RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX  	CASE:  PD-2017-02195
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E7, Combat Engineer, medically separated from the Temporary Disability Retired List (TDRL) for “major depressive disorder [MDD] with post-traumatic stress disorder [PTSD]” with a disability rating of 10%.  

CI CONTENTION:  “The information that I have enclosed was not taken into consideration for my 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 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 - 20060127	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
MDD with PTSD	9434	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

MDD with PTSD.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s mental health (MH) disorder began in July 2000 after a tent fell down and hit him on the head.  The CI was separated and placed on TDRL on 15 December 2003.   The 12 December 2005 MEB TDRL NARSUM examination, 3 months prior to TDRL removal, noted complaints of daily sadness and worthlessness and a feeling he could not be productive.  The CI reported frequent episodes of angry outbursts.  At least once per week he threw things or punched a wall.  He reported persistent marital problems including frequent arguments and marked symptoms of PTSD including distressing recollections and nightmares about his injury every other day.  He felt very nervous in crowds and in small spaces with other people.  He endorsed hypervigilance, insomnia and increased startle response with persistent suicidal thoughts that occurred usually in the middle of the night when he awakened from a nightmare.  These thoughts occurred two to three times per week.  He recognized he had an alcohol problem but stated there was no outpatient treatment available nearby.  The CI had continued treatment with Paxil and valium daily.  He was followed every two to four months by a psychiatrist.  The CI drank a twelve pack of beer plus often an additional bottle of wine or up to a quart of hard liquor.  He admitted to tolerance, spending a great deal of his time drinking and to multiple unsuccessful attempts to stop drinking over the past several years but no current treatment for alcoholism.  

The CI noted on the 2003 NARSUM he used alcohol in 1992 as a form of self-medication for several years in association with depression but a pattern of use had resolved in 1998.  He denied psychiatric admissions since his last TDRL evaluation.  He had not been able to find a job and he believed this was due to his physical disabilities.  The low back pain and right knee pain were severe and he described these as prominent stressors that played a role in his persistent depressive symptoms.  Prognosis was poor but his clinical and functional status were stable and compliance with treatment was good with the exception of the drinking.  The mental status examination (MSE) showed a mildly disheveled appearance with fair grooming.  He described his mood as depressed and anxious and affect was moderately depressed and mildly constricted.  Diagnoses of PTSD and MDD were rendered.  The examiner noted his condition had not improved since the last TDRL evaluation.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MH disorder 10%, coded 9434 (MDD), citing social and industrial adaptability of mild, not definite IAW AR 635-40, Appendix B-107, and alcoholism was a significant factor.  The panel considered the provisions of VASRD §4.129 (mental disorders due to traumatic stress), noting the diagnosis and treatment of MDD early in the CI’s service.  The CI remained in service and was not separated until he was diagnosed with PTSD.  The commander’s statement did not implicate a mental illness as a reason for impaired performance and neither the MDD nor PTSD required profile restrictions.  However, the NARSUM and MEB examinations judged both MH disorders to be medically unacceptable, and the PEB found both MH disorders to be unfitting.  The panel determined that the PTSD, subsumed in the MDD diagnosis IAW VASRD 4.14 (avoidance of pyramiding), was due to a “highly stressful event,” and that application of §4.129 was appropriate in this case.  Members agreed there was no evidence to support a rating higher than 50% at the time of TDRL placement.  Therefore, a minimum 50% rating for the period on the TDRL is recommended.  

The panel next considered whether the evidence at the time of TDRL removal supported a rating higher than the 10% adjudicated by the PEB.  The most proximate source of comprehensive evidence on which to base the permanent rating in this case is the TDRL NARSUM.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  The PEB opined alcohol was a significant factor in the CI’s current condition and also the CI remained unemployed since placement on the TDRL.  There was a previously documented history of alcoholism in association with a mental illness.  The panel noted the recurrence of alcoholism after the PTSD diagnosis.  Furthermore, the examiner noted there had been little change in the CI’s condition since placement on the TDRL.  The panel agreed the CI met the criteria for a 30% disability at the time of TDRL removal.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 50% at the time of TDRL placement (IAW §4.129/§4.130) and a permanent 30% rating at the time of TDRL removal for the MH disorder, coded 9434.  

BOARD FINDINGS:  In the matter of the MH disorder, the panel recommends a disability rating of 50%, coded 9434 at the time of TDRL placement and a permanent 30% rating at the time of TDRL removal 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	
Major Depressive Disorder with Posttraumatic Stress Disorder	9434	50%	30%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170407, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20190008894, XXXXXXXXXXXXXX

Dear XXXXXXXXXXXXX

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 permanent 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.  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