RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00891
BRANCH OF SERVICE:  army	SEPARATION DATE:  20070104

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, M1 Armor Crewman, medically separated for “posttraumatic stress disorder,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends he was discharged for PTSD, migraines, and a shoulder injury and that the disability rating was too low.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20061205	VARD - 20070625	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD w/ MDD…	9411	70%	20070214	
Left Shoulder Pain	Not Unfitting 	Left Shoulder Strain…	5201	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Posttraumatic Stress Disorder (PTSD).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s PTSD condition began while deployed to Iraq (February 2004 to March 2005), and Mental Health confirmed a diagnosis of PTSD.   

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 11 September 2006, 4 months prior to separation, the CI reported fainting spells and anxiety attacks, and minor depression from PTSD.  A diagnosis of PTSD with somatization/anxiety and alterations in consciousness and some depression was rendered.  
The MEB NARSUM examination on 18 October 2006, 3 months prior to separation, noted complaints of nightmares and flashbacks related to things that happened in Iraq that were “worse.” He was sleeping an average of 2 to 3 hours per night and still could not be around crowds.   Current duties consisted of minor duties in the rear detachment.  The CI denied suicidal or homicidal ideation or plans.  He required no hospitalizations for psychiatric problems.  Current medications were an anti-depression medication and a sleep aid.  Medications to stop his alcohol craving were stopped since he reported he had not been consuming alcohol since mid-June.  Diagnoses of PTSD and alcohol abuse in early remission were diagnosed.   

On 14 February 2007 (1 month after separation) the CI underwent two VA Compensation and Pension (C&P) evaluations; one for General Medical complaints, the second for an initial PTSD evaluation.  The C&P General Medical exam noted the CI worked as a mover 2-3 days per week part time.  At the PTSD examination later that day, he complained of symptoms of PTSD and depression, denied hobbies or social contacts, and reported he had run out of medicine and was no longer taking it.  Medications included an anti-depression medication and two anxiolytic (anxiety reducing) medications.  He was not currently in psychiatric treatment but reported dissociative flashbacks, a high level of anxiety that led to verbal abuse, panic attacks three times per week, and recent visual hallucinations.   The CI was separated from his wife recently and lived alone with divorce pending.   He often saw his children and planned to return to his home state.  He had a couple of alcohol binges per week.  He indicated at this examination that he worked 7 days per week as a mover for the previous 3 weeks and watched television for relaxation.   The examiner indicated the CI was not employable from a psychiatric view.  Diagnoses of PTSD, depressive disorder due to PTSD and alcohol abuse due to PTSD were rendered with a Global Assessment of Functioning (GAF) score of 49 (severe symptoms, impairment.)

At the 12 January 2008 VA Compensation and Pension (C&P) evaluation, performed 12 months after separation, the CI reported he had attempted suicide by overdosing in May or June of 2007 prior to his relocation to his home on the east coast.  He had insomnia and slept 4-5 hours per nights and also reported dissociation, nightmares and flashbacks several times per day.  There was nothing he enjoyed.  He worked the nightshift driving a forklift and stocking shelves for the previous 5 months and slept during the day.  His wife was very supportive and they had remarried a few days prior to this examination.  The CI reported that he was easily frustrated and could not be around many people.  He was seeing a psychiatrist and taking an anti-depression medication.  Sometimes the CI forgot to take medications due to memory issues.  No medication helped with sleep.  He denied issues with alcohol, and felt he could not stay on his job long-term due to dissociative episodes, distraction, problems with startle response and memory, and reported that he worked better alone.  The CI and his wife planned to start a moving company so he could work with one just other person.  MSE showed some psychomotor retardation, an anxious appearance, and sad and tearful mood.  He reported flashbacks of combat.  He denied suicidal ideation.  A diagnosis of PTSD, chronic, severe was rendered with a GAF score of 42 (serious symptoms, impairment.)  The examiner noted the CI had significant problems with memory, had social adaptability that was severely impaired and had difficulty in an industrial environment.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD condition 10%, coded 9411, citing combat experiences in Iraq, with mild social and industrial impairment with ongoing medication and psychotherapy.  The VA rated the PTSD with major depressive disorder (MDD) condition 70% coded 9411, based on the VA C&P examination 1 month after separation.  
  
The panel first considered whether application of VASRD §4.129 with a 6 month (50% minimum) period on the TDRL was indicated in this case (per panel directive from DOD).  Panel members agreed that the provisions of VASRD §4.129 were applicable in this case due to the traumatic combat experiences and PEB disability acknowledgment of PTSD.  The panel next considered if there was evidence for a §4.130 rating higher than the §4.129 minimum mandated 50% at time of placement on the TDRL.  Criteria for a 70% disability rating requires occupational and social impairment with deficiencies in most areas.  The panel 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 is the January 2008 C&P examination.  The §4.130 criteria for a 10% rating include “symptoms controlled by continuous medication,” while those for a 30% rating include “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” and criteria for a 50% include “occupational and social impairment with reduced reliability and productivity.” The CI reported a suicide attempt which occurred 4 or 5 months after separation, and he was seeing a psychiatrist and taking psychotropic medication.  He reported sleep, dissociative and memory problems as well as other symptoms of PTSD.  MSE showed him to have a sad and tearful mood, psychomotor retardation and anxiety.  However, he was working and planning on opening a moving business with his wife.  A majority of panel members agreed the CI most appropriately met criteria for 30% disability at the time of removal from the TDRL.    

Contended PEB Condition:  Left Shoulder Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not specifically mentioned, but was indirectly implicated in the commander’s statement (25 October 2006), which referenced an inability to lift heavy objects, run for great distances, and conduct physical fitness tests.  Radiographic studies showed no significant abnormalities.  There were no treatment records in evidence.  The C&P examination noted the CI had pain in the shoulder after lifting for about an hour.  Standing for more than an hour made the left shoulder painful, and the CI could run about half a mile before experiencing shoulder pain, and lifting more than 25 pounds brought on shoulder pain.  Dressing, eating, writing and driving were not impaired.  The CI took over the counter medication as needed and would feel better with rest.   Examination of the shoulder showed no atrophy and no tenderness with normal strength.  The contended condition was not profiled and was judged by the MEB to not fail retention standards.  There was inadequate performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation; therefore, after due deliberation, the panel unanimously concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the PTSD condition, the panel recommends a disability rating of 50%, coded 9411 IAW VASRD §4.129 for 6 months from the time of discharge consistent with a constructive period of TDRL and then a permanent separation rating of 30% IAW VASRD §4.130.  In the matter of the contended left shoulder condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  

The panel 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	
PTSD	9411	50%	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150606, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170007149, XXXXXXXXXXXXXXXXXX.

Dear XXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to constructively place you on the Temporary Disability Retired List (TDRL) at 50% disability for six months effective the date of your original medical separation for disability with severance pay and then following this six month period recharacterize your separation as a disability retirement with the combined disability rating of 30%.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The constructive TDRL period and the recharacterization of your separation as a disability retirement will result in an adjustment to your pay providing you 50% retired pay for six months from the date of your original medical separation and then 30% disability retired pay effective the date following the constructive six month TDRL period, minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,