RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02273
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Mortarman, medically separated for “post-traumatic stress disorder” rated 10%.

CI CONTENTION:   The CI contends he was rated by the VA at 30% for his unfitting 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 - 20061129	VARD - 20070630	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD…and MDD…	9411	10%	PTSD & MDD	9411	30%	STRs	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

PTSD and MDD.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) the 23 August 2006 psychiatric narrative summary (NARSUM), the CI’s condition began in summer of 2005.  He had problems with work, family and finances but a major precipitant of his emotional decline was his combat deployment to Iraq from August 2004-July 2005.  He reported daily life threatening situations and witnessed numerous atrocities.  He had flashbacks triggered by reminders of Iraq, irritability and intense anger.  He developed sleep disturbance, disconnectedness, anhedonia with numbness, loss of energy, difficulties with concentration and weight loss.  He reported the use of alcohol to dull the pain and a urine test was positive for drugs as well.  He also reported enduring racist remarks from other soldiers and involvement in divorce proceedings.  He had an infant son he had barely seen and was unaware of the location of his wife and son.  He also had mounting bills.  The CI was awarded the Combat Infantryman‘s Badge.  

Mental status exam (MSE) showed him to be markedly depressed and tearful with congruent affect.  There was some distractibility and he complained of flashbacks and low startle threshold.  He denied suicidal/homicidal ideation but felt increasingly hopeless and had thoughts of dying Diagnoses of major depressive disorder (MDD) and PTSD were rendered with a Global Assessment of Functioning (GAF) score of 55 (moderate symptoms, impairment.)  The examiner noted he was unable to function as a soldier.  The MEB forwarded PTSD and depression 	for PEB adjudication.  

The 25 October 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of flashbacks, intrusive memories, hyper startle reflex and avoidance.  The Commander’s letter substantiated the CI’s combat experiences.  For a while he had suicidal ideations but managed usually to put those thoughts away.  Field training exercise, handling firearms and hearing gunshots bothered him.  He was being seen by a psychiatrist and so far had about 15-20 visits.  He did not like crowds or enjoy playing soccer as he used to.  He felt sad and had crying spells and a sense of frustration due to the derogatory comments at work regarding his accent and national origin.  He was depressed about separation from his wife and son.  He was taking an anti-depression medication daily but declined to participate in the PTSD group therapy.  He was feeling some better and had a new puppy that was creating some happiness.  He infrequently took medication for sleep.  The CI had not worked in his MOS for almost 2.5 months.  He was attending morning formations, performing staff duty and attending medical appointments.  He reported a lack of motivation and energy to participate in physical training.  The Commander reported he could not perform the duties of his MOS.  The CI was interested in moving west and seeking work in computer game development.  The CI did not report for his C&P examination on April 2007. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD and MDD conditions 10%, coded 9411 (PTSD), citing symptoms of both disorders rated as mild industrial impairment.  The VA rated the PTSD and MDD conditions 30% coded 9411 based on the service treatment records (STR) and MEB.  

The panel first considered if application of VASRD §4.129 with a 6 month (50% minimum) period on the TDRL was indicated in this case (per Board directive from DOD).  Panel members agreed that the provisions of VASRD §4.129 were applicable in this case due to the 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 MH conditions.  The panel then considered if there was evidence for a §4.130 rating higher than the §4.129 minimum mandated 50% at time of TDRL placement.  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 was the 31 August and 25 October 2006 NARSUM examinations.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” 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 PTSD and depression and was being followed by psychiatry and taking an anti-depression medication.  He was beginning to feel better and was making plans to move and to work.  The CI appeared to be more stable with plans for the future.  The panel agreed he met VASRD criteria for 10% criteria.  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 10% permanent rating thereafter for the PTSD and MDD condition.

BOARD FINDINGS:  In the matter of the PTSD and MDD 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 10% IAW VASRD.  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 and MDD	9411	50%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150715, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

AR20170012167, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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 no re-characterization of your separation or modification of the permanent disability rating of 10%.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The constructive TDRL period 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 no re-characterization of your separation or modification of the permanent disability rating of 10% following the constructive six month TDRL period. 

	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. 

	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 U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXX.

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

Sincerely,

Enclosure