RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00053
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050413

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6, Bradley Linebacker Crew Member, medically separated for a posttraumatic stress disorder (PTSD) condition rated at 10%. 

CI CONTENTION:  “The applicant makes no specific contention in his application.  His complete submission is at Exhibit A.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the 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/Naval 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 confined to 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:  

IPEB - Dated 2005-413	VA* - (~3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	10%**	20050714	
Other Conditions x 0 (Not In Scope)	Other x 1 	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20050504 (most proximate to date of separation (DOS)).  **VARD 20050504 warded 30% rating after date after separation and then VARD 20060123 awarded 50% effective date after separation.

ANALYSIS SUMMARY:  

Posttraumatic Stress Disorder Condition.  The narrative summary (NARSUM) documented the CI was sent back from Iraq on 12 September 2004 after sustaining a gunshot wound to his chest in a fire-fight.  He was shot in the chest by a sniper who was aiming at his head and missed because the CI stood up from a crouched position just as the bullet reached him.  His nightmares of the event started on that same night of the incident.  The CI attempted to deal with his symptoms on his own; however, he later sought help from his case manager who documented his symptoms of rage, anxiety, depression, flashbacks, nightmares, insomnia, and decreased appetite.  His initial psychiatric evaluation was accomplished in October 2004.  At the time the CI noted he felt guilty about having to leave his troops in Iraq and his plan was to return to Iraq. His doctors in Iraq were concerned about the potential for wound infection and it was recommended the CI be returned to the States where he could be appropriately treated. 

The NARSUM recorded the CI completed four sessions of therapy specific for reducing PTSD symptoms, and had several psychotropic medication trials opined to be of little benefit.  At the NARSUM dated 24 January 2005, the CI reported he was very anxious and just wearing his uniform caused him to be anxious.  He was very anxious about going to sleep because of nightmares.  He has difficulty driving and being in crowds.  He sometimes has flashbacks of being in Iraq, and continued to have feelings of extreme anger which caused some marital difficulties.  He took Ambien which allowed him to sleep for a few hours.  Mental status examination (MSE) noted his mood was angry and depressed with an anxious and angry affect.  The examiner also indicated the CI was hypervigilant and had issues with trust.  There was no evidence of psychosis and he denied suicidal or homicidal thoughts.  The diagnosis of PTSD was assessed and a Global Assessment of Functioning (GAF) score of 55 (moderate symptoms or moderate impairment) was recorded.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition of PTSD at 10%, coded 9411 and assigned a 10% disability rating, noting that his condition required psychotropic medication and outpatient treatment.  The VA used the service treatment records to assign a 10% rating.  The PEB rating, as described above, was derived from DoDI 1332.39 and preceded the promulgation of the National Defense Authorization Act (NDAA) 2008 mandate for DoD adherence to Veterans’ Administration Schedule for Rating Disabilities (VASRD) §4.129. The Board, IAW DoDI 6040.44 and DoD guidance (which applies current VASRD §4.129 to all Board cases as appropriate), must recommend a minimum 50% rating for a retroactive 6-month period on the Temporary Disability Retired List (TDRL).  The Board must then determine the most appropriate fit with VASRD 4.130 criteria at 6 months for its permanent rating recommendation, based on the facts in evidence which were most probative for that interval.  The higher 70% rating criteria requires evidence of “Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.”  Available treatment records prior to constructive TDRL period demonstrates some impairment in occupational and social functioning; however, no documented evidence to support impairment in judgment or thinking.    The Board concluded there was insufficient reasonable doubt (IAW VASRD §4.3) for recommending a 70% TDRL placement rating.  The Board next determined the most appropriate fit with VASRD §4.130 criteria at the end of TDRL for its permanent rating recommendation.  The Board deliberated the evidence for the 50%, 30% and 10% disability rating.  The 50% disability rating requires evidence of “Occupational and social impairment with reduced reliability and productivity due to symptoms such as: flat affect, panic attacks more than once a week, difficulty in understanding complex commands, impaired short and long-term memory and impairment in judgment and thinking…”  The Board found one single psychiatric evaluation for review during the TDRL removal period.  That document represented an initial psychiatric evaluation dated 22 October 2005, 5 months after separation.  At the time of this examination, the CI reported he was taking Prozac daily, which was not working as well as it had in the past, and he took Trazadone for sleep, but the medicine makes him sleep 10-12 hours so he only takes it when he does not have to go to work the next morning.  The CI reported in addition to his issues with sleep, he had anger problems that caused him to lose his last job on the first day on the job, after he “knocked his boss out.”  He worked with a cable satellite company.  He was still married and living with his wife and two children.  He had no specific hobby; he played with his children, read and watched television.  MSE documented that he was pleasant but anxious, and talked freely and spontaneously.  His mood and affect was flat and depressed, cognition was intact and he was preoccupied with obtaining a steady job.  There was no evidence of psychosis and he denied suicidal or homicidal ideation. The examiner opined that his symptoms are responding partially to treatment.  A GAF of 55 was recorded.  The August 2005 VARD documented findings from “a recent VA exam” that occurred either in July or August 2005, which recorded symptoms opined to be consistent with the 30% disability criteria.  Board members considered the absence of recorded impairment in thinking or judgment, no impairment in cognition, no history of suicidal thinking, panic attacks or visits to the ER.  Although he reported violence in the workplace, a documented legal history was not recorded; the Board concluded the 50% disability level was not supported by the evidence.  All Board members agreed the 10% descriptor of “mild or transient symptoms…or symptoms controlled by continuous medication” did not sufficiently capture the extent of the CI’s functioning.  Although the CI was working, his condition remained unstable; therefore, the Board concluded the 30% disability criteria better reflected his condition at permanent separation.  After due deliberation, and in consideration of all the evidence and VASRD §4.3 (reasonable doubt), the Board recommends a 30% permanent disability rating for the condition of PTSD.

BOARD FINDINGS:  In the matter of the PTSD condition, the Board unanimously recommends an initial TDRL rating of 50% in retroactive compliance with VASRD §4.129 as DOD directed; and a 30% permanent rating 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 his prior medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Post-Traumatic Stress Disorder	9411	50%	30%	
RATING	50%	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150122, 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 XXXXXXXXXXXXXXXXXX, AR20160013335 (PD201500053)

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