RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03063
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041119

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Tank Maintainer, medically separated for “PTSD” with a disability rating of 10%.  

CI CONTENTION:  Review all conditions.  The CI also requested review of an additional condition 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 Do DI 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’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 - 20040817	VARD - 20041216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD 	9411	10%	PTSD	9411	50%	20040903	
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 July 2003 after redeployment from a tour in Iraq.  He reported nightmares but thought they would go away.  The CI referred himself to outpatient mental health (MH) in May 2004 with symptoms of insomnia, nightmares, irritability, depressed mood, relationship problems and impaired work performance.  The CI reported being enraged with supervisors and felt he was targeted for mistreatment.  The CI reported he was directly involved in combat in Iraq and felt depressed, angered and guilty from war experiences.  The CI was treated with Wellbutrin (depression), Seroquel (psychosis, mood stability), Klonopin (uncontrolled anxiety, panic attacks) and Zoloft (depression).  The CI was admitted to inpatient psychiatry from the emergency room (ER) in June 2004 due to suicidal and homicidal ideations.  During the admission history and physical, the CI reported difficulty with his supervisor, financial problems, strained relationship with his wife at times and dealing with an MEB for PTSD.  He was discharged after one week.  The 2 July 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of insomnia, nightmares, irritability and depressed mood.  Mental status examination (MSE) showed a depressed, anxious mood with an irritable affect.  The CI reported daily episodes of anger and panic but denied suicidal or homicidal ideation.  A diagnosis of PTSD with mild social and industrial adaptability was rendered.  

At the 3 September 2004 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported a short temper, anger, irritability, anxiety, panic attacks, worsened depression, lack of motivation and no energy.  The CI also reported combat exposures as well as difficulty with his supervisor while in Iraq.  He reported dreams of people wanting to shoot him at least three to four times per week.  The CI reported avoidance of reminders of war and diminished interest and participation in significant activities.  He had difficulty with sleep, although medication helped.  The CI was taking the above identified medications and reported having a good relationship with family members.  He desired to return to Oklahoma and work as a mechanic with the post office or similar place.  He was able to manage his own benefit payment and had no problems with activities of daily living.  He performed office work.  MSE showed a sad, anxious mood and constricted, sad affect.  A diagnosis of PTSD, mild to moderate, was rendered with a Global Assessment of Functioning (GAF) score of 75-80 (transient symptoms).  The 27 September 2004 C&P examination, 2 months prior to separation, noted the CI was able to perform activities of daily as well as other activities e.g. driving.  He was employed in the same job he had as a tank mechanic since 2002.  MSE was unremarkable.  

The 19 February 2005 C&P psychological examination for PTSD, 3 months after separation, noted complaints of ongoing symptoms of PTSD.  The CI reported being unable to work.  A friend of his had to drive him to a job interview.  The CI reported constant panic attacks, and quit his job because his co-workers thought it was funny when they made loud noises, and he would drop to the floor and seek shelter.  He reported difficulty in maintaining relationships.  During the MSE the CI reported suicidal and homicidal ideation that he had not revealed due to fear of re-hospitalization.  The CI reported some perceptual abnormalities that could be hallucinations, and severe short term memory problems.  He appeared anxious and depressed with blunted affect.  Diagnoses of PTSD, dysthymia, generalized anxiety disorder, intermittent explosive disorder and insomnia related to PTSD were rendered with a GAF score of 45 (deficiencies in multiple areas).  The examiner commented on several occasions the CI’s disability met criteria for 70% disability.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD 10%, coded 9411 (PTSD), citing mild social and industrial impairment.  The VA rated the PTSD 50%, analogously coded 9411, based on the C&P examination, citing 38 CFR 4.129.  The panel considered the provisions of VASRD §4.129 (mental disorders due to traumatic stress), and determined that 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.  Members agreed there was no evidence to support a rating higher than 50% at the time of TDRL placement.  
  
Panel deliberations centered on the discrepancy between the mild to moderate social and occupational impairment and MH symptoms documented by the NARSUM and the September 2004 C&P examinations.  The panel also deliberated the significant impairment and symptoms documented in the February 2005 evidence.  The former examinations documented the CI’s ability to drive, perform a variety of tasks and resume a job he had held for years.  The latter examination noted the CI was unable to drive and had terminated employment due to symptoms.  The pre-separation C&P examination documented a GAF score of 75-80, while the post-separation C&P examination documented a GAF of 45 (disability in multiple areas).  Panel members noted the initial MH presentation focused on the CI’s relationship with his commander and not on combat exposures.  For the first time the CI reported “constant panic attacks,” yet the MSE did not show manifestations of panic.  The CI had reported he was working in his old job and was able to drive.  At the February 2005 examination, the CI reported he had a friend drive him to the interview and he was not working.  Yet, the March 2005 follow-up noted he was unable to attend counseling due to his work schedule.  The February C&P examination also rendered four new diagnoses and no explanation for the deterioration of the CI’s condition.  The panel concluded the September C&P examination was more consistent with the MH record and concluded symptoms more closely approximated the criteria for a 10% rating at TDRL removal.  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% IAW §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 as DoD directed; 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	
Posttraumatic Stress Disorder	9411	50%	10%	

The following documentary evidence was considered:

[AR NUMBER], 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 no re-characterization of your separation or modification of the permanent disability rating of 10%.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The constructive TDRL period 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 no re-characterization of your separation or modification of the permanent disability rating of 10% following the constructive six month TDRL period. 

	The accepted DoD PDBR recommendation has been forwarded to the 
Army Physical Disability Agency for required correction of records and then to the 
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.  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.

Sincerely,					      
Enclosure