RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01187
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Military Police, medically separated from the Temporary Disability Retired List (TDRL) for “post-traumatic stress disorder (PTSD) attributed by psychiatrist to combat stressors experienced during Iraq deployment” rated 10%, with a disability rating of 10%.

CI CONTENTION:  CI contends that he was treated unfairly as his benefits were denied and his condition has shown no improvement.  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 –20070612/20090706	VARD - 20091222	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Post-Traumatic Stress Disorder (PTSD)	9411	30%	10%	PTSD	9411	-	Not Service Connected (NSC)	
				Conversion Disorder	9424	-	NSC	
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Conversion Disorder/PTSD.  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 January 2006 while in Kuwait returning home from his Iraq deployment.  The CI started having seizure-like episodes and was told that he would “curl up and shake” during the episodes.  His condition was treated with anti-epileptic medication with limited benefit.  He was referred for fitness for duty evaluation and was medically cleared.  The CI also underwent consultations with neurology and cardiology.  Cardiology and neurology work-ups were negative for organic etiology.  Due to the nature of his condition, the CI was referred to MEB.

At the NARSUM dated 3 May 2007, approximately 3 months prior to TDRL placement, the CI reported his symptoms started when he was in Kuwait.  He had been deployed to Iraq and had not experienced any symptoms.  His episodes consisted of curling up and shaking, lasting from 1-5 minutes.  He reported loss of consciousness during the episodes, and waking up feeling tired, sleepy, with occasional headaches.  The frequency of his episodes was not documented.

The CI noted while in Iraq, he was exposed to IED attacks, and other incidents that bothered him.  He specifically reported the loss of a Sergeant who was well liked by his unit and the death of 2 fellow Soldiers, 1 of whom he felt close to.  The CI indicated he had nightmares after returning home, but no longer had them.  He denied problems with depression, concentration, or other symptoms suggestive of PTSD or depression.  He noted that his wife stated he was a little more irritable.  At the time of the NARSUM, the CI had not been prescribed any psychotropic medications and had a history of two appointments with MH in response to consults placed by his primary care physician (PCP).  The mental status examination (MSE) was unremarkable.  The examiner opined that his symptoms were consistent with conversion disorder, and that it was likely that PTSD and depressive symptoms will manifest themselves going forward.  He was separated and placed on the TDRL.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 30% rating at TDRL placement, coded 9424 (conversion disorder).  The VA did not service-connect the conversion disorder since the CI did not appear for the examination.  At TDRL removal, the PEB adjudicated the diagnosis of PTSD, coded 9411 (PTSD), and rated the condition at 10%.  The PEB stated the diagnosis of PTSD was “attributed by the psychiatrist to combat stressors experienced during Iraq deployment.”  It was noted that the CI was placed on the TDRL with diagnosis of conversion disorder (separation diagnosis).  The PEB cited the CI “currently works on an oil field.  He states that he gets along well with both co-workers and supervisors.  He states his supervisors are satisfied with his job performance and denies any disciplinary issues at work…He states he last experienced seizure-like episodes and syncope about 6 months ago.”  

The Board first noted that the provisions of VASRD §4.129 were not applicable at the time of TDRL placement (separation), for a mental disorders due to traumatic stress.  The Board next proceeded with the rating of the condition at the time of TDRL removal.  The TDRL removal examination dated July 2009, 6 weeks prior to permanent separation, noted the CI’s complaint of PTSD.  The CI reported experiencing extreme fear on multiple occasions during his deployment.  The CI reported that he had been married for 5 years and the couple had 2 children.  He noted that his relationship with his wife was very good and that he worked on an oil field and got along with everyone on the job.  He had some occupational difficulties and stated that often at work he was surrounded by crowds of people, which made him uncomfortable, caused anxiety symptoms.  The CI also reported that as of yet his symptoms related to crowds had not caused any significant impairment in his ability to perform occupationally.  The MSE was unremarkable.  
The examiner noted the CI last experienced seizure-like episodes about 6 months ago and that the episodes generally occurred during periods of perceived intense stress.  It was noted that the CI had some PTSD symptoms but that his symptoms were having mild impact on his occupational functioning.  The CI was considered to have been doing very well, he enjoyed several activities recreationally, and was not receiving any form of MH services.  The panel considered the absence of hospitalizations, visits to the emergency room treatment for any MH condition.  All Panel members agreed, the CI’s condition at permanent separation did not meet a rating higher than the 10% disability rating for “Occupational or social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress.” 

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the MH conditions at TDRL removal.  

BOARD FINDINGS:  In the matter of the conversion disorder with seizures or convulsions and PTSD condition and IAW VASRD §4.130 the panel recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.   

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150611, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170007450, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate. I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.

This decision is final. Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,

	
Enclosure