RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX.	CASE:  PD-2015-00452
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030317
DATE PLACED ON TDRL:  19980901	
DATE REMOVED FROM TDRL:  20030317

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, medically separated from the Temporary Disability Retired List (TDRL) for “post-traumatic stress disorder (PTSD)” with a disability rating of 0%.  

CI CONTENTION:  “Review 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 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 – 19980711/20030317	No VA Rating Decisions 	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
PTSD	9411	30%	0%	No VA Examination in Evidence	
COMBINED RATING: 30% → 0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Posttraumatic Stress Disorder (PTSD).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) mental health (MH) narrative summary (NARSUM), the CI’s PTSD condition began in October 1997 after experiencing a flashback during a night time live fire exercise, while deployed to Somalia in 1992-1993.  His flashbacks persisted and he developed other symptoms suggestive of PTSD.  The MEB forwarded PTSD for PEB adjudication.  
At the NARSUM, the CI reported he had difficulty with crowds; however, was able to enter crowded places but tended to avoid them.  He had problems with maintaining sleep due to nightmares; however, he was able to sleep for about 6 hours and felt rested afterwards.  He had normal energy and appetite, but had issues with concentration and irritability.  He was having marital problems secondary to his temperament.  The examiner noted that the CI was prescribed an antidepressant medication to address sleep and irritability which improved his symptoms to an extent.  The CI reportedly took medication for his symptoms.  He was involved in psychotherapy twice a month, and reported he had continued to have a quick temper and nightmares.  He continued to avoid public places, and he felt bad about not being able to lead his soldiers and do the job that he was trained to do.  He noted he was afraid to go to the range due to his experiences in Somalia.  

The mental status examination (MSE) was unremarkable with the exception of a “worried” mood and affect.  The examiner noted that the CI denied recollection of the content of his nightmares but reported sleep disruption secondary to them.  His judgment was noted as good and his memory was intact.  The examiner indicated that the diagnostic criteria for PTSD had been established and that continued treatment was necessary.  On 28 July 1998, the CI was granted a vocational rehab rating from the VA.  The VARD noted that the CI was entitled to an evaluation “because a 20% rating has been assigned for the following: PTSD.”  The VARD also cited 38 CFR 4.129; however, it was not clear if this was applied.  In September 1998, the CI was placed on the TDRL.  

At the VA Compensation and Pension (C&P) mental examination in February 2000, 19 months after TDRL placement, the CI reported he had not had any form of MH treatment since he was placed on the TDRL.  He noted that he was unable to shop except for during “off hours,” and he was unable to go to movies, restaurants, or other outings because of crowds.  He reported problems with irritability and concentration, and noted he had marital problems as well.  The CI was working full-time for an insurance company and noted that he had no problems at work, and was able to concentrate on his work.  At the time of the examination, the CI was not taking psychotropic medications and had not taken any since placement on TDRL.  MSE was unremarkable with the exception of “a blank stare at times”, “edgy” mood and restricted affect.  A Global Assessment of Functioning (GAF) score of 60 (mild to moderate impairment) was recorded.  

On 18 July 2001, the CI participated in a second C&P mental examination as a follow up to the initial examination conducted by the same psychiatrist in February 2000.  The examiner noted that since the previous examination, the CI continued to report symptoms of PTSD, including insomnia, nightmares, irritability, alienation, and difficulty being in crowds.  It was also noted that he has continued to be fully employed as an auditor at a community bank, and apparently has performed well.  The examiner stated, “He misses little work” because of his symptoms.  The CI had marital problems which had resolved with therapy, and he was not taking any psychotropic medication.  The examiner recorded that the CI had not taken any medications over the 18 months (which is now more than 3 years), and noted that his PTSD symptoms remained static. However, the CI reported depressive symptoms.  The psychiatrist recommended medication and therapy as treatment for his new onset depression.  A GAF of 58 (moderate) was recorded with the diagnoses of PTSD, delayed onset and depressive disorder NOS.  

In November 2001, the CI underwent a mental status evaluation at the request of his VA case manager.  The stated purpose of the evaluation was to determine the status of his PTSD diagnosis.  The CI had expressed his desire to return to active duty.  The examiner noted that the CI participated in outpatient treatment for his PTSD, was happily married, and had a good job in a bank that paid well and his social skills were excellent.  His MSE was normal.  The examiner concluded that the CI had experienced significant reduction of his symptoms and that some of his symptoms persisted but his symptoms did not interfere in his occupational or social functioning.  There was no indication that the CI was taking psychotropic medications.  

At the TDRL removal examinations in January 2003 and February 2004, more than 4 years after TDRL placement and 2 months before separation, the CI reported social anxiety which had interfered with work, guilt feelings, and problems with sleep.  He had left his banker job and was currently working a sales job.  He noted he has worked for 2 weeks on his new job, and there was no indication of any work issues at the time.  His MSE was normal and a GAF score of 60 (mild to moderate) was recorded.  The CI noted he was not taking psychotropic medications, and there was no indication from the record that he took any medications since being placed on the TDRL. 

The Board directed its attention to its rating recommendation, based on the evidence just described.  The PEB assigned a 30% rating at TDRL placement.  In March 2003, the PEB rated the PTSD condition 0%, citing the CI was working full time and not receiving any psychiatric care nor medications.  There were no VA Rating Decisions available for review.  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, must apply §4.129 for any PTSD condition resulting in medical separation and recommend a minimum 50% rating for a retroactive period on the Temporary Disability Retired List (TDRL).  The Board must then determine the most appropriate fit with VASRD 4.130 criteria for its permanent rating recommendation, based on the facts in evidence which are most probative for that interval.  The CI reported his symptoms developed after his deployment to Somalia, and the MEB recorded his PTSD was the result of exposure to trauma while in Somalia.  The Board next considered the evidence for the higher rating of 70% at TDRL placement.  Board members agreed at the time of TDRL placement, there was insufficient evidence to support the 70% disability level.  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 the PTSD condition at TDRL placement.  

The Board next considered whether the evidence at the time of removal from TDRL and permanent disability disposition supported a rating higher than the 0% rating adjudicated by the PEB.  The Board considered the February 2000, July 2001, November 2001 mental status evaluation, and the VA general 2003 examinations, as well as the TDRL removal exam.  All five examinations noted the CI was not taking psychotropic medications and none recorded any form of MH treatment for PTSD.  All MSEs were essentially normal.  The February 2000 TDRL VA examination noted his PTSD symptoms continued, and he was working full-time.  The same examiner recorded in July 2001 that he continued to work full-time and his symptoms were static.  He had no problems at work and his marital problems had resolved with marital therapy.  Medication was not indicated for treatment of PTSD, but could be helpful for treating his depressive symptoms.  

At the November 2001 mental status evaluation, the CI requested to return to active duty and he reported very few symptoms.  He stated he was happily married, and the examiner stated he had “excellent” social skills.  The TDRL examiner opined that his condition of social phobia had led to job loss without elaboration.  At the General C&P exam, 4 days before the TDRL MH examination, the CI indicated he had started a sales job a month ago and was able to work from home, and he worked over 40 hours a week.  He noted that the sales job was less stressful than his banking job which he stated was very high stress, and stated “the anxiety was burning up half his day.”  

Board members considered the following: absence of treatment in the TDRL period; absence of psychiatric hospitalizations, no visits to ER; absence of legal or substance history; the ability to sustain a marriage for more than 8 years; maintaining full-time employment in highly stressful jobs, and absence of evidence of clinically significant impact on occupational or social functioning.  All Board members agreed that his condition, at the time of permanent separation, was best reflected at the 0% level of disability for “symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends no change in the PEB adjudication for the PTSD condition at permanent separation.  

BOARD FINDINGS:  In the matter of the post- traumatic stress disorder condition, the Board unanimously recommends an initial TDRL rating of 50% in retroactive compliance with VASRD §4.129 as DOD directed; and a 0% 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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
PTSD	9411	50%	0%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150601, 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 
XXXXXXXXXXXXXXXXXX, AR20170001035 (PD201500452)

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 rather than 30% for the period September 1, 1998 to October 1, 2003 and then following this period no recharacterization of the individual’s separation or modification of the permanent disability rating of 0%.

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 0% effective the day following the 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 temporary disability retired period effective the date of the individual’s original medical separation and adjusting severance pay as necessary.

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