RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00600
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050118

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Helicopter Repairer, medically for “posttraumatic stress disorder” with a disability rating of 10%.

CI CONTENTION:  “Review all 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 - 20041018	VARD - 20050617	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Stress Disorder	9411	10%	Posttraumatic Stress Disorder	9411	50%	20050112	
Hypothyroidism	Not Unfitting	Hypothyroidism with Fatigue	7903	10%	20050119	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Posttraumatic Stress Disorder.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health (MH) condition began following a medical evacuation mission in which his aircraft come under direct enemy fire in the spring of 2003.  At the July 2004 MEB examination (recorded on DD Forms 2807-1 and 2808) 6 months prior to separation, the CI reported frequent trouble sleeping and anxiety.  The examiner noted the diagnosis of acute stress disorder was rendered in June 2003 and that the CI was being treated with medication and therapy.  

The 4 October 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of nightmares of traumatic events and combat situations, flashbacks, anxiety and panic, unprovoked irritability and hyper-vigilance since returning from Iraq, in June 2003.  It was noted that the CI had sought assistance after the helicopter experience and his symptoms of panic and fear abated during the remainder of his deployment.  However, after returning, his wife started complaining that he was “yelling a lot” in his sleep and was sometimes having violent movements-occasionally hitting her.  He noted that his sleep was poor because of nightmares.  His symptoms did not abate, but continued to worsen.  He then sought help from psychiatry.  The CI took medication that was helping but he still had symptoms.  

The STR related to MH treatment was silent going forward until June 2005, 5 months after separation.  A 30 June 2005 PTSD group note documented the CI was having difficulty managing anxiety.  No symptoms were recorded, and he was an active participant.  A subsequent Psychiatry note documented that the CI’s condition was “much improved.”  He expressed optimism about getting started with treatment.  His mood was “up” and affect appropriate.  Nightmares occurred about once/week.  He remained irritable with an exaggerated startle.  There was no mention of employment status or social impairment.  He had continued his medication.  A Global Assessment of Functioning (GAF) score of 55 (moderate) was recorded.  The last psychiatry noted dated September 2005, 8 months after separation noted the CI continued to have some symptoms, but “they are less intense and he is able to cope with them better.”  His mood was “upbeat and therapy helps.”  The VA Rating Decision noted an examination had occurred that documented flashbacks, impaired sleep and avoidance with social isolation.

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).  The VA rated the condition of PTSD, coded 9411 at 50%.  The panel, IAW DoDI 6040.44 and DoD guidance (which applies current VASRD §4.129 to all cases as appropriate), must recommend a minimum 50% rating for a retroactive 6-month period on the Temporary Disability Retired List (TDRL).  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 next proceeded with its rating recommendation under VARSD§ 4.130 based on the evidence at constructive TDRL placement.  The panel considered the NARSUM, commander’s statement and the letter recommending promotion, dated 30 September 2004, 4 months prior to separation.  The panel also considered the absence of hospitalization, visits to the emergency room for MH symptoms, absence of evidence of impaired judgment, problems with thinking, frequent panic attacks, suicidal or homicidal ideation.  The commander stated, “the only limitation of duty due to the Soldiers condition are his medical appointment.  His ability is inadequate to perform his duties as a helicopter crew chief due to his grounding condition.”  The commander also stated that the CI’s most recent duty performance was excellent.  He was recommended for promotion, 4 months prior to separation.  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 STR in the months following separation, did not indicate that the CI was employed, but noted he had significant improvement in his condition, had continued to take medication and was participating actively in PTSD groups.  There was no evidence suggesting that if the CI had employment that he would have occupational impairment from his PTSD symptoms.  The CI continued to have symptoms of flashback, irritability and avoidance, and combat-related nightmares once a week; however, symptoms of panic attacks, chronic sleep impairment, issues with memory, of judgment were not documented.  His mood and affect was unremarkable.  Psychiatry treatment note dated September 2005, noted the CI report of continued symptoms of lesser intensity, and improved ability to cope with them.  The CI noted he tolerated crowds better.

The panel considered the record in totality and noted that the CI had no history of hospitalization, ER visits, no history of suicidal or homicidal ideation, and no evidence of impairment in judgment at any time before or after separation.  Panel members concluded the evidence demonstrated the CI’s condition was stable during 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 mild or transient”  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. 

Contended PEB Condition.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended hypothyroidism condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition 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 the contended condition and so no additional disability rating is recommended.  

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; and a 10% permanent rating at 6 months IAW VASRD §4.130.  In the matter of the contended hypothyroidism condition, the panel unanimously recommends no change from the PEB determination 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	
PTSD	9411	50%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160912, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170016306, 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