DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD DC 20374-5023

From: To:

Director, Secretary of the Navy Council of Review Boards PD-2017-02459

IN REPLY REFER TO

1850
CORB:003
19 Feb 20

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr of 3 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 your assignment to the Temporary Disability Retired List with a 50 percent disability rating for six months after your date of discharge followed by disability separation with a final disability rating of 10 percent.

3.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the office of the Deputy Commandant, Manpower and Reserve Affairs, 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-2017-02459
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20070531

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

CI CONTENTION:   “…I should be medically retired.”  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 - 20070413	VARD - 20080228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD with Depression	9411	30%	20071016	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

PTSD. According to the service treatment record and MEB narrative summary (NARSUM), the CI was deployed to Iraq twice. During the first deployment in 2003, he was involved in frequent firefights, and had just a few months after returning home before deploying to Iraq again in 2004. During the months after redeploying from the second tour, he experienced the gradual onset of intense nightmares and intrusive recollections of the trauma experienced while in Iraq. He also started to have problems falling and staying asleep (slept 2-4 hours a night), was actively avoiding thoughts and scenarios that reminded him of the deployment (i.e. avoiding dark places), and noticed a rapid decline in frustration tolerance. He started to drink between 12-24 beers a week and upwards of 2 cases over a weekend to help manage symptoms. The CI was evaluated by a psychiatrist  in  September  2006  and  diagnosed  with  PTSD.   He  was  started  on  a daily anti-

depressant medication and referred for substance abuse counseling. He had no prior psychiatric history and received a Combat Action Ribbon.

During the 1 January 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the examiner documented PTSD controlled with medication according to mental health (MH) records. The 16 February 2007 non-medical assessment noted the CI was treated for PTSD symptoms and reassigned to the platoon office as a clerk and later as a carpenter.  No deficiencies were noted and he was observed to be a diligent worker.

The 27 March 2007 MEB NARSUM examination, 2 months prior to separation, recorded CI complaints of flashbacks and the inability to sleep. He denied the use of any alcohol since the completion of intensive outpatient treatment, and described his marriage as “all right” but admitted his temper created tension. Medications included an anti-depressant and a sleep aid. He reported that that his symptoms would greatly improve while on leave but recurred after returning to work. The mental status examination (MSE) showed adequate grooming, constricted affect, and denial of suicidal ideation. The diagnoses included PTSD and alcohol dependence, early full remission, with a Global Assessment of Functioning (GAF) score of 55 (moderate symptoms, impairment.) The examiner noted moderate impairment in civilian industrial capacity on the basis of PTSD, and that the CI was working in a limited duty capacity with some limitations.

At the 16 October 2007 VA Compensation and Pension (C&P) PTSD examination, 5 months after separation, the CI reported avoidance of memories from Iraq, increased anxiety, hypervigilance, intrusive thoughts about combat, sleep problems, fatigue and depression. He endorsed daytime flashbacks and dreams, and nightmares 2-3 times per week. Treatment included anti-depression medication and a sleep aid. He reported no social interactions outside his home and only left about once every 3 months. He did not feel any emotion towards his wife, had difficulty playing with his son, and had no further interests in past leisure activities or family events. He was employed full-time installing cables, and although he often showed his irritation, no one had complained about his behavior at work. He reported being in one fight but the police were not called. The MSE showed moderate anxiety, speech latency which was otherwise normal, constricted affect and mood self-described as anxious, nervous and depressed. He denied suicidal ideation and showed intact short term and immediate memory. A diagnosis of PTSD was rendered with a GAF score of 55 (moderate symptoms, impairment.)

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the PTSD 10%, coded 9411 (PTSD). The VA rated the PTSD with depression 30%, coded 9411, based on the C&P examination, citing occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 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. Panel 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 PTSD examination performed 5 months after TDRL placement. Of note, during the NARSUM examination, the CI reported that his symptoms improved significantly when he was on leave, and the commander noted the CI had been a diligent worker with no deficiencies after his reassignment. During the C&P examination, the CI reported improved but ongoing PTSD symptoms. His marriage was intact and he was employed full-time with no known complaints from peers or supervisors. Although some anxiety and a constricted affect were noted during the MSE, with a GAF score of 55, he had no hospitalizations, emergency room visits or legal involvement. There were no MH visits between March 2007 and October 2007.  Thus the panel concluded the CI’s condition most closely met criteria for a   10%

disability 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 10% for PTSD, coded 9411.

BOARD FINDINGS: In the matter of the PTSD, the panel recommends an initial TDRL rating of 50%, coded 9411, in retroactive compliance with VASRD §4.129; and a 10% 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, effective the date of medical separation:

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Post-Traumatic Stress Disorder	9411	50%	10%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170227, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record