RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04361
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantry, medically separated for “post-traumatic stress disorder (PTSD),” with a disability rating of 10%.

CI CONTENTION:  The CI makes no contentions.  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 - 20061221	VARD - 20070913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	50%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Posttraumatic Stress Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) psychiatric narrative summary (NARSUM), the CI completed three combat tours.  He was returned early from his second deployment in March 2005.  The CI was declared deployable without limitation and deployed again in October2006 for his third tour and experienced worsening of his PTSD symptoms.  He was evacuated from theater due to mental health complications.  He was treated with psychotropic medications, counseling and hospitalization but his condition could not be rehabilitated to meet the requirements of his Military Occupational Specialty (MOS).  He received a permanent S3 profile and was referred to the Medical Evaluation Board (MEB).  The MEB forwarded “chronic post-traumatic stress disorder” for PEB adjudication.    

At the MEB NARSUM dated 1 December 2006, 2 months prior to separation, the CI reported that after he returned in March 2005 he started experiencing symptoms suggestive of PTSD.  The CI noted that he had witnessed several deaths and was involved in several IED explosions which resulted in an injury (lip laceration requiring stitches and pain medication).  He felt hopeless so he attempted suicide by hanging in July 2006.  He was hospitalized and started on medication.  

The CI reported that he continued to have nightmares, irritability, avoidance and hyper-startled responses.  The mental status examination (MSE) documented he was at times tearful, but his mood and affect was normal.  There was no evidence of a thought or psychotic disorder.  He denied suicidal or homicidal ideation.  The diagnosis of chronic PTSD was recorded and the psychiatrist noted that the CI had trouble with social relationships, and that his symptoms affected his ability to function in the military setting.  A Global Assessment of Functioning (GAF) score of 50 for serious symptoms and or impairment was recorded.

The VA Compensation and Pension (C&P) mental examination was accomplished 12 months after separation in January 2008.  During the examination, the CI reported he took antidepressant medication that was ineffective.  There had been no hospitalizations since separation.  He continued to have problems with sleep and had gained 50 pounds since separation.  He lived a mostly isolated life, had a few friends he saw every 3-4 months and had no recreational activities.  He reported that prior to Iraq, he had once been an outgoing person with many friends.  His isolation was due to being uncomfortable around people, “don’t have to worry about nothing when I am alone.”  The CI was not working.  He reported he had tried to sell cars but found it too difficult talking to people.  He noted that he had been employed for less than a year.  MSE noted psychomotor slowing, flat affect, and that he was guarded and suspicious.  Judgment was intact, and immediate memory was moderately impaired.  The diagnosis of PTSD was recorded with a GAF score of 50.  The examiner stated that the CI found it difficult to work because of social discomfort which led to family conflict due to lack of money.  It was stated that his career opportunities may be limited to jobs where he can work in isolation.  It was also noted that the CI was unwilling to seek treatment because of the discomfort he experiences when he thinks about his experiences in Iraq.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD condition 10%, coded 9411 (PTSD), citing mild social/industrial impairment IAW AR 635-40 appendix B-17.  The VA rated the PTSD condition 50%, coded 9411, based on STR and noted the CI would be scheduled for a VA C&P examination.  The Board considered whether the provisions of VASRD §4.129 (mental disorders due to traumatic stress) was applicable.  The PEB acknowledged that his conditions was the direct result of armed conflict, therefore, Board members agreed the provisions of §4.129 were applicable in this case.  In accordance with VASRD §4.129, when a mental disorder that develops in service as a result of a highly stressful event is severe enough to bring about the CI’s release from active military service, the rating agency should assign an evaluation of not less than 50% and schedule an examination within the 6-month period following the veteran’s discharge to determine whether a change in evaluation is warranted.  The Board is therefore obligated to recommend a minimum 50% rating for a retroactive 6-month period on the Temporary Disability Retired List (TDRL).  The Board next considered if a higher rating was warranted IAW §4.130, but determined there was no evidence supporting a higher than 50% rating for TDRL placement.   

The Board next determined the most appropriate rating with VASRD §4.130 criteria at the end of TDRL period for its permanent rating recommendation.  The 14 August 2007 VA psychosocial assessment, 7 months after TDRL placement, noted the CI was employed selling cars, but reportedly disliked his job.  The CI was living with his wife and step son.  Evidence covering the next 2-6 months demonstrated very little improvement in the CI’s condition.  The CI worked less than a year in the 1 year after the separation date.  He quit several jobs due to inadequate social skills.  The CI was required to complete a work release program 1 day a week as the result of a domestic violence case in 2006.  He was having problems with his marriage of less than a year, was socially isolated, and was not accepting MH treatment due to his avoidance of talking about his Iraq experiences.  There were three recorded MSEs in the STR, including the C&P examination in January 2008, and all noted flat affect, motor slowing, and tearfulness.  His GAF scores remained consistently in the serious range.  The C&P examination recorded symptoms of irritability, distrust, hypervigilance, poor sleep, panic attacks, intrusive thoughts, nightmares, and difficulty concentrating.  The C&P examiner noted that his career opportunities may be limited to jobs where he can work in isolation.  The CI was prescribed an antidepressant medication which he did not take consistently, and he had not been hospitalized or seen in the emergency room for MH issues.

The Board deliberated between 10% and the 30% level of disability, and all Board members agreed, the CI’s condition was not mild or transient, and was not demonstrated to be controlled with continuous use of medication.  However, all Board members agreed the constellation of symptoms was best reflected in the 30% disability 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% at TDRL placement and a 30% permanent rating, coded 9411.  

BOARD FINDINGS:  In the matter of the PTSD condition, the Board unanimously recommends a TDRL entrance rating of 50% and a permanent rating of 30%, coded 9411 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%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141217, 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 AR20160018430 (PD201404361)

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 recharacterize 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 day 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:	      
						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA