DEPARTMENT  OF THE NAVY

IN REPLY REFER TO

1850
CORB:003
19 Feb 20

From: To:

Director, Secretary of the Navy Council of Review Boards 
PD-2017-02377

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr of 23 Sep 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy for  appropriate
·action.

2.	On 12 February 2020, the Assistant Secretary of the Navy took action in your case by accepting the correct recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Physical Evaluation Board from 10 to 30 percent with assignment to the Permanent Disability Retired List.

3.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the Navy Personnel Command, for correction of your records as  stated above.	You will be notified once those changes are complete.

RECORD OF PROCEEDINGS
 PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX		CASE: PD-2017-02377 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060317

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Aviation Electronic, Electrical and Computer Technician, medically separated for “posttraumatic stress disorder [PTSD]” with a disability rating of 10%.

CI CONTENTION: Review requested of PTSD as well as additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 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 RPEB - 20060210	VARD - 20061011	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9499-9411	10%	PTSD with Depressive Disorder	9411	30%	20060825	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

PTSD. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s PTSD began in January 2004 after an alleged sexual assault and rape by another service member. She was referred to the emergency room on 25 March 2004 due to suicidal threats and episodes of tearfulness. She denied suicidal ideation, related problems with her command since the assault, and declined a mental health (MH) referral at that time. A diagnosis of PTSD was rendered.

The CI was referred to the MH clinic in November 2005 after expressing suicidal thoughts. She reported an anxious and irritable mood, a sense of foreboding and despair, crying without cause, constant intrusive thoughts, avoidance of social interactions and leaving home, decreased concentration, detachment, disrupted sleep and other PTSD symptoms. Besides the assault, other factors contributed to the disabling PTSD symptoms to include: seeing and remaining in the same unit as the assailant, working in a hostile and unsupportive environment, lack of support from her command to attend counseling sessions, removal from assignment to the honor guard, and numerous write-ups and inappropriate comments made by her supervising Chief.

During the 3 January 2007 MEB NARSUM mental status examination (MSE), the psychiatrist observed a depressed affect congruent to the CI’s stated mood. She denied suicidal ideation and blamed completely blamed herself for the assault. Moving to a new work environment outside the unit significantly improved her mood, but not other symptoms. She did not want to take medication nor was it “medically indicated,” and she had attended individual therapy 3 times. She had a supportive boyfriend and although a cervical screening (PAP) was abnormal after the assault, further pathology tests were negative. The examiner stated that her continued exposure to the military environment was resulting in constant re-traumatization with increased symptoms of depressed mood, sleep problems and intrusive memories. A diagnosis of PTSD was rendered with a Global Assessment of Functioning (GAF) score of 50 (severe symptoms, impairment).

The 2 February 2006 MEB NARSUM addendum examination for a reconsideration PEB, 1 month prior to separation, noted the CI was referred for an MEB, but found “fit for full duty” at the January 2006 Informal PEB. On 31 January 2006, a suicide note written by the CI was found, and it described her despair at the IPEB findings and outlined a clear plan to shoot herself. She was admitted for inpatient psychiatric treatment for a week, and upon discharge she returned to administrative work. While she continued to report suicidal ideation, she agreed to not act on suicidal thoughts, and attended weekly therapy with a plan for immediate access to the MH clinic as needed. Her work situation was very supportive and she was not taking medication since she was 4 months pregnant.

At the 25 August 2006 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported she began seeing a psychiatrist in the previous month for weekly counseling, and was not taking medication due to breast feeding. Her PTSD symptoms had not significantly decreased since the time of diagnosis, with continued flashbacks accompanied by brief panic attacks. She had enrolled for online classes and expressed concerns about completing a degree since she did not want to attend classroom courses due to ongoing anxiety and difficulty leaving her home. She was caring for her 2-month old infant and was not working nor felt ready to do so. She reported significant guilt for drinking at the time of the assault and currently drank one to two glasses of wine about 3-4 times a week. The CI reported no cutting behaviors for the past year, although she had cut her left and right upper arms one month after the assault. She had been married for 5 months but described a distant and withdrawn relationship with her husband and little intimacy. She felt isolated with no close friends or interest in social activity, rarely left the house (and became nervous driving when she did), and spent leisure time reading. She experienced increased fear for her safety when home alone and checked doors 5 times a day. Since the assault, the CI reported a poor body image, self-induced vomiting once a week, food denial and excessive exercise to prevent weight gain. At the MSE, she described her mood as “up and down, depressed, despair” and endorsed vague thoughts of suicide and death, but denied suicidal ideation or a current plan/intent. Affect was restricted and congruent with reported mood, and she described feeling depressed 4-5 days a week. Diagnoses of PTSD, major depressive disorder (MDD) and eating disorder, not otherwise specified, were rendered with a GAF score of 45 (severe symptoms, impairment.). The examiner opined that the PTSD would prohibit her ability to obtain or maintain gainful employment.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the PTSD 10%, analogously coded 9499-9411 (PTSD). The VA rated the PTSD 30%, coded 9411, based on the STR and C&P examination, citing VASRD criteria for a 30% disability. 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. Members agreed there was no evidence to support a rating higher than 50% at the time of TDRL placement. The most proximate source of comprehensive evidence on which to base the permanent rating recommendation in this case was the C&P examination performed 5 months after TDRL placement.  The CI described persistent PTSD symptoms with additional diagnoses of

MDD and an eating disorder. She was in therapy weekly, was not able to take medication due to breast feeding, and reported mild to moderate drinking, panic attacks, flashbacks, a reluctance to leave the house, social isolation, and a distant relationship with her husband that included little intimacy. She checked doors, tried to avoid leaving the house, and had no friends. She did not have a job but took care of her 2-month old baby, was enrolled in online college courses and liked to read. The panel agreed the mental health condition most closely met criteria for a 30% rating. 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 PTSD condition, 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	
Post-Traumatic Stress Disorder	9411	50%	30%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170305, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record