RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2016-00115
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050512

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantryman, medically separated for “posttraumatic stress disorder (PTSD)” with a disability rating of 10%.

CI CONTENTION:  The CI contended for his PTSD condition.  The 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 – 20050217	VARD - 20111012	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	30%	20110926	
RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Posttraumatic Stress Disorder (PTSD). According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s PTSD condition began during his deployment to Iraq from August 2003-April 2004. After a particularly traumatizing event, he developed moodiness, troubled thoughts, increased tension, anger, and depression. Upon his return the CI began seeking psychiatric help but felt work prevented him from attending the Behavioral Health Clinic. He began to feel suicidal and went to the Emergency Room, where he was admitted July 2004 to in-patient psychiatry. He was referred to a PTSD group and received anti-depression medication and a sleep aid. He was treated for 3 weeks and discharged with diagnoses of PTSD, major depressive disorder (MDD) and tobacco use disorder.

The 26 October 2004 MEB NARSUM examination, 7 months prior to separation, noted complaints of frequent intrusive memories, avoidance of anything that had to do with Iraq, detachment and distance from people most of the time and severe anxiety. He had trembling and shaking reactions when certain traumatic events were discussed. He had nightmares of events in Iraq and had at least two flashbacks, during which he had panic reactions. He had frequent and severe startle reactions. He often stayed in his room alone, where he was more comfortable. He did have one soldier buddy who insisted on taking him out to play pool. He reported he the only person he felt close to was his mother. His ability to concentrate, which was badly impaired, was improving. He was in Medical Hold but planned to marry and eventually have a family. At the mental status examination (MSE) the CI appeared anxious and at times wrapped his arms around himself as he talked to prevent trembling as he discussed events in Iraq. He denied suicidal feelings since he left the hospital. He denied hallucinations and delusions. A diagnosis of PTSD was rendered with a Global Assessment of Function (GAF) score of 60 (moderate bordering on mild).

The January 2006 mental health consult confirmed a range of symptoms consistent with PTSD. He remained socially withdrawn and avoided reminders of the military. He slept well with medication but remained on guard and jumpy. He had flashbacks and black out and act out violently. He remained isolated and stayed away from triggers. He was drinking “a fifth” a day when he wrecked his vehicle and admitted himself for detox in September 2005. He received a citation for driving under the influence of alcohol. He was attending intensive outpatient alcohol abuse program. He was unable to work and lived at home with his parents and had no social contact. He was taking anti-depression medication and a significant dose of a mood stabling agent whose side effect included sleep. MSE revealed the CI had psychomotor agitation, bouncing his leg with increasing intensity, depressed and anxious mood and affect, fair insight and poor judgment. A diagnosis of PTSD and alcohol dependency in remission was rendered with a GAF score of 45 (

The VA Compensation and Pension (C&P) evaluation was performed in 2011, 5 years post after separation, and outside of the probative period. The Board 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 the VA rated the PTSD condition 30% % coded 9411, based on the VA C&P examination 7 years after separation, citing anxiety, suspicion and chronic sleep impairment.

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). 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.” Panel members agreed that the provisions of VASRD §4.129 were applicable.  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 50% rating is for “reduced reliability and productivity” and the 70% rating is for impairment in nearly all 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 was the mental health consult conducted 8 months after 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 CI reported hospitalization for detoxification in September 2005 after a major vehicle accident due to heavy drinking. He remained isolated and withdrawn with continued symptoms of PTSD. He was living with his parents and unable to work. He was also taking an anti-depression and a mood-stabilizing medication at significant dosage. MSE confirmed agitation, anxiety and depressed symptoms. The panel agreed the CI met criteria for 50% disability. 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 50% permanent rating thereafter for the PTSD condition.

BOARD FINDINGS: In the matter of the PTSD condition, the panel by minority 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 50% IAW VASRD §4.130. There were no other conditions within the Board’s scope of review for consideration.

The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
PTSD	9411	50%	50%	

AR20170008722, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR)
reviewed your application and recommended to constructively place you on the
Temporary Disability Retired List (TDRL) at 50% disability for six months and then
following this six month period re-characterize your separation as a disability retirement
with the combined disability rating of 50%. I have reviewed the Board’s
recommendation and record of proceedings (copy enclosed). I regret to inform you that
I reject the Board’s recommendation to re-characterize your permanent separation as a
disability retirement with the combined disability rating of 50%. You will be placed on
the TDRL at 50%; and then following this six month period no re-characterization of
your separation or modification of the permanent disability rating of 10%. There is
insufficient justification to support the Board’s recommendation in accordance with Army
and Department of Defense regulations.
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 minority 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), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557.
A copy of this decision has also been provided to the Department of Veterans
Affairs.