RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01982
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051028

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Motor Transport Operator, medically separated for “posttraumatic stress disorder” with a disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 - 20051006	VARD - 20070619	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Stress Disorder	9411	10%	Posttraumatic Stress Disorder	9411	50%* 	20060612	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%*	
*Increased to 100% effective 20070110

ANALYSIS SUMMARY:  

Posttraumatic Stress Disorder (PTSD).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s PTSD began in 2005 after returning from Iraq, where he experienced numerous instances of ambushes and incoming fire while on convoys, and encountered dead, dismembered and charred bodies.  He was referred to mental health for evaluation of combat stress symptoms immediately upon redeployment.  He reported numerous combat exposures and worry about his son’s imminent deployment to Iraq.  While deployed, he had trouble concentrating and remembering to finish tasks, and had to write everything down.  He started becoming confused about his mission, and his inconsistent instructions, in turn, caused others in the unit to become confused. He had visual distortions that endangered his night driving and trouble digesting food.  Due to memory problems, inability to sleep, bad dreams, loss of appetite and high irritability, he was diagnosed with acute stress disorder and prescribed a sleep aid and an anti-anxiety medication.  

At the 16 August 2005 MEB NARSUM examination, 2 months prior to separation, the CI stated, “I can’t sleep, I can’t remember simple things, and I’m having terrible dreams.”  He reported improved eating and sleeping, but still had serious memory difficulties and irritability.  He was taking anti-depression medication and a sleep aid.  The examiner noted that he had last seen a counselor in 1995 due to family problems, and felt it was helpful.  The mental status examination (MSE) showed blunted affect and depressed mood, and a diagnosis of PTSD was rendered with a Global Assessment of Functioning (GAF) score of 60 (moderate bordering on mild symptoms).  

At the 12 June 2006 VA Compensation and Pension (C&P) PTSD examination, 8 months after separation, the CI reported anxiety, sleep disturbance, difficulty with hot and cold night sweats, angry outbursts and significant ongoing depressed mood.  He occasionally became involved in physical fights, and stated that he while he did not like being “around people,” he enjoyed limited social interactions with his son and grandsons.  He did not have interest in leisure, recreational or social activities.  Sleep medication was mildly helpful, but prescriptions to treat anxiety and depression were not very effective.  During the MSE, the CI reported visions of tracers at night, and that claps of thunder and lightning would sometimes elicit mild flashback type experiences.  He denied panic attacks, but described increased concentration difficulties and some ritualistic behaviors which mildly interfered with routine activities of daily living.  A diagnosis of PTSD was rendered with a GAF score of 51 (moderate symptoms, impairment.)  A November 2006 PTSD assessment noted the CI attempted to work briefly (20 days) at a casino as a security guard but quit due to pain, difficulty concentrating and interpersonal conflicts.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD 10%, coded 9411 (PTSD), citing moderate persistent symptoms, mild industrial impairment, and that he was currently working in his assigned section.  The VA rated the PTSD condition 50%, coded 9411, based on the STR or C&P examination.  Members first considered the provisions of VASRD §4.129 (mental disorders due to traumatic stress), and determined that the PTSD was due to a “highly stressful event,” and that application of §4.129 was appropriate in this case.  Therefore, a minimum 50% rating for a retroactive 6‐month period on the Temporary Disability Retired List (TDRL) is recommended.  

The panel turned to its rating recommendation at the time of TDRL placement, and agreed the §4.130 criteria for a higher 70% rating for “occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood” were not met; and, therefore the minimum 50% TDRL rating prescribed by §4.129 is applicable.  The panel then turned to its permanent rating recommendation at the time of TDRL removal, noting the most probative sources of comprehensive evidence were the June 2006  C&P examination, as well as STR entries from 16 June-27 July 2006.  The §4.130 criteria for a 10% rating stipulates “symptoms controlled by continuous medication,” while a 30% rating requires “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  The CI reported anxiety, depression, sleep difficulty, occasional flashbacks and some ritualistic behaviors, and remained in regular therapy after the C&P examination; thus, members agreed a 30% rating was justified.  After due deliberation, considering all 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 30% for the PTSD, coded 9411. 

BOARD FINDINGS:  In the matter of the posttraumatic stress disorder, the panel recommends an initial TDRL rating of 50%, coded 9411, in retroactive compliance with VASRD §4.129 as DoD directed; and a 30% 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 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 the date of medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Posttraumatic Stress Disorder	9411	50%	30%	

AR20190007584, 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 recharacterize 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 recharacterization 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.  Inquiries 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.