RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04162
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070725

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Avenger Crewmember, medically separated for “Posttraumatic Stress Disorder (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 - 20070726	VARD - 20071031	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	50%	20070914	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

PTSD.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was deployed to Iraq from July 2004-March 2005 as part of a unit providing convoy security.  He was exposed to several traumatic events, and in November 2004, began having panic attacks with hyperventilation, sweating, palpitations, a sense of foreboding and dread lasting 5-15 minutes.  The attacks happened 1-2 times per month, but upon redeployment, occurred daily.    The CI made recurring visits to the emergency department and was prescribed an anti-anxiety medication which proved effective.  In early 2006, he arose from a nightmare and was “choking his wife.”  He self-referred to psychiatry and was prescribed an anti-depressant and different anti-anxiety medications.  He developed symptoms of hypervigilance, persistent nightmares resulting in poor sleep, episodes of awakening while choking his wife, sleep walking to “clear the house” and social isolation.  He had no history of psychiatric symptoms and one non-judicial punishment due to underage drinking while in Korea.  

At the time of the MEB NARSUM examination, date 14 May 2007 (2 months before separation), the CI continued to have episodic panic attacks and mild to moderate PTSD symptoms.  He was taking a medication to treat anxiety and depression.  Mental status examination (MSE) showed an irritable mood and effect.  He denied suicidal ideation.  A diagnosis of PTSD was rendered with a Global Assessment of Functioning (GAF) score of 55 (moderate symptoms, impairment).  Impairment for social and occupational functioning was marked and he was followed by outpatient mental health.  

The 14 September 2007 VA Compensation and Pension (C&P) PTSD examination (2 months after separation) noted that the CI had no previous psychiatric hospitalizations.  He reported nightmares and intrusive thoughts from combat as well as panic attacks and symptoms of PTSD.  He had difficulty concentrating, a quick temper, and trouble not reacting to customers with anger and irritability.   He was recently employed as a financial consultant and the previous day had a panic attack in the middle of a meeting with the company CEO.  The CI had started school to get a marketing degree and reported a strong and supportive relationship with his wife while maintaining some social and family relationships.  He denied alcohol use although he drank heavily after his return from Iraq.  He had trouble with frequent verbal confrontations and had kicked doors down at his house.  He was able to work and meet responsibilities.  MSE showed dysphoric mood and sweating.  The examiner observed the beginning of a panic attack but the CI calmed himself, admitting he had recently run out of medication.  He reported difficulty with memory and concentration and endorsed compulsive checking of doors and windows at night.  He reported sleep impairment and an anxious and depressed mood.  A diagnosis of PTSD was rendered with a GAF score of 52 (moderate symptoms, impairment).

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating, coded 9411 (PTSD) based on mild industrial impairment.  The VA assigned a 50% rating, using the same coding, based on the VA C&P examination 2 months after separation, citing occupational and social impairment with reduced reliability and productivity.  The Board, IAW DoDI 6040.44 and DoD guidance (which applies current VASRD 4.129 to all cases as appropriate), agreed that the stipulations of §4.129 were met in this case and thus recommended a minimum 50% rating for a retroactive 6-month period on the Temporary Disability Retired List (TDRL).  The Board next considered if a rating higher than 50% was warranted at the time of entry on the constructive TDRL period.  The next higher 70% rating requires “occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.”  Board members agreed, however, that these criteria were not approached, and therefore a rating higher than 50% was not supported.  

The Board then determined the most appropriate fit with VASRD 4.130 criteria at 6 months for its permanent rating recommendation.  Members agreed that the most proximate source of comprehensive evidence for rating was the VA C&P examination performed 2 months after separation.  There were no other relevant VA outpatient or civilian provider treatment records providing psychiatric details during the 6-month interval.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” and for a 30% rating, “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  The CI endorsed continuing symptoms of PTSD and during MSE began to show early signs of a panic attack.  He continued to have symptoms of anxiety, depression, sleep and panic attacks.  Both the NARSUM and VA examiners noted a functional score in the moderate range of impairment.  The Board agreed that the CI met criteria threshold for a 30% rating.  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.

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 a permanent separation rating of 30% 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

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

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

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 AR20160011855 (PD201404162)

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 date 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.

BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA