RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02599
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050506

Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Combat Engineer, medically separated for “post-traumatic stress disorder [PTSD] history ” with a disability rating of 10%.

CI CONTENTION:  Review of all conditions requested.  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 - 20050420	VARD - 20050913	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD History	9411	10%	PTSD	9411	30%	20050729	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

PTSD History.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s mental health (MH) condition was first diagnosed in 1998 during a 10- day hospitalization.  He did not recall the actual reason for admission but reported nightmares, flashbacks, sleep problems, irritability and easy anger.  He was drinking heavily at this time and had tried to stop several times.  He was initially deployed to Iraq during Operation Desert Storm from 1990 to 1991, followed by an Iraq deployment in 2003 where he experienced combat exposures that resulted in flashbacks.  His third Iraq deployment in 2004 was the worst.  He did not think he would survive this deployment.  He was medically evacuated after being shot in the right knee.  The CI received numerous medals to include the Purple Heart.
A social work mental status examination (MSE) on 29 November 2004 noted the CI appeared unstable while tank blasts occurred in the back ground.  His eyes darted sharply across the room and he began to stare ahead, appearing to have a flashback to Iraq.  He fell into a vegetative state, saying he was in Iraq.  He shook during much of the session.  After intervention and when the tank blasts stopped, he appeared to become oriented and returned to reality.

The 15 December 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of severe anxiety, sleep problems, easy startle/arousal, anger, hypervigilance, memory and concentration difficulties, avoidance of people and places, and flashbacks to include a strong odor associated with mutilated bodies.  He admitted to thoughts of killing Iraqi soldiers, but also stated he wished he had not taken anyone’s life.  He reported visual/auditory hallucinations and distorted perceptions associated with his flashbacks.  He reported crying a lot for no reason and that he had given his shotguns away.  The CI reported working numerous jobs over the last few years but was repeatedly fired due to interpersonal difficulties with supervisors, problems with focus and concentration, the inability to read blueprints that he used to be able to read, and the inability to adjust to work.  He was told his work was subpar and he felt his poor performance was due to his combat experiences.  The maximum time he held a job was 8 months.  

He felt his combat experience placed a strain on his 6 years of marriage.  He took anti-depressant, anti-psychotic, and anti-alcohol medication daily.  The MSE noted very short fingernails from biting.  The CI reported his moods fluctuated a lot and happiness was seldom a feeling.  His affect included tears, agitation, and withdrawal.  His thought process became mildly confused when asked to recall certain details of his history.  He had some difficulty remembering past dates, treatment, and names.  He startled easily twice when the phone rang unexpectedly.  He denied suicidal/homicidal ideation but admitted he did not want access to weapons.  He had recently started Antabuse (alcoholism mediation) and was open to enrollment in a substance abuse treatment program.  PTSD was diagnosed with severe occupational and social impairment, and a Global Assessment of Functioning (GAF) score of 45 (serious symptoms, impairment) was rendered.  The February 2005 commander’s statement noted the CI’s PTSD diagnosis, that he was incapable to perform his duties and unable to handle normal situations at home during a recent leave period. He was given an S3 profile for PTSD. 

At the 29 July 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported taking medications that helped him calm down and he was not as depressed but had “bad nightmares” from which he would awaken yelling and sweating.  He was irritable and avoided crowds.  He endorsed PTSD symptoms to include irritability, concentration, and hypervigilance.  He would binge drink once every 10 days.  His last alcohol consumption was 3 days earlier.  He continued to see a psychiatrist monthly.  He was unemployed and had been fired from his last civilian job due to poor performance.  The CI reported some friends from the Army.  At times he fished and went into the woods.  The MSE showed slight disorientation, and he was able to recall one of three items after 5 minutes with no hint.  He denied obsessive behavior but reported washing his hands often because they felt bloody.  He endorsed episodes of anxiety that caused an increased heart rate and shortness of breath.  He did not want to be around people.  He was hyper-vigilant at times.  PTSD and alcohol abuse diagnoses were rendered with a GAF score of 60 (moderate bordering on mild symptoms).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD condition 10%, coded 9411 (PTSD).  The VA rated the PTSD condition 30%, coded 9411, based on the C&P examination, citing the MH criteria for a 30% rating. The panel 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.  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% rating.

The panel then turned to its permanent rating recommendation at the time of TDRL removal. The most proximate source of comprehensive evidence on which to base the permanent rating recommendation in this case is the C&P psychiatry examination, 6 months after TDRL placement.  The CI reported his medication helped his depression but PTSD symptoms, to include sleep difficulty and daily nightmares, persisted.  He was irritable and had a memory impairment.  Anxiety was present in the form of compulsive hand washing, easy startle and hypervigilance.  The CI was unemployed and had recently been fired due to poor performance.  The panel agreed the MH symptoms most closely met criteria for 30% disability at separation.  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 PTSD condition, coded 9411.

Contended PEB Conditions:  Low Back Pain (LBP) and Right Knee Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The low back condition was not profiled but was implicated in the commander’s statement proximate to separation.  The 18 March 2005 MEB orthopedics addendum noted the CI reported developing back pain while deployed to Iraq in 2003.  He reported occasional LBP but was otherwise fairly functional.  Physical examination showed no spinal tenderness and “full” back range of motion.  The examiner opined that the CI’s low back condition in and of itself would not necessitate an MEB. The right knee condition was not profiled but was implicated in the commander’s statement proximate to separation.  As noted above, the CI sustained a right knee gunshot wound and was medically evacuated from Iraq.  During the MEB NARSUM orthopedics addendum the CI reported right knee pain.  Physical examination showed “full” extension and flexion which elicited pain.  There was mild right knee tenderness.  There was normal right lower extremity sensation with the exception of the dorsomedial aspect of the right foot.  The examiner opined that the CI’s right knee condition in and of itself would not necessitate an MEB.

The panel agreed there was no performance-based evidence from the record that the low back and/or right knee condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions, so no additional disability ratings are recommended.

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.  In the matter of the contended low back and right knee conditions, the panel recommends no change from the PEB determinations as not unfitting.  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 20170306, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190011591, 

Dear XXXXXXXXXXXXXXX

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 and to the counsel you listed on your application, XXXXXXXXXXXX, XXXX XXXXX XXXX, Suite XXX, XXXXXXX, XX XXXXXX.