RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00537
BRANCH OF SERVICE:  ArMY 	SEPARATION DATE:  20070423

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

CI CONTENTION:  “I was separated for PTSD from the Army due to an in-service trauma which I was awarded a Purple Heart which resulted in my medical separation.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20070214	VARD - 20090106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Stress Disorder…	9411	10%	Post-Traumatic Stress Disorder and Bipolar Disorder	9411	30%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Posttraumatic Stress Disorder.  According to the service treatment record (STR) and the mental health (MH) MEB narrative summary (NARSUM), the CI was diagnosed with bipolar disorder in February 2006 and was treated for the condition.  However, while receiving inpatient treatment for alcohol abuse in May 2006, he received the additional diagnosis of PTSD.  No specific traumatic event was identified, and the only recorded PTSD symptoms were flashbacks and nightmares of combat experiences and avoidance of conversation about combat experiences.  The CI was hospitalized over a 2 day period for suicidal ideations 2 weeks prior to entering the alcohol rehabilitation program noted above.

During the 4 January 2007 MEB NARSUM examination, 4 months prior to separation, the CI reported at the time of presentation to MH in February 2006, he had been experiencing increasing depressive symptoms that led to him holding a knife to his neck causing a superficial laceration while contemplating suicide.  This action was provoked by relationship issues.  He noted that he had intermittent episodes of high irritability, increased impulsive behavior, decreased need for sleep, and intermittent episodes of severe depression with suicidal ideation.  In September 2006, his duty section was moved due to conflicts with supervision.  Since being on mood stabilizing medication he reported he was overall doing well with reduced irritability.  At the time of the NARSUM, the CI was in treatment for alcohol dependence.  The mental status examination was unremarkable with the exception of dysphoric mood and “subdued” affect.  Suicidal ideation or homicidal ideation was absent, and judgment was noted to be fair.  The examiner noted his condition required medication to maintain stability.  There was no VA examination in evidence proximate to separation.  The CI was again hospitalized in September 2008.

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 industrial impairment.  The PEB indicated the diagnosis of bipolar disorder, type II was considered in rating the PSTD condition.  The VA rated the PTSD condition combined with a bipolar disorder at 30%, coded 9411, based on the STR and a September-October 2008 VA treatment record.  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.”  

The panel must then determine the most appropriate fit with VASRD 4.130 criteria at 6 months for its permanent rating recommendation, based on the facts in evidence which are most probative for that interval.  The panel proceeded with its rating recommendation under VARSD§ 4.130 based on the evidence at constructive TDRL placement.  Regardless of the diagnosis, 4.130 rating is based on symptoms independent of diagnosis, therefore, all mental health symptoms (bipolar disorder) are considered in the rating, and reflected in the panel’s recommendation.  The panel considered the NARSUM and the commander’s statement, dated 5 months prior to separation.  The panel also considered the absence of psychiatric hospitalization in the 11 months prior to constructive TDRL, or visits to the emergency room for MH symptoms; and the absence of clinical evidence of impaired judgment, problems with thinking, and suicidal or homicidal attempts.  The commander's statement documented, “His performance in the operations shop with planning, coordinating, and execution of operational and logistical support has been superb,” but noted that the CI had exercised poor judgment in regards to a recent DUI charge.  The commander also stated that treatment of the CI’s condition had a positive impact on his mental health, both on and off duty.

The panel considered the record in evidence did not support a higher than 50% rating for 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 next considered whether the evidence at the time of removal from TDRL and permanent disability disposition supported a rating higher than the 10% rating adjudicated by the PEB.  The 50% disability rating requires evidence of “Occupational and social impairment with reduced reliability and productivity due to symptoms such as: flat affect, panic attacks more than once a week, difficulty in understanding complex commands, impaired short and long-term memory and impairment in judgment and thinking…”  The STR in the months following separation was silent with the exception of an 8-day psychiatric inpatient admission (24 Sep-3 Oct), 12 months after separation.  The discharge summary noted there had been no hospitalization since the May 2006 inpatient treatment and that the CI had been stable for 12 months after separation in the absence of medication.  In late September, in the absence of medication, he impulsively stabbed himself in the neck while intoxicated after an argument with his live-in girlfriend.  He denied he had experienced suicidal thoughts or plan before that moment of stabbing himself.  The CI reported he had not taken any medication since discharge from service in April 2007 and that the medications had helped, and that he had not had any problems before the admission during which he was off medication.  Employment history was not disclosed other than that he was employed at the time of admission.  The panel considered the record in totality and noted that the CI had no history of hospitalization in the 12 months after constructive TDRL with the exception of the hospitalization at the 12 month mark, no recorded ER visits, and no evidence of impairment in judgment as a result of his mental illness.  Although he was hospitalized 12 months after TDRL removal, he was employed and was not taking medication therefore, panel members concluded the evidence demonstrated the CI’s condition was stable during and post constructive TDRL period; and that his disability was most reflective of the 10% level for “Occupational or social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication.” After due deliberation, considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a retroactive 6-month period of TDRL with a rating of 50% (in accordance with §4.129), and a permanent rating of 10% for PTSD. 

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 at 6 months IAW VASRD §4.130.  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 20160906, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180005706, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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. 

	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), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

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

Sincerely,					      
Enclosure