RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00552
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20060614

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

CI CONTENTION:  The CI made no specific contention.  The 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 - 20060407	VARD 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Traumatic Stress Disorder	9411	10%	No VA examination in evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  	

ANALYSIS SUMMARY:  

Post-Traumatic Stress Disorder (PTSD).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health condition began on 12 October 2000.  The CI was aboard the USS Cole when attacked.  In 2005 he was involved in a collision between the McFaul and the Churchill and his anxiety symptoms increased.  In September 2005, he presented to the emergency room with the complaint of feeling “stressed out” and was referred to mental health (MH).  The CI was diagnosed with PTSD and prescribed treatment.  Despite treatment with psychotherapy and psychotropic medication, his PTSD condition did not improve sufficiently to meet the requirements of the CI’s military specialty and he was referred for a MEB.  The MEB forwarded “prolonged post-traumatic stress disorder” for PEB adjudication.  

The CI’s first mental health evaluation occurred in September 2005.  At the evaluation, he reported nightmares, sleep disturbance, difficulty concentrating, hypervigilance and other symptoms consistent with PTSD.  He noted that he began having mild to moderate symptoms after the USS Cole incident; however, his symptoms intensified after the collision.  He had no prior history of mental health evaluation or treatment.  The CI reported he had recently ended a 7-year marriage and had two children by this marriage; however, he was in another relationship which he described as good.  His mental status examination (MSE) was unremarkable with the exception of anxious mood and flat affect.  He was noted to have good insight and judgment.  The diagnosis of PTSD “by history” was recorded and a Global Assessment of Functioning (GAF) score of 60 for mild-moderate impairment or symptoms, was assessed.  The CI was placed on 6 months limited duty.   Treatment records going forward demonstrated stable symptoms with good response to medication.  The CI had no history of hospitalization, had one initial visit to the emergency room (ER), and no evidence of urgent care treatment related to MH.  Mental Health clinic note on 2 December 2005, recorded a normal MSE, noted the CI reported marked improvement in sleep and decrease in PTSD symptoms.  His GAF score was 70 for very mild impairment and or symptoms.

The MEB NARSUM on 7 March 2006 was prepared by a non-MH provider.  It was noted that the CI was prescribed psychotropic medication in September 2005, and that his symptoms improved but never completely resolved.  It was also noted that he had no history of suicidal or homicidal ideation, or psychotic symptoms.  The NARSUM recorded the CI’s MSE that reflected the time of initiation of medical board.  At that time, his MSE revealed no abnormalities in speech, motor activity, thought process, content, orientation, cognition, or judgment.  It was noted that despite treatment, he continued to experience symptoms of PTSD “that make him unfit to return to full duty status.”  It was noted that continued treatment with medication was necessary to treat his condition.

Psychiatry entry on 7 March 2006 documented that the CI presented for medication refill after he ran out 3 weeks prior.  The psychiatrist noted that his symptoms had improved on medication.  MSE was unremarkable.

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 15 March 2006, 3 months before separation, the CI endorsed he has had trouble sleeping and depression or excessive worry. He indicated that he was taking an antidepressant medication.  The examiner listed PTSD as the diagnosis.  There was no VA Compensation and Pension examination in evidence proximate to separation.    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD condition 10%, coded 9411 (post-traumatic stress disorder).  The Board determined that the PTSD was due to a “highly stressful event” as used in the VASRD, and that application of §4.129 was appropriate in this case.  The Board turned to its rating recommendation at the time of placement on the TDRL.  The Board noted the CI was never hospitalized nor treated in the emergency room.  Suicidal ideation was not reported.  There was no evidence of a legal or substance abuse history, no domestic violence, and no impairment in judgment or thinking.  Board members agreed at the time of TDRL placement, there was insufficient evidence to support a rating higher than 50%.  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 10% rating adjudicated by the PEB.  

The Board considered the MH records in evidence with greater focus on the last 6 months of service since comprehensive examinations were not in evidence.  The Board noted a total of seven records in evidence, from October 2005 through March 2006.  Each visit recorded improved sleep with medication with only a few residual PTSD related symptoms which were noted significantly reduced in intensity and frequency.  Each entry recorded a GAF score in the mild to very mild range. The 4 November 2005 entry noted the CI had obtained a part time job.  All of the MSEs were essentially normal.  The last entry, 7 March 2007 noted that he had ran out of his medication, and his condition was stable.  However, the CI noted that since running out of medication he noticed an increase in irritability and anxiety.  A GAF score was not provided.

Board members considered the following: absence of documented treatment or evaluation in the TDRL period, absence of psychiatric hospitalizations, no visits to ER after the initiation of treatment, good response to treatment, absence of legal or substance, commander's statement noting minimal time away from work due to MH treatment, and no report of interpersonal difficulties.

All Board members agreed, that the CI’s condition at the time of permanent separation did not justify a rating higher than the 10% level of disability for “occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or: symptoms controlled by continuous medications.  After due deliberation, considering the totality of the evidence and mindful of VARSD § 4.3 (reasonable doubt), the Board recommends a retroactive 6-month period of TDRL with a rating of 50% (in accordance with §4.129), and a permanent rating of 10% for PTSD.

BOARD FINDINGS:  In the matter of the PTSD condition, the Board recommends an initial TDRL rating of 50% in retroactive compliance with VASRD §4.129 as DOD directed; and a 10% permanent rating at 6 months 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	
Post-Traumatic Stress Disorder	9411	50%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150603, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 25 Nov 16 ICO XXXXXXXXXXXXXXXXXX    
	(c) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 17 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 25 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 19 Nov 16 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 17 Nov 16 ICO XXXXXXXXXXXXXXXXXX

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

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:
     
     a. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, retroactive placement on the Temporary Disability Retired List with a 50 percent disability rating for six months, followed by a final disability rating of 10 percent. 

     b. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 20 percent) effective date of discharge.  

     c. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 60 percent disability rating (increased from 10 percent) effective date of discharge.  

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

     e. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, entitlement to disability severance pay with a 20 percent disability rating (increased from 10 percent).   

     f. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, entitlement to disability severance pay with a 20 percent disability rating (increased from 10 percent).  

     g. XXXXXXXXXXXXXXXXXX, former USN: Effective date of discharge, entitlement to disability severance pay with a 20 percent disability rating (increased from 0 percent).

     h. XXXXXXXXXXXXXXXXXX, former USN: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 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.