RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04085
BRANCH OF SERVICE: Army 	SEPARATION DATE:  20080127

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 Posttraumatic Stress Disorder (PTSD), with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20071204	VARD - 20080509	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	50%	20080219	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

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 November 2005-December 2006.  He reported he sought counseling from a chaplain both while deployed and when he redeployed.  The psychiatric addendum, dated 13 November 2007, noted there were three specific incidents that continued to affect him.  After he returned he felt anxious and under threat, and began to sleep with a gun.  He eventually secured his weapon with a friend.  He would awaken and spend hours cleaning his apartment.  He was restrained when he became enraged upon seeing men he thought were from the Middle East.  He had nightmares and intrusive thoughts about these events, irritability, withdrawal, anxiety, insomnia, anxiety and detachment.  He consumed large amounts of alcohol.  He visited the Soldier Readiness Center in April 2007 but declined referral to mental health (MH), fearing they would think he was crazy and make fun of him. He received a Combat Infantry Badge.  He was scheduled to redeploy but visited MH and was treated with individual psychotherapy with psychotropic medication.  Mental status examination (MSE) was unremarkable.  The MEB forwarded PTSD for PEB adjudication.  

The MEB NARSUM examination on 13 November 2007, 3 months prior to separation, noted complaints of difficulty with concentration, feeling lost and confused, and flashbacks from his combat experiences.  He felt he could not return to combat.  Alcohol intake had significantly decreased in September 2007 and he reported he drank only on weekends and not to excess.  He had not worked in his primary MOS since July 2007.  Training for the Army Physical Fitness Test (APFT) was not significantly affected by his psychiatric condition.   The commander noted his mental state would interfere with critical decision making during training and combat.  He was taking a sleep aid, a medication to treat nightmares, as needed, and fish oil, an over the counter agent commonly used to treat depression.  The NARSUM examination referenced the findings of the psychiatric addendum, which noted an Axis I diagnosis of PTSD with a Global Assessment of Functioning (GAF) score of 60 (moderate bordering on mild symptoms, impairment.)  Impairment for social and occupational function was definite.  

At the 19 February 2008 VA Compensation and Pension (C&P) evaluation, performed 1 month after separation, the CI reported sleep disturbance with nightmares and bad dreams with intrusive thoughts, hypervigilance, nightmares, anxiety and easy startle.  He denied panic attacks.  He was not seeing a psychiatrist and was not taking medication.  He had not worked since separation but enjoyed working on cars.  He lived with his girlfriend, performed household chores and did not have friends locally.  MSE was unremarkable.  A diagnosis of PTSD was rendered with a GAF score of 57 (moderate symptoms, impairment.)  

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 symptoms controlled by continuous medication.  The VA rated the PTSD condition 50% coded 9411, based on the VA C&P examination 1 month after separation, citing reduced reliability and productivity.  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 examination a month after separation.  The Board then considered if there was evidence for a §4.130 rating higher than the 10% assigned by the PEB.  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.”  The CI reported continuing symptoms of nightmares, sleep disturbance and anxiety.  He was not taking any medication and was not seeing a psychiatrist.  MSE was normal and GAF score was in the moderate classification.  He was able to enjoy leisure pursuits and had a girlfriend with whom he was living.  There were no hospitalizations or emergency room visits for psychiatric problems and there were no legal issues.  Board members therefore concluded the 10% 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 TDRL placement rating of 50% and permanent disability rating after removal from TDRL of 10% for the PTSD condition.  

BOARD FINDINGS:  In the matter of the PTSD disorder, the Board recommends an initial TDRL rating of 50% in compliance with VASRD §4.129, as DOD directed, and §4.130; and a 10% permanent rating at 6 months 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 his 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 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, AR20160018231 (PD-2014-04085)

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 no recharacterization of the individual’s separation or modification of the permanent 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:

Enclosures

CF: 
(  ) DoD PDBR
(  ) DVA