RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01775
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050215

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

CI CONTENTION:  The CI’s representative submitted a brief in support of the application requesting the board review the CI’s PTSD and other MEB/PEB 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 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 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 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 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 - 20041215	VARD - 20050503	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD w/ MDD	9411	30%	STR	
Major Depressive Disorder	Not Unfitting					
Pes Planus		Bilateral Pes Planus	5276	0%		
Right Shoulder Clicking		Right Shoulder AC Separation	5099-5203	NSC		
Recurrent Low Back Pain		Thoracolumbar Spine Condition	5237	NSC		
Retropatellar Pain Syndrome		Right Knee RPPS	5099-5260	NSC		
		L Knee Contusion w/ Chronic Pain	5299-5260	NSC		
Recurrent Ankle Sprains		Left Ankle, Grade II Chronic Strain	5271	NSC		
		Right Ankle Dislocation	5271	NSC		
Chronic Sinus Congestion		Sinusitis	6513	NSC		
Hyperlipidemia		Hyperlipidemia	7099-7005	NSC		
Headaches		Headaches	8100	NSC		
Personality Disorder, NOS		No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

PTSD.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s post-traumatic stress disorder (PTSD) began in 2003 after experiencing insomnia, nightmares, paranoia and depression related to a deployment.  The 15 September 2004 MEB psychiatric NARSUM examination, 5 months prior to separation, noted complaints of ongoing nightmares, insomnia, irritability and getting into fights in the community, both when sober and drinking.  The CI had also been socially isolated but not drinking more recently.  He reported symptoms of PTSD and dating multiple women without feeling emotional closeness.  He reported numerous neuro-vegetative symptoms of depression, sadness, disappointment, weight loss and fatigue.  He was taking an anti-depression medication and a mood stabilizing/anti-psychosis medication for sleep.  The CI was proceeding with a divorce.  Psychological testing was consistent with possible psychotic thought process and signs of major depression.  Mental status examination showed a slightly blunted affect.  He reported intermittent hearing stimuli that others could not hear, such as a phone ringing.  He denied current hallucinations or suicidal/homicidal ideation.  An Axis I diagnosis of PTSD and major depressive disorder (MDD), and an Axis II diagnosis of personality disorder NOS was rendered with a Global Assessment of Functioning (GAF) score of 58 (moderate symptoms, impairment).  At the 9 November 2004 NARSUM examination, the CI noted symptoms of insomnia, nightmares, paranoia and depression.  Depressed mood, sleep disturbance and irritability were especially significant.  Treatment included the same medications as described above.  He had not worked in his MOS since May 2004 and had been assigned to various administrative tasks due to his inability to tolerate the psychological stress of that MOS, especially in a combat theater.  The commander’s performance statement concurred with his physicians and noted the CI displayed several positive attitudes and behaviors towards troops and earned a Combat Infantryman Badge.  The NARSUM examiner noted his prognosis was fair in a civilian environment and placement on TDRL was recommended.  Diagnoses of PTSD and MDD, EPTS but aggravated by service, were rendered.  There was no VA Compensation and Pension proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD condition 10%, coded 9411 (PTSD), citing multiple combat patrols resulting in sleep disturbance, withdrawal and increased irritability.  The PEB acknowledged deducting 20% from the initially assigned rating, though, citing “apportionment down one level of impairment,”   thereby indicating an initial rating of 30%.  The PEB cited past factors of adolescent depression, significant abuse in childhood and conduct/personality disorder with multiple suspensions from school for fighting as contributing to present overall impairment and the reason for apportionment down.  The VA rated the PTSD with MDD condition 30% coded 9411, based on STR, citing nightmares, avoidance feelings of detachment, hypervigilance, insomnia, decreased concentration, depression, decreased interests in pleasurable activities and decreased energy level.  

Panel members agreed that the provisions of VASRD §4.129 were applicable in this case due to the CI’s combat experiences and the PEB acknowledgement of 10 A/C.  Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for mental health conditions.  The panel next considered if there was evidence for a §4.130 rating higher than the §4.129 minimum mandated 50% at time of TDRL placement.  A 70% rating requires impairment in most areas.  The panel agreed that the §4.130 criteria for a rating higher than 50% was not met near the time of separation, and therefore the minimum 50% initial TDRL rating is appropriate.

The most proximate source of comprehensive evidence on which to base the permanent rating is the November 2004 NARSUM exam, which references the September Psychiatric NARSUM.  The §4.130 criteria for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  The CI continued to have symptoms of depression and insomnia and was taking one anti-depression medication daily and one anti-psychotic medication as needed for sleep.  The NARSUM examiner noted the MDD was aggravated by service and there was no evidence offered for previous anxiety/PTSD symptoms (e.g. nightmares, hypervigilance, avoidance, detachment.)  Nor was evidence presented for the NARSUM diagnosis of personality disorder. The PEB referenced conduct/personality disorder with multiple suspensions from school for fighting.  Suspensions and fighting alone do not equal personality disorder.  The Commander’s statement was highly supportive of the CI’s personality, did not indicate behaviors that negatively affected troops, and noted that the CI enforced a strong sense of spirit among troops.  There was no evidence of behaviors that triggered military disciplinary procedures in the 7 years the CI was active duty.  There was no evidence of behaviors that impaired his ability to function in his MOS.  All panel members agreed there was insufficient evidence to support a PTSD diagnosis in which a personality disorder, childhood abuse, or adolescent depression might have contributed negatively.  All members agreed that the PEB’s deduction could not be upheld for application to the panel’s recommendation.  The panel agreed there was insufficient evidence to support the apportionment down (from 30%) by one level of impairment (to 10%).  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 6-months of constructive TDRL and a 30% permanent rating thereafter for the PTSD condition.

Contended PEB Conditions:  Major Depressive Disorder, Pes Planus, Right Shoulder Clicking, Recurrent Low Back Pain, Retropatellar Pain Syndrome, Recurrent Ankle Sprains, Chronic Sinus Congestion, Hyperlipidemia, Headaches, and Personality Disorder, Not Otherwise Specified (NOS).  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The personality disorder, NOS is a condition not constituting a physical disability, IAW DoDI 1332.38; therefore, the panel has no basis for recommending it as unfitting.  None of the conditions were profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are 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.  In the matter of the contended major depressive disorder, pes planus, right shoulder clicking, recurrent low back pain, retropatellar pain syndrome, recurrent ankle sprains, chronic sinus congestion, hyperlipidemia, headaches, and personality disorder, NOS conditions, the panel unanimously recommends no change from the PEB determinations 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, 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 20150630, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170008874, XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

	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 re-characterize 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 re-characterization 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.  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 XXXXXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs and to the counsel listed on the application, XXXXXXXXXXXXXXXXXXXXX.

Sincerely,

	
Enclosure