RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00531
BRANCH OF SERVICE:  Air Force
DATE PLACED ON TDRL:  20000415
DATE REMOVED FROM TDRL:  20020324

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Aerospace Maintenance Craftsman, medically separated from the Temporary Disability Retired List (TDRL) for “post-traumatic stress disorder (PTSD), delayed onset, associated with major depression,” with a disability rating of 10%.

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 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 – 20000128/20020211	VARD - 20010108	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
PTSD, Delayed Onset, Associated with Major Depression	9411	50%	10%	PTSD	9411	NSC	NSC	
Alcohol Dependence	Cat III	No VA Placement	
COMBINED RATING:  50% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

PTSD, Delayed Onset, Associated with Major Depression.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) mental health (MH) narrative summary (NARSUM), the CI’s MH symptoms began in 1998 and were exacerbated by his visit to his hometown.  The CI described having a childhood history of neglect, abandonment, and witnessing the abuse of his mother at his father’s hand.  He described symptoms of anxiety and depression, and noted that his response to the witnessed abuse was one of significant fear and helplessness.  In 1998 returning from home after on temporary duty (TDY), he began to consistently re-experience the traumatic events and had intrusive and recurrent thoughts as well as dissociative flashbacks.  He initially presented to MH in February 1999 and on 7 November he was hospitalized secondary to suicide attempt via alcohol ingestion.  The CI was able to present to the emergency room (ER) and consent to a voluntary admission.  There had been several stressors prior to the attempt that led to his being distraught and his desire to “escape.”  The CI’s condition was treated with medication and psychotherapy with good benefit; however, stability was difficult to achieve.

The MEB forwarded the conditions of “post-traumatic stress disorder, with delayed onset and chronic in nature, and major depressive episode, severe intensity without psychotic features, and melancholic in nature” for PEB adjudication.  

At the MEB NARSUM on 15 December 1999, 5 weeks before TDRL placement, the CI reported intrusive and recurrent thoughts, dissociative flashbacks, and nightmares, as well as other symptoms consistent with PTSD.  It was noted that he had spent 16 days on the inpatient unit, was prescribed medications and participated in therapy sessions.  The CI had reported a prior history of suicidal thoughts in 1989 and was diagnosed with alcohol abuse.  Although the NARSUM was dated 15 December, the psychiatrist presented a clinical resume of events up until hospital discharge (23 November, 1999).

Prior to hospitalization, the CI participated in therapy and was taking medication with reported benefit.  He began to report improvement and indicated his medication had provided good symptom relief in the 6 months before hospitalization.  A series of stressful events and reminders of childhood abuse culminated in the CI’s expression of suicidal ideation (SI) which eventually led to his hospitalization. 

Service treatment records indicated the CI’s condition stabilized after hospitalization and remained stable for approximately 2 months.  In January 2000, he was hospitalized for 2 days after reporting feelings of lack of control.  He was not suicidal at the time of admission.  The last treatment entry of record dated 1 February 2000, noted the CI was feeling better.  In April 2000, the CI was placed on the TDRL.

The Board directed its attention to its rating recommendation, based on the evidence just described.  The PEB assigned a 50% rating at TDRL placement.  The VA did not service connect the PTSD, there was no VA Compensation and Pension mental examination in evidence, the CI failed to report for an examination on 18 October 2000.

The Board next considered the evidence for the higher rating of 70% at TDRL placement.  The STR noted absence of clinical evidence suggestive of impairment in judgment or thinking, and SI was not present beyond the initial hospitalization.  There was no evidence of psychosis and panic attacks requiring ER intervention, none were recorded in the clinical documentation.  However, the Commander’s Statement noted he was unable to perform his duties due to safety issues working around aircraft and due to possibility of blacking out or anxiety attacks.  The Board found no clinical evidence reporting blackouts or panic attacks.  Therefore, based on the evidence, 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 no change to the 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 10% rating adjudicated by the PEB.  The PEB noted the CI’s condition had improved and appeared to have stabilized since being placed on the TDRL.  There were no clinical records available to review at the time of TDRL removal.  However, the CI, in his contention, noted that he was working and that he attended counseling when his symptoms are “so bad he cannot deal with them.”  He did not report current medication use.  The CI also indicated that he was working at the time of TDRL removal.  There was no indication of any hospitalizations during the TDRL period or MH symptoms interfering with job performance.  All Board members agreed, based on the available evidence, there was insufficient evidence to recommend a higher rating at separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the PTSD condition at TDRL placement and removal.  

Contended PEB Condition:  Alcohol Dependence.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  Alcohol dependence is a condition not constituting a disability IAW DoDI 1332.38, Enclosure 5, and therefore, is not ratable or compensable.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the post-traumatic stress disorder and IAW VASRD §4.130 the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended alcohol dependence condition, the Board recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150601, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR

XXXXXXXXXXXXXXXXXXXXX
Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00531.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings