RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00743
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20080721

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “posttraumatic stress disorder (PTSD)” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 - 20080616	VARD - 20081119	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD with Major Depressive Disorder	9434-9411	50%	20080707	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

PTSD.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s PTSD began in 2004 while deployed and was due to combat stressors.  He first saw behavioral health after his first deployment from February 2004-May 2005 to Iraq.  He reported heavy drinking to relieve his anxiety.  Symptoms included nightmares, flashbacks and awakening with shaking.  He deployed again to Iraq November 2005-November 2006 where he also was exposed to multiple stressors.  

The January 2008 commander’s statement noted no direct decline in his performance since being diagnosed with PTSD but he was frequently away from work due to medical appointments.  He was still working in his MOS, which did not appear to affect his duty performance.  After an AWOL incident (4 months), he had been on time to work and performed his duties to standard.  He was able to function normally and interact in a professional manner with other members of his platoon and company.  The commander’s statement indicated the CI’s medical conditions were slightly exaggerated based on his current duty performance and that he was capable of performing his duties.  

The 14 February 2008 MEB psychiatry NARSUM, 5 months prior to separation, noted complaints of memories of his experiences in Iraq several times a day with nightly disturbing dreams of his experiences.  When reminded of those experience, he developed sweaty palms, nervousness and his chest becomes tight.  He stayed in his room alone and couldn’t be in big or enclosed areas.  He did not go out and did not like being around people.  He slept poorly, took medications for sleep, anxiety and depression and was AWOL for 4 months.  Mental status examination (MSE) showed an anxious and depressed mood with congruent affect.  A diagnosis of PTSD was rendered with a Global Assessment of Functioning (GAF) score of 55 (moderate symptoms, impairment.)  The examiner opined he had significant symptoms and impairment with poor tolerance of stress.  The 28 April 2008 commander’s statement noted the CI felt he would be a burden to the service due to his physical restrictions…he was unable to physically do most jobs in the Army…he was undergoing college courses for bible school and kept all appointments required.

At the 7 July 2008 VA Compensation and Pension (C&P) psychiatry evaluation, 2 weeks before separation, the CI reported problems with intrusive thoughts, nightmares, avoidance behaviors, anhedonia, feelings of detachment, sleep disturbance, difficulty concentrating, hypervigilance and exaggerated startle response.  He reported vivid nightmares.  He also reported depressive symptoms.  He was taking Seroquel and Mirtazapine (anti-depression) and had been treated at a civilian hospital since November 2007.  He reported two non-judicial punishments, one for disrespect after his combat service to Iraq and another related to alcohol use.  He planned to move near his wife’s family, was interested in returning to bible school and intended to work part time while going to school part-time.  He stayed in his room much of the day and occasionally went fishing alone.  He also ran errands during the day and denied any social activities.  He watched television and read his bible.  He took a sleep aide, sometimes with Benadryl, to fall asleep faster.  He denied alcohol or drug abuse.  Physical examination showed rapid, pressured circumstantial speech with a blunted and dysphoric affect.  He described his mood as “tired.”  Memory and concentration appeared mildly impaired.  He made several mistakes performing serial 7 subtractions from 100 while unaware of the mistakes.  Diagnoses of PTSD, major depressive disorder and alcohol abuse were rendered with a GAF score of 55 (moderate symptoms, impairment.)  The examiner noted his social functioning was impaired as he was highly isolative.  Employment was impaired.  At the 7 July 2008 VA C&P general evaluation, 2 weeks before separation, the CI reported no missed no workdays in the past 12 months and had been diagnosed with sleep apnea, treated with CPAP with some relief and otherwise asymptomatic with no effects on his daily activities or work.  The 2011 VA C&P joints examination noted the CI had not worked since November 2008.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD 10%, coded 9411 (PTSD), citing good performance and requirement for medication.  The VA rated the PTSD condition 50%, coded 9434-9411 (major depressive disorder-PTSD), based on the C&P examination 2 weeks before separation, citing occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships.

In accordance with DoD guidance, the PDBR will apply VASRD Section 4.129 to PTSD unfitting conditions for applicants discharged after 11 September 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 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 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 is the 7 July 2008 C&P examination.  The examiner stated his symptoms were continuous. He was in treatment, but despite treatment, his symptoms persisted. He had been treated with both medications and counseling. His social functioning was impaired, as he was highly isolative.  His employability was also impaired.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” for a 30% rating it 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 panel agreed the CI met criteria for a 30% rating.  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 30% permanent rating thereafter for the PTSD. 

BOARD FINDINGS:  In the matter of the PTSD, the panel 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 30% IAW VASRD §4.130.  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; 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%	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170221, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004897, 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 re-characterize your separation as a disability retirement with the combined disability rating of 30%.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The constructive TDRL period and the re-characterization of your separation as a disability retirement 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 30% disability retired pay effective the date following the constructive six month TDRL period, minus the amount of severance pay you were previously paid at separation.
 
	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 and will provide information on your retirement benefits.  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