RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03475
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20021220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Heating, Ventilation, Air Conditioning, Refrigeration Apprentice, medically separated for “PTSD” with a disability rating of 10%.

CI CONTENTION:  “Please consider 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 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 - 20021122	VARD - 20031119	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	0%*	20030911	
Alcohol Abuse 	Cat III 	No VA Placement	
Back Pain	De Facto Not Unfitting	Low Back Pain	5237	10%	20030911	
Neck Pain	De Facto Not Unfitting	Cervical Spine	5237	Deferred**	20030911	
Memory Difficulties	De Facto Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	
VARD dated 20040603 increased PTSD rating to 50% and assigned a 20% rating for the cervical spine.

ANALYSIS SUMMARY:  

Post-Traumatic Stress Disorder (PSTD).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s PTSD symptoms began in April 2002 after he reported he was assaulted by three males in the barracks.  He was intoxicated and got into an argument with four individuals and was taken outside and beaten with a billiard cue.  A Line of Duty determination documented the CI was in a physical confrontation on 23 April 2002 with a blood alcohol content (BAC) of 0.2.  A Life Skills technician and a psychologist rendered a diagnosis of PTSD in June 2002 without describing symptoms that met the criteria for PTSD.  The CI had been diagnosed with panic disorder in February 2002 after a 1 year history of recurrent anxiety/panic attacks.  He was seen for substance abuse evaluation and for eyes-on supervision of substance abuse in May 2002.  He was taking two medications (an anti-depression and an anxiolytic) to treat the panic disorder.  The MEB forwarded PTSD for PEB adjudication.  

The MEB psychiatric addendum on 28 September 2002, 3 months prior to separation, noted complaints of irritability and intrusive recollections of trauma.  He was hypervigilant and had diminished participation in relationships and activities in the workplace.  He was taking anti-depression and anxiolytic medications and attended psychotherapy aimed at diminishing avoidance and cognitive distortions.  The first commander’s statement in September 2002 noted the CI was working full-time at the Self-Help store for the last few weeks.

The NARSUM examination on 13 November 2002, 1 month prior to separation, noted complaints of irritability, excessive startle response, avoidance, anger and intrusive recollections of trauma.  Since the assault, the CI had a steady decline of work performance and had been removed from multiple work related responsibilities to the frustration of his command.  He had been involved in periodic underage drinking and was diagnosed with a Substance Related Disorder on 1 May 2002.  He had been stopped by police in March 2002 and issued a citation for possession of alcohol as a minor.  He received one LOR for underage drinking in April 2002.   The CI reported he stopped drinking after the April assault.  Mental status examination (MSE) was essentially unremarkable.  A diagnosis of PTSD was rendered with a Global Assessment of Functioning (GAF) score of 60 (moderate bordering on mild symptoms, impairment).

The second commander’s statement dated 14 November 2002, noted the CI was cited by local police on 10 November for minor consumption (underage drinking) of alcohol with a blood alcohol content (BAC) of 0.14.  He had been drinking at a local party and instigated a confrontation with attendees by waiving a kitchen knife and pointing it at people.  This led to a physical confrontation where he was forcibly ejected.  He returned with baseball bats, leading to further fighting.  He was beaten, resulting in a chipped tooth and severely swollen eye.  Based on police reports, the CI was the instigator and primary cause leading to the confrontation.  Peers informed leadership that the CI had been involved in at least nine separate physical confrontations, mostly undocumented.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB initially rated the PTSD condition 30%, coded 9411 (PTSD) but deducted 20% for contributory/aggravating factors, resulting in a 10% rating.  The PEB cited social and industrial impairment as mild if not for alcohol abuse.  The VA rated the PTSD condition 0%, coded 9411, but increased the rating to 50% effective the date of separation based on a C&P examination in January 2004.  The Board agreed application of VASRD §4.129 with a 6 month (50% minimum) period on the TDRL was indicated in this case.  The Board agreed that the §4.130 criteria for a rating higher than 50% were not met near the time of separation, and therefore the minimum 50% TDRL rating is applicable.  The Board then considered the permanent rating at 6 months.  The most proximate source of comprehensive evidence on which to base the permanent rating is the November 2002 NARSUM examination.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication.” A 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  

The STR, the NARSUM and the commander’s statement confirmed that the CI had recurring episodes of underage drinking, a pattern of misconduct and a pattern of physical confrontations.  At the NARSUM examination, the CI reported he had not consumed alcohol since April 2002.  Yet his commander noted the police authorities had cited the CI for minor consumption (underage drinking) with a BAC of 0.14 on the day he reported he had been assaulted.  He was at a party at which he initiated a physical confrontation/fight, was ejected and returned with a baseball bat, which escalated the conflict, resulting in his beating.  He did not acknowledge these events during the NARSUM or other MH examinations and denied that he had drank alcohol since April 2002.  The commander noted he had not responded to disciplinary efforts, consistently violated the law and exacerbated his own condition.  The NARSUM examination noted an unremarkable MSE with a functional score boarding on mild.  The Board did not find evidence that a higher than 10% rating was warranted.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a disability rating of 50% for 6 months of constructive TDRL and a 10% permanent rating thereafter for the PTSD condition.

Contended PEB Conditions. Alcohol Abuse. Back Pain. Neck Pain. Memory Difficulties. The Board’s main charge is to assess the fairness of the PEB’s determination that alcohol abuse, back pain, neck pain and memory difficulties were not unfitting.  The contended conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.    

BOARD FINDINGS:  In the matter of the PTSD condition, the Board unanimously recommends a retroactive placement on the TDRL with a disability rating of 50%, coded 9411 (PTSD) IAW VASRD §4.129 and then a permanent separation rating of 10% IAW VASRD §4.130.  In the matter of the contended conditions, the Board unanimously 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%	10%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140620, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03475.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your records to reflect placement on the Temporary Disability Retired List for a period of 6 months, without change to your previously assigned disability rating with severance pay and separation characterization upon final disposition.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

Sincerely,

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR