RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01640
BRANCH OF SERVICE:  Coast Guard 	SEPARATION DATE:  20080926

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

CI CONTENTION:  “My disorder was aggravated by the Coast Guard.  I am still suffering from emotional distress.  Review all conditions.”  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 - 20071128	VARD - 20091103	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

PTSD.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI presented with symptoms of extreme emotional stress and suicidal ideation on 27 March 2007 while underway for the first time.  He was medically evacuated and admitted for psychiatric treatment, reporting recurrent thoughts of nearly drowning at age 16 when he was trapped underwater in a motor vehicle accident (MVA).  He was assessed with water phobia and severe major depression which was later diagnosed as delayed PTSD.  In June 2007, the CI underwent an evaluation for duty fitness and was recommended for administrative separation.  He continued to demonstrate significant anxiety regarding the potential to return to sea duty and was therefore referred for a MEB.  

The 22 August 2007 MEB NARSUM examination, 13 months prior to separation, noted the CI briefly engaged in talk therapy but was not motivated to pursue treatment.  The examiner stated that the CI “is not capable of performing his duties in his rate and rating due to emotional stress.”  

There was no VA Compensation and Pension (C&P) evaluation in the record of evidence. The original VA rating decision, dated 3 November 2009, was based on a review of the STR and VA outpatient treatment records.  At a 14 July 2009 VA mental health (MH) examination, 10 months after separation, the CI stated that “I am trying to get a letter to get back in the Army or Air Force.”  He reported being prescribed medications in the past but did not use them because he did not believe he had PTSD.  The mental status examination (MSE) was normal and the CI denied intrusive thoughts, nightmares, and flashbacks regarding the MVA trauma.  However, he avoided friends who were present at the time of the accident.  The examiner recorded a diagnosis of PTSD by history, and noted that the PTSD was “not active at this time as long as he does not go into large bodies of water.”  A Global Assessment of Functioning (GAF) score of 80 was assessed.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the PTSD condition 10%, coded 9411 (post-traumatic stress disorder), citing VASRD criteria and noting the condition was service aggravated.  The VA rated the PTSD condition 0%, coded 9411, based on a review of the STR and VA records, citing symptoms that were not severe enough either to interfere with occupational and social functioning or to require continuous medication.

The panel first considered whether application of VASRD §4.129 (mental disorder due to a highly stressful event) with a minimum 50% rating for a retroactive 6-month period on the Temporary Disability Retired List (TDRL) was appropriate based on the evidence.  The PEB indicated that the CI’s condition did not result from a combat related injury but acknowledged it was service aggravated and was the result of a result of a highly stressful event dating back to age 16.  Therefore, panel members agreed the provisions of §4.129 were applicable in this case.  

The panel next proceeded with its rating recommendation IAW VARSD§ 4.130 based on the evidence at constructive TDRL placement.  The STR documented one acute hospitalization and stabilization of symptoms with the exception of continued anxiety about sea duty.  There were no emergency room visits and minimal treatment for the condition.  The panel also considered the absence of clinical records of impaired judgment, problems with thinking, and suicidal or homicidal attempts and agreed the evidence did not support a rating higher than 50% at TDRL placement.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 50% for the PTSD condition at TDRL placement.

The panel finally considered whether the evidence at the time of TDRL removal supported a rating higher than the 10% adjudicated by the PEB.  Ten months after separation, the CI denied PTSD symptoms and the VA examiner indicated his condition was no longer active.  His MSE was normal with a GAF score of 80, indicating no more than slight impairment in functioning.  He was not taking medication nor had he received MH treatment.  Panel members concluded the CI’s disability did not exceed the 10% level for “occupational and social impairment due to mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks, only during periods of significant stress” at TDRL removal.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a retroactive 6-month period on the TDRL with a rating of 50% (in accordance with §4.129), and a permanent rating of 10% for PTSD coded 9411.

BOARD FINDINGS:  In the matter of the PTSD condition, the panel recommends an initial TDRL rating of 50% in retroactive compliance with VASRD §4.129 as DOD directed; and a 10% permanent rating IAW VASRD §4.130.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends 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	
Posttraumatic Stress Disorder	9411	50%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150623, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX,

I am the Designated Decision Authority for the Coast Guard on applications submitted to the Department of Defense Physical Disability Board of Review (PDBR).  Under the authority of Title 10, United States Code, section 1554a, I accept the PDBR’s recommendation in your case (Case Number PD-2015-01640) and recommend that your findings be changed to 50% and placement on the Temporary Disability Retired List for six months following retirement. At the end of the six month period, your findings should be changed to 10% and to be separated with severance pay.

Enclosed for your information are a copy of the PDBR’s recommendation and a copy of the record of proceedings. 

A copy of this decision has also been provided to Coast Guard Enlisted Personnel Management Branch, the PDBR, and the Department of Veterans Affairs. 

If you have any further questions, please contact the Coast Guard Personnel Service Center at XXXXXXXXXXXXXXXXXXX. 

	Sincerely,

	XXXXXXXXXXXXXXXXXXX
Rear Admiral, U. S. Coast Guard
Assistant Commandant for Human Resources

2 Enclosures	

Copy:	CG Personnel Service Center (EPM-1)
DoD Physical Disability Board of Review
Department of Veterans Affairs