strokes.  Her father had to leave his job in order to take care of her mother. The CI believed she was needed at home in order to reduce the burden.  The psychiatrist wrote, “By her account, her Coast Guard experiences have exacerbated more long-standing psychiatric difficulties including PTSD, eating disorder, and borderline personality disorder.  She believes her troubles began during an interval of sexual abuse at the hands of her step-grandfather between the ages of 5-11.”  The examiner also noted the CI stated she had repeated intrusive strong recollections of the sexual assault from childhood and described it in detail.  It was noted that the CI was discharged on medication (antidepressant) but had not yet begun to take it because of trust problems around the medicine, although she continued to use the medicine on which she overdosed (prescribed for sleep).  She did note that she was participating in talk therapy and wished to continue that.  She denied symptoms suggestive of a bipolar condition.

The mental status examination was unremarkable.  She described her mood as “empty, apprehensive and hopeless.”  The diagnoses of subsyndromal PTSD (symptoms of PTSD not fully expressed as PTSD) with occasional panic attacks, depressive disorder NOS and eating disorder NOS were recorded and documented as EPTS (existed prior to service).  The subsyndromal PTSD and depressive disorder NOS were noted as “probable” service exacerbated conditions.  The diagnosis of borderline personality disorder was noted as EPTS on Axis II.  The psychiatrist opined that the CI was suffering from some aspects of PTSD (with emphasis on the childhood abuse), and that her description of borderline personality disorder was unambiguous and overlapped with the PTSD and depressive disorder.  The examiner stated that the antidepressant medication would improve all of her psychiatric conditions; however, “the density and duration of her long-standing problems are such that she cannot be considered fit for full duty now or in the future.” 

The VA Compensation and Pension (C&P) examination was accomplished approximately 6 months after separation.  The CI reported she had panic like symptoms and felt very depressed at times.  She was unable to trust people and had difficulty establishing relationships with people due to her mistrust based on her previous experience, which was traumatic to her.  She described the situation at the birthday party.  The examiner noted that she was hospitalized once while in service “for a suicidal gesture.”  She noted she had spent 3 days inpatient and since her discharge from the service she had seen a therapist and a psychiatrist who prescribed medication.  The MSE was normal.  The psychiatrist diagnosed panic disorder without agoraphobia, anxiety disorder with symptoms of PTSD, but “the patient does not meet the full-fledged diagnosis of PTSD.”  A GAF of 75 (if symptoms are present, they are transient and expectable reactions to psychosocial stressors).  The examiner noted that there was no diagnosis on Axis II.  The examiner was non-committal as to the origin of her PTSD symptoms.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 9411 code (PTSD), citing her condition caused occupational and social impairment due to mild or transient symptoms ….”  The VA assigned a 10% rating, coded 9412 (panic, anxiety disorder), based on “symptoms requiring no more than psychotropic medication for management.”  It was noted the conditions of PTSD and depression were not service connected.  The VARD noted the MEB psychiatrist evaluation which cited diagnoses of PTSD and depression, having onset prior to military service, but exacerbated during service, and that the VA examination results “failed to confirm a definitive diagnosis of PTSD and depression.”  

The PEB rating, as described above, was derived from DoDI 1332.39 and preceded the promulgation of the National Defense Authorization Act (NDAA) 2008 mandate for DoD adherence to Veterans’ Administration Schedule for Rating Disabilities (VASRD) §4.129.  The Board, IAW DoDI 6040.44 and DoD guidance (which applies current VASRD §4.129 to all PTSD cases), must recommend a minimum 50% rating for a retroactive 6-month period on the Temporary Disability Retired List (TDRL).  The Board must then determine the most appropriate fit with VASRD 4.130 criteria at 6 months for its permanent rating recommendation, based on the facts in evidence which are most probative for that interval.  

The Board next proceeded with its rating recommendation under VARSD§ 4.130 based on the evidence at constructive TDRL placement.  The MEB examiner recorded one psychiatric hospitalization (3 months before separation) in response to a delay in her discharge from service.  She was prescribed medication but did not take it.  After hospital discharge, her symptoms included sleep disturbance, occasional recollection of sexual abuse from childhood, and occasional depressed mood.  Her MSE at both the MEB and C&P examinations was normal.  The MEB psychiatrist did not assess specific industrial impairment but noted that given the history of her long-standing problems she was not fit for duty.  The record demonstrated absence of crisis treatment, emergency room treatment, repeated hospitalization, panic attacks, suicidal gestures or attempts, aggression or violence in the months before separation and in the 6 months after separation.  The record also demonstrated that in the 3 months prior to separation, the CI’s condition was stable and she had no new issues or concerns.  

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 VA C&P examination was the sole examination available for consideration.  At the C&P examination, the CI indicated that she had not been hospitalized post separation or treated in the emergency room for MH concerns.  Her symptoms were reported as mild and transient.  The record demonstrated a pattern of symptom stability with symptom exacerbation in response to transient stressors.  Board members concluded, at the time of separation, the CI’s condition was most reflective of the 10% disability level for mild and transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or 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 PTSD, recurrent condition, the Board recommends a disability rating of 50%, coded 9411 for the TDRL interval and a permanent disability rating of 10%, coded 9411 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 her 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 20140515, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

Dear XXXXXXXXXX,

I am the Designated Decision Authority for the Coast Guard on applications submitted to the Department of Defense Physical Disability Board of Review (PDBR).  Under the authority of Title 10, United States Code, section 1554a, I accept the PDBR’s recommendation in your case (Case Number PD-2014-03018) and hereby modify the disability rating previously assigned to reflect a rating of 50% and re-characterization of your separation to temporary disability retirement for six months from the date of separation. After six months, your final disposition is 10% and separation with severance pay. This decision will be effective as of the date of your prior medical separation.  Please allow up to ninety (90) days for the corrections to be made. 

Please note, if you received a lump-sum or other payment of back pay and allowances at separation, your disability retired pay may be reduced to take into account receipt of such lump-sum or other payment.  Please contact the Coast Guard Pay and Personnel Center at (800) 772-8724 for questions relating to retired pay matters. 

Enclosed for your information are a copy of the PDBR’s recommendation and a copy of the record of proceedings. 

A copy of this decision has also been provided to Coast Guard Enlisted Personnel Management Branch, the PDBR, and the Department of Veterans Affairs. 

If you have any further questions, please contact the Coast Guard Personnel Service Center at (703) 872-6628. 
	Sincerely,
2 Enclosures		
	
Copy:	CG Personnel Service Center (EPM-1)
DoD Physical Disability Board of Review
Department of Veterans Affairs