RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-00006
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20050916

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “posttraumatic stress disorder (PTSD)” with a disability rating of 10%.  

CI CONTENTION:  Condition should be rated higher.  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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20050617	VARD - 20060207	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	30%	20050623	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

PTSD.  According to service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was exposed to multiple combat-related traumatic events during his deployment to Iraq.  Symptoms of increased anger outbursts, sleep disturbance, startle responses, problems in crowds, social isolation and mood issues were noted in the initial mental health evaluation in February 2005.  In addition to combat stressors, the CI was dealing with the divorce of his parents and the pregnancy of his girlfriend, as well as financial issues.  His condition was treated with anti-depressant medication and talk therapy.  The CI was never suicidal or homicidal and his condition did not require treatment in the emergency room or hospital.

During the 28 April 2005 MEB NARSUM examination, 5 months prior to separation, the CI complained of sleep difficulty.  He reported that in order to help calm his nerves and help him to sleep at night, he “drank like a fish.”  He reported he had significant anger but had not acted out aggressively towards others.  The mental status examination (MSE) was unremarkable with the exception of irritable mood and depressed and irritable affect.  Suicidal and homicidal ideation were absent, judgment was noted to be adequate and cognition was intact.  The examiner noted the CI’s condition required “continued intensive outpatient treatment.”  It was also noted that his response to medication had not been robust. 

At the 23 June 2006 VA Compensation and Pension (C&P) mental examination, 9 months after separation, the CI reported continued sleep problems, anger, irritability, hypervigilance, hyperarousal, and social avoidance.  He planned to attend online college courses to become a computer technician.  He received treatment from the local VA and his symptoms had improved with medication.  The CI was married and the couple had a baby.  He had not been hospitalized nor treated in the emergency room for mental health symptoms.  The CI also noted he had stopped drinking large amounts of beer at night.  The MSE was unremarkable with the exception of anxious mood and mildly irritable affect.  The examiner opined that the CI’s symptoms persisted at the moderate level with “at least mild if not moderate disruptions in his capacity to engage in either occupational or educational activities.”  However, a Global Assessment of Functioning (GAF) score of 62 for mild symptoms and impairment was assessed.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD condition 10%, coded 9411 (PTSD), and noted the condition was secondary to deployments to Iraq where “he was exposed to intense combat situations.”  The VA rated the condition of PTSD at 30%, coded 9411.

The panel agreed that IAW DoDI 6040.44 and DoD guidance, the CI’s PTSD resulted from combat exposure in Iraq and met the criteria for application of VASRD §4.129 (a mental disorder that developed in service as a result of a highly stressful event).  Therefore, the CI will receive a minimum 50% rating for a retroactive 6-month period on the Temporary Disability Retired List (TDRL).  The panel next considered if the CI’s rating at TDRL placement met the criteria for a disability rating higher than the minimum 50% rating under VARSD §4.130 based on the evidence at constructive TDRL placement.  The 50% disability rating requires evidence of occupational and social impairment with reduced reliability and productivity.  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 or visits to the emergency room for mental health symptoms; and the absence of clinical evidence of impaired judgment, problems with thinking, and suicidal or homicidal attempts.  The commander indicated the CI was a highly motivated leader before he began suffering from severe symptoms of PTSD, and his condition had negatively impacted his performance.  Panel members agreed 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 constructive removal from TDRL and permanent disability disposition supported a rating higher than the 10% rating adjudicated by the PEB. The C&P mental examination documented that the CI was planning to take college courses, but employment status was not mentioned.  He was married to the mother of his baby, and he continued to report problems with sleep, anger and PTSD symptoms.  He was receiving treatment that included medication and it was noted that his condition had improved somewhat.  He no longer drank alcohol to help him sleep.  He had some difficulty with sleep but chronic insomnia was not reported.  There was no indication that he was using sleep medication.  Although the examiner opined that he had moderate impairment, his GAF score represented mild impairment.
Treatment records going forward demonstrated treatment that was primarily focused on stress caused by marital issues.  PTSD symptoms were rarely mentioned, and were clearly not the focus of treatment.  An STR entry dated 4 May 2006 indicated the CI was working and noted that he expressed that he “loves his job.”  The session focused on his relationship with his spouse.  The record demonstrated a pattern of increased stress and anxiety during periods of marital conflict, and relative stability in the absence of marital stress

The panel considered the record in totality, which demonstrated the CI’s condition was stable and had not required hospitalization or treatment in an emergency room.  The CI worked at a job he enjoyed.  There were no reports of panic attacks, chronic insomnia or memory issues during the year before separation.  Therefore, the panel majority concluded that at the time of constructive 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 evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a retroactive 6-month period of TDRL with a rating of 50% IAW §4.129, and the panel majority recommends a permanent rating of 10% for PTSD. 

BOARD FINDINGS:  In the matter of the PTSD, the panel recommends an initial TDRL rating of 50% for 6 months in retroactive compliance with VASRD §4.129 as DOD directed; and the panel majority recommends a 10% permanent rating IAW VASRD §4.130.  The single voter for dissent recommends re-characterization to reflect permanent disability retirement and elected not to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends 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 20170103, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180002688, 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.

Sincerely,					      
Enclosure