RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00203
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20080630

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Machine Gunner, medically separated for “chronic posttraumatic stress disorder (PTSD),” with a disability rating of 10%.

CI CONTENTION:  The CI contends he was given a higher rating by the VA.  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 - 20080501	VARD - 20080811	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Posttraumatic Stress Disorder	9411	10%	Posttraumatic Stress Disorder	9411	30%	20080605	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Posttraumatic Stress Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic PTSD condition began after a combat deployment to Iraq.  He denied a history of mental health (MH) treatment prior to deployment.  He was involved in frequent firefights and was exposed to various explosive attacks and believed his life was in danger several times.  He reported several combat stressors that led to anxiety, bad feelings, insomnia, and nightmares and flashbacks that were combat related.  He became emotionally detached, withdrawn and “numb.”  After his return home symptoms persisted and worsened and he developed suicidal ideation in late July 2007.  After a Post Deployment Heath Reassessment (PDHRA) in August 2007, during which he endorsed PTSD symptoms as well as depression and low interest in doing things, he was referred for MH treatment.  He had individual therapy and trials of psychotropic medication.  He was placed on limited duty from September 2007-March 2008.  He was eventually referred to the MEB.  The 

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 20 February 2008, 4 months prior to separation, the CI reported he was being treated for PTSD and major depression.  The MEB NARSUM examination on 21 February 2008, 4 months prior to separation, noted complaints of anxiety, irritability, hypervigilance and heightened startle response.  He found it difficult to be in social settings with large groups and shopped late at night.  He did have a girlfriend but symptoms stressed the relationship.  He attended PTSD group therapy in February and took anti-depression medication.  Mental status examination (MSE) showed a moderately anxious affect and a mood described as “tired of getting angry and upset.”  He denied suicidal or homicidal ideation.  A diagnosis of PTSD was rendered with a Global Assessment of Functioning (GAF) score or 45 (serious symptoms, impairment).

At the 5 June 2008 VA Compensation and Pension (C&P) evaluation for PTSD, performed 3 weeks before separation, the CI reported he slept 4-7 hours and that stress, anxiety and depression had taken a toll on his family, girlfriend and himself.  He was haunted by having to kill others in combat.  He was distant from friends and family, had decreased activity level and increased social withdrawal. MSE showed suspicion towards the examiner, constricted affect, and anxious, agitated mood.  A diagnosis of PTSD was rendered with a GAF score of 50 (serious bordering on moderate.)    

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the PTSD condition 10%, coded 9411 (Posttraumatic stress disorder), and cited that the disability was the direct result of a combat related injury.  The VA rated the PTSD condition 30% coded 9411, based on the VA C&P examination 3 weeks before separation, citing occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  

The provisions of VASRD §4.129 were applicable in this case due to the combat experiences and diagnosis.  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 was the June 2008 C&P examination, performed 1 day prior to 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 continued to report symptoms of anxiety, depression, and other PTSD symptoms.  He had decreased interests, had lost his girlfriend and was distant to family and friends.  MSE showed impairments of mood and affect.  Board members agreed that he met 30% disability criteria.  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 recommends a permanent 30% disability rating IAW VASRD §4.130 following the 6-month TDRL rating of 50% in retroactive compliance with VASRD §4.129.  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	
Chronic Post Traumatic Stress Disorder	9411	50%	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150310, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
	         DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX  
	(c) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 29 Jul 16 ICO XXXXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 12 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 28 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 12 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX
	(k) PDBR ltr dtd 12 Sep 16 ICO XXXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (k) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:
     
     a. XXXXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.  

     b. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.  

     c. XXXXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 50 percent disability rating (increased from 10 percent) effective date of discharge.  

     c. XXXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Temporary Disability Retired List for six months with a 50 percent disability rating effective date of discharge followed by transfer to the Permanent Disability Retired List with a final disability rating of 30 percent. 

     d. XXXXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge. 

     e. XXXXXXXXXXXXXXXXXXXX, former USMC: Placement on the Temporary Disability Retired List for six months with a 50 percent disability rating effective date of discharge followed by transfer to the Permanent Disability Retired List with a final disability rating of 30 percent.
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

     f. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.  

     g. XXXXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 50 percent disability rating (increased from 10 percent) effective date of discharge.

     h. XXXXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.

     i. XXXXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.  
 
3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

	XXXXXXXXXXXXXXXXXXXX
	Assistant General Counsel
	(Manpower & Reserve Affairs)