RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03602
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20050525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “post- traumatic stress disorder” 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 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 - 20050321	VARD - 20051004	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	50%	20050731	
RATING:  10%	COMBINED RATING:  70%	

ANALYSIS SUMMARY:

Post-Traumatic Stress Disorder (PTSD).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s PTSD condition began during deployment to Iraq from January to July 2003 where he experienced numerous combat traumatic events and was treated by a psychiatrist for anger issues.  Prior to re-deployment he began to have nightmares about being surrounded by dead body parts.  After his return, he noticed high irritability, decreased energy and concentration, difficulty sleeping and daytime flashbacks.  He self-referred to psychiatry in October 2004 and he had two hospital inpatient psychiatric admissions from 15-30 November 2004 due to increasingly violent and impulsive behavior and again from 13-20 December 2004.  The MEB forwarded PTSD for PEB adjudication.

The MEB NARSUM examination performed in December 2004, 6 months prior to separation, noted complaints of PTSD that had improved slightly with medication adjustment.  He still had increased irritability, and difficulties occupationally and in personal relationships.  He was taking an anti-depression medication, a mood-stabilizing medication, an anti-psychotic medication daily and an anti-anxiety medication twice daily. The mental status examination noted mild psychomotor agitation, periodic suicidal thoughts, and a mood described as anxious and irritable.  A diagnosis of PTSD was rendered.  A psychiatric addendum performed in March 2005, confirmed the presence of combat related trauma that resulted in a diagnosis of severe PTSD.  He received a permanent S3 (mental health) profile (6 months before separation) and the commander’s performance statement (5 months before separation) implicated the CI’s mental health condition stating the condition prevented him from carrying weapons, ammunition and performing his infantry duties.  A follow-up commander’s performance statement (rear detachment) questioned the CI’s combat experiences though the record shows the CI was awarded the Combat Infantryman Badge.  There was no other STR evidence after this time period.

At the 31 July 2005 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported continuing symptoms of PTSD, including hallucinations, flashbacks, anxiety and nightmares with 3-4 hours of sleep daily.  He was taking a mood stabilizing medication, an anti-psychosis medication and an anti-depression medication.  He reported limited recreational activities and limited social supports but performed household chores and paid the bills at home.  He was unemployed.  The mental status examination showed a flat affect, and psychomotor retardation in speech and movements, as well as a report of hallucinations while falling asleep.  A diagnosis of PTSD was rendered with a Global Assessment of Functioning (GAF) score of 45 (severe symptoms, impairment.)  The examiner noted social and occupational functioning was moderate to severe.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD condition 10%, coded 9411 (PTSD), citing psychotropic medication and outpatient therapy.  The VA rated the PTSD condition 50%, coded 9411 based on the VA C&P examination 2 months after separation, citing moderate to severe impairment with a GAF (score) of 45.  The Board first considered if application of VASRD §4.129 with a 6 month (50% minimum) period on the TDRL was indicated in this case (per Board directive from DOD).  Board members agreed that the provisions of VASRD §4.129 were applicable in this case due to the combat experiences.  The Board 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 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% initial TDRL rating is applicable.

The most proximate source of comprehensive evidence on which to base the permanent rating is the C&P evaluation, conducted 2 months after separation.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” for 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 CI reported he and his wife had separated due to PTSD symptoms but he was able to manage affairs in the home and had some activities and relationships.  He remained in treatment though medications had been decreased.  He continued to experience anxiety, sleep problems and other signs of PTSD.  The examiner noted he was severely functionally impaired with a GAF score of 45.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the PTSD condition, coded 9411, at TDRL removal.

BOARD FINDINGS:  In the matter of the PTSD condition, the Board unanimously recommends a disability rating of 50% at the time of placement on the TDRL and a rating of 30% at the time of removal from TDRL and permanent disability disposition, coded 9411 IAW VASRD §4.129 and §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 to reflect a 6 month period on TDRL with a disability rating of 50% (PTSD at 50% IAW §4.129 and DoD direction), and then medically separated with a disability rating of 30%.

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
PTSD	9411	50%	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140730, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB														

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 XXXXXXXXXXXXXXXXXXXXX, AR20160017719 (PD201403602)

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 30%.

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 of this memorandum:

	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 retired with permanent disability effective the day following the six month TDRL period.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, provide 50% retired pay for the constructive temporary disability retired six month period effective the date of the individual’s original medical separation and then payment of permanent disability retired pay at 30% effective the day following the constructive six month TDRL period.  

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

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.

 

CF: 
(  ) DoD PDBR
(  ) DVA