RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02529
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040902

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve O3, Signal Officer, medically separated for “posttraumatic stress disorder…” with a disability rating of 10%.

CI CONTENTION:  The CI contends for all his conditions and asserts he should be permanently retired.   The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’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 Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’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 Board 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 Board 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 - 20040630	VARD - 20040907	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Stress Disorder…	9411	10%	Post Traumatic Stress Disorder	9411	50%	20040809	
Chronic Wrist and Back Pain	Not Unfitting	Residuals, Status Post Left Wrist Scaphoid Fracture	5299-5215	10%	20040820	
		Degenerative Disc Disease, Thoracic and Lumbar Spine	5010-5237	10%	20040820	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

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 in August 2003 after traumatic experiences related to remotely observing video footage of operations taking place in Iraq and Afghanistan.  He had sleep difficulties, nightmares, intrusive memories and flashbacks.  He attended a PTSD group for several months.  After treatment for 6 months, it was apparent he was not making progress towards overcoming symptoms.  Flashbacks, tearfulness and shaking persisted. 

The MEB NARSUM examination on 21 June 2004, 2 months prior to separation, noted complaints of continuing flashbacks and nightmares that have decreased to twice a week.  His anxiety and depression was more tolerable outside of the military environment.  Mental status exam (MSE) noted he was hyper alert with a vigilant gaze and forced smile, with mildly depressed and anxious mood but no suicidal/homicidal thought.  He was taking anti-depression and anti-nightmare medication.  At the 9 August 2004 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI reported constant PTSD symptoms since April 2003 that fluctuate from moderate to severe and occur daily.  He reported moderate depression and nightmares twice weekly about deployment to Iraq.  He married in May 2003 and he and his wife were expecting a child.  He had few friends outside of immediate family but enjoyed preaching as a pastor, woodworking and hunting.  A diagnosis of PTSD was rendered with a global assessment of functioning (GAF) score of 50 (serious bordering on moderate.)

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 mild social and industrial impairment IAW AR 635-40.  The VA rated the PTSD condition 50% coded 9411 (post-traumatic stress disorder), based on the VA C&P examination 1 month before separation, citing VA regulations (38 CFR §4.129) stipulating a discharge from service due to a mental health condition is given an evaluation of not less than 50 percent and requiring a routine future examination within 6 months of separation from service.

The Board considered whether the provisions of VASRD §4.129 (Mental disorders due to traumatic stress) was applicable.  The panel noted the PEB documented that 10A/C (combat-related) was awarded, and PTSD was the diagnosis described.  The Office of the Under Secretary of Defense memorandum dated 17 July 2009 states:  "Therefore, as a matter of policy, the PDBR and all three BCMRs will apply VASRD Section 4.129 to PTSD unfitting conditions for applicants discharged after September 11, 2001, and in such cases, where a grant of relief is appropriate, assign a disability rating of not less than 50% for PTSD unfitting conditions for an initial period of 6 months following separation, with subsequent fitness and PTSD ratings based on the applicable evidence.” 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 then 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% 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 August 2004 VA Compensation and Pension (C&P) evaluation, 1 month prior to separation, with additional input from the mental health intake, 3 months after intake separation.  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 C&P examination noted daily fluctuating moderate to severe symptoms that included depression and twice weekly nightmares.  However, he married, he and his wife were expecting a child, and he enjoyed preaching and other activities.  During the MH intake, the examiner noted overall there was good response to the anti-depression medication.  He felt down but denied suicidal ideation.  He reported recent morning anxiety but the anti-anxiety medication was helpful.  The examiner increased the dose and frequency of his anxiety medication and also increased the dose of his anti-depression medication.  After some discussion, the panel by majority agreed the CI met criteria for a 10% disability rating at the time of separation.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel by majority recommends a disability rating of 50% for 6-months of constructive TDRL and a 10% permanent rating thereafter for the PTSD condition.

Contended PEB Conditions: Left Wrist and Low Back Pain.  The Board’s main charge is to assess the fairness of the PEB’s determination that left wrist and low back pain were not unfitting.  The wrist pain and back pain conditions were profiled, implicated in the commander’s statement and were judged to fail retention standards.  However, the CI noted on the Form 2697, prior to separation, that neither condition limited his performance of duties.  The P2 profiles did not significantly limit his duties.  The Orthopedic examiner noted the conditions were stable, prognosis good and pain was slight though constant.  There was no performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the PTSD condition, the Board by majority 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 §4.130.  In the matter of the contended left wrist and low back pain conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are 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	
Posttraumatic Stress Disorder	9411	50%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151110, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170013313, 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