1RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-00899
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20040831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Armor Crewman, medically separated for “post-traumatic stress disorder (PTSD)” with a disability rating of 10%.

CI CONTENTION:  PTSD condition should receive a higher rating.  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 - 20040417	VARD - 20050113	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD with Major Depressive Disorder	9411	30%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

PTSD.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was exposed to multiple combat-related traumatic events beginning in 1995, diagnosed as PTSD in the fall of 2003.  On 17 November 2003 he was medically evacuated from a deployed location in the Middle East and admitted to the hospital for PTSD and depression.  He had been deployed for approximately 3 months, and had spent more than 30 days hospitalized while deployed prior to being evacuated to Europe, where he remained for about 1 week.

During the 12 June 2004 MEB NARSUM examination, 3 months prior to separation, the CI reported he had vivid traumatic memories of events that occurred in 1995 from witnessing the deaths of service members after two helicopters collided during an exercise.  He was among the team present during the collision and retrieval of bodies.  He was no longer able to fly in helicopters without feeling fearful.  In 2003, while deployed, he had combat exposure and developed symptoms of irritability, emotional lability and insomnia.  He later developed other symptoms of PTSD and depression which continued after returning to the U.S.  The CI received talk therapy and medication.  He had no further hospitalizations and was not seen in the emergency room (ER) for any mental health concern.  

At the time of the NARSUM, the CI reported continued to report symptoms of anxiety, nightmares, angry outbursts, anxiety attacks, decreased sleep, decreased interest, energy, concentration, and psychomotor slowness.  He also noted he was withdrawn from his family, often hitting his wife while sleeping, and he awoke one night to find himself about to choke his daughter.  He had once thought of having a car accident in the hopes of dying.

The mental status examination (MSE) was unremarkable with the exception of a depressed mood and constricted affect.  Suicidal and homicidal ideation were absent, and judgment was noted to be good.  The examiner noted his condition required medication and outpatient psychotherapy.  The CI failed to report to a November 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, but did undergo a mental evaluation 14 months after separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD condition 10%, coded 9411 (PTSD), citing mild industrial impairment.  The PEB indicated that the depressive symptoms were considered in the rating of the PSTD condition.  The VA rated the PTSD condition with major depressive disorder at 30%, coded 9411, based on the STR.  The panel opined that the depressive condition was an integral part of the PTSD pathology and could not be recommended for additional rating IAW VASRD 4.14 (avoidance of pyramiding).

The panel, IAW DoDI 6040.44 and DoD guidance (which applies current VASRD §4.129 to all PTSD cases as appropriate), and will 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 TDRL placement.  Regardless of the diagnosis, 4.130 rating is based on symptoms independent of diagnosis, therefore, all mental health symptoms (depressive disorder and PTSD) are considered in the rating and reflected in the panel’s recommendation.  

The panel considered the NARSUM and the commander’s statement dated 4 months prior to separation.  The panel also considered the absence of psychiatric hospitalization in the 9 months prior to constructive TDRL, or visits to the ER for mental health symptoms; and the absence of clinical evidence of impaired judgment, problems with thinking, and suicidal or homicidal attempts.  The commander stated the CI was a good soldier, but “his mental condition creates a burden for others…and adversely impacts readiness,” and that “he is totally incapable of performing his [military occupation] duties in any situation.”  It was noted that his profile prevented him from serving in combat arms and from deploying to combat operations, specifically prohibited access to ammunition and weapons, which were all requirements of his military occupational specialty.  However, the commander made no mention of difficulties with co-workers or supervisors, panic attacks, or problems with focus or concentration.  The panel considered the record in evidence did not support a higher than 50% 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 TDRL removal and permanent disability disposition supported a rating higher than the 10% 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.  However, an audiology C&P examination dated 6 October 2005, 13 months after separation, noted the CI had worked at a large chain store distribution center for the past year.  On 1 November 2005, 14 months after separation, the CI underwent the C&P mental examination.  He reported that the single most stressing event he experienced occurred when he attempted to rescue victims from helicopter collision. He noted there had been no hospitalizations and he had not sought mental health treatment since discharge, although he reported ongoing symptoms of PTSD with depressed mood.  He noted he was seeking full-time employment and was working 3 days a week at the same job.  The CI reported that his PTSD symptoms had no negative impact upon his employability.  He had remained married and the couple had a 7-year-old child.  He denied a history of assaultive behaviors, and denied ever having had suicidal ideation or attempts.  He reported that his psychosocial functional status was generally within normal limits except that he had not been able to obtain full-time employment, and he was also socially avoidant with limited leisure pursuits. 

The MSE was unremarkable with the exception of decreased concentration during cognitive exercise.  The CI did not report panic attacks, stated he had periods of anxiety that would last a whole day if he is reminded of military service.  He had some difficulty with sleep but chronic insomnia was not reported.  He stated that he “hates his job.”

The panel considered the record in totality, and assigned probative value to the C&P mental examination.  During the post-constructive TDRL period the CI’s condition was stable.  He had no mental health treatment and no psychiatric inpatient treatment or ER visits in the 14 months after separation.  He was able to work and was seeking full-time employment.  He noted his condition had not interfered with his job performance.  The CI reported no panic attacks, chronic insomnia or memory loss.  Panel members concluded, at the time of TDRL removal, the CI’s 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.”  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.  There are no other conditions within the Board’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 20160917, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170018417, 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 [and to the counsel you listed on your application; [name and address]].

Sincerely,

Enclosure