RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03154
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050817

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Bradley Fighting Vehicle System Maintainer, medically separated for “post traumatic stress disorder,” with a disability rating of 10%.

CI CONTENTION:  The CI requests 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 - 20050707	VARD - 20060504	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	50%	20051222	
Left Wrist Ganglion Cyst	Not Unfitting 	Left Wrist Ganglion Cyst	5015-5215	NSC	STR	
Hypercholesterolemia		No VA Placement	
Pes Planus		B/L Pes Planus w/ Plantar Fasciitis	5276	10%	20051228	
Iliotibial Band Syndrome		Iliotibial Band Syndrome, L Knee	5257	10%		
		Iliotibial Band Syndrome, R Knee	5257	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Posttraumatic Stress Disorder (PTSD). According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI deployed to Iraq from April 2003-July 2004.  He had many combat exposures and developed social withdrawal, anxiety, difficulty with eating, sleeping, and irritability.   After redeployment he reported nightmares, intrusive thoughts, hypervigilance, insomnia, dysphoria, and decreased interests.  He first sought psychiatric care after in March 2005.  In May 2005 he was diagnosed with PTSD.  He was treated with counseling and medications with improvement of most symptoms.  His girlfriend noticed he frequently checked his wallet and his alarm clock up to 10 times per night prior to going to bed.  He has a history of ADHD, diagnosed in third grade and treated with anti-stimulants until tenth grade.  He received a waiver to join the army because of this condition.  He was taking a medication for depression.  He had not worked in his specialty since April 2004 due to his mental state.  At the time of the NARSUM he was performing details and working in a gym.  He reported he forgot things, broke things and had a quick temper.  Sometimes he wanted to hurt himself or others when upset.  The commander’s statement noted he was assigned to a variety of details and performed tasks in an exceptional manner but required a lot of supervision due to his forgetfulness.  A diagnosis of PTSD was rendered.  

At the VA Compensation and Pension (C&P) examination in August 2005, performed 4 months after separation, the CI reported sleep difficulty, irritability or outbursts of anger, difficulty concentrating, hypervigilance, frequent nightmares, isolated, withdrawn, depression, crying spells, and flashbacks.  He was unemployed but attending college.  He was single and enjoyed running, snowboarding and playing basketball.  He had a fight and hit another person.  He was not receiving any treatment.  Mental status exam (MSE) noted blunt affect and agitated, depressed mood, paranoid ideation, persecutory and paranoid delusions.  All areas of memory were mildly impaired.  Diagnoses of PTSD and depressive disorder not otherwise specified were rendered with a Global Assessment of Functioning score of 49 (serious symptoms, impairment.)  

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 moderate improvement, sleeping without medication but with continuing hypervigilance and irritability.  The VA also assigned a 50% rating using the 9411 code based on reduced reliability and productivity due to symptoms.  The Board first considered if application of VASRD §4.129 with a 6 month (50% minimum) period on the Temporary Disability Retired List (TDRL) was indicated in this case.  Board members agreed that the provisions of VASRD §4.129 were applicable in this case due to the combat experiences.  The Panel then considered if there was evidence for a §4.130 rating higher than the §4.129 minimum mandated 50% at time of TDRL placement.  The Panel agreed the §4.130 criteria for a rating higher than 50% were not met near the time of separation, and therefore the minimum 50% initial TDRL rating is applicable.

The most proximate source of comprehensive evidence on which to base the permanent rating recommendation in this case is the C&P examination performed 4 months after separation.  There was no other relevant VA outpatient or civilian provider evidence providing psychiatric details during the 6-month interval.  The CI did not receive treatment or work after separation but was able to attend college.  He continued to endorse symptoms of PTSD, felt isolated and withdrawn but enjoyed leisure activities.  He had engaged in assaultive behavior and showed signs of anxiety and depression during the MSE.  Board members, therefore, concluded that the 30% rating most accurately depicted the condition at the time of removal from TDRL.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 50% for 6-months of constructive TDRL and a 30% permanent rating thereafter for the PTSD condition.

Contended PEB Conditions:  Left Wrist Ganglion Cyst, Hypercholesterolemia, Pes Planus, and Iliotibial Band Syndrome.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  None of the four contended conditions were profiled or implicated in the commander’s statement and each was judged to not fail retention standards.   All were reviewed and considered by the Board.  There was no performance-based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the PTSD condition, the Board unanimously recommends a disability rating of 50%, coded 9411 IAW VASRD §4.129 for 6 months from the time of discharge consistent with a constructive period of TDRL and then a permanent separation rating of 30% IAW VASRD §4.130.  In the matter of the contended the left wrist ganglion cyst, hypercholesterolemia, pes planus, and iliotibial band syndrome conditions, the Board recommends no change from the PEB determinations as not unfitting.  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	
PTSD	9411	50%	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140628, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160011127,  XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

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), XXXXXXXXXXXXXXXXXXX.
A copy of this decision has also been provided to the Department of Veterans Affairs.