RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-03221
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050707

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E4, Ammunition Technician, medically separated for “post-traumatic stress disorder (PTSD)” with a disability rating of 10%.

CI CONTENTION: “I was rated by the VA at 100% permanent and total for combat related PTSD. I only got 10% from military which was for PTSD as a direct result of armed conflict.” 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 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 - 20050628	VARD - 20060317	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD, Chronic, with Delayed Onset	9411	10%	PTSD	9411	100%	STR	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 100%	

ANALYSIS SUMMARY:

PTSD. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s mental health (MH) condition began in April 2004 when he began having suicidal thoughts related to the onset of distressing recollections of experiences in Iraq. He served in Iraq from February 2003-May 2003 and initially denied involvement in direct combat on a post- deployment questionnaire and again when completing a DD Form 2967. On 18 January 2004, he denied mental problems or health concerns that would prevent mobilization or work. At an evaluation by a psychologist on 16 April 2004, he endorsed intrusive recollections, sleep difficulties, hypervigilance, unstable mood with constant anxiety, and nightmares of war experiences; a diagnosis of PTSD was rendered.   During his first psychiatric examination on     22 June 2004, he reported additional symptoms of PTSD, including periodic flashbacks of combat. He was living in a friend’s basement and often felt irritable and had frequent fights with his girlfriend. He denied receiving any benefit from his medications in contradiction to a report given 13 days earlier.

The 14 April 2005 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of not being able to work more than 1-2 days a week. He stated that he was at risk of losing his current job as a stocking clerk at a spa because of his irritability and inability to manage conflicts with coworkers. He endorsed distressing nightmares 4-7 nights a week, which were related to scenes of maltreatment of dead bodies by other active duty service members. He reported most of his symptoms came from guilt over seeing other soldiers steal from dead soldiers and not doing anything about it. He denied experiencing active combat but felt he was in danger due to overhearing gunfire in the distance. He brought in photographs of his experiences in Iraq so other providers could understand what he had seen, and showed these to the examiner. The CI stated that he felt socially isolated and detached which led to difficulties in maintaining intimate relationships. At times he used alcohol to manage emotional distress, but did not feel he had other coping skills to deal with service-related anger and frustration. He reported difficulty with concentration, but was able to complete his sociology and criminal justice degree in May 2004, and while he experienced vague intermittent thoughts of suicide, he denied a history of suicidal or self-injurious behaviors, or assaultive behavior or legal problems. He participated in weekly group and individual therapy and received monthly management of his anti-depressant, anti- psychotic and anti-anxiety medications.

The mental status examination (MSE) showed the CI sitting calmly with a friend in the waiting area while completing his psychiatric questionnaire promptly and without difficulty. He was guarded and evasive throughout the interview and repeatedly responded, “I don’t know,” to many questions regarding timeframes related to his distress and dysfunction. He eventually became somewhat agitated, and at one point, arose and hung over the interviewer to look at VA documents and post-deployment questionnaires that were forwarded. He did return to his seat for the remainder of the interview. The examiner opined that he seemed very emphatic on impressing how dysfunctional and distressed he was, commenting on his need for medical benefits and that this was a way to ensure that as well as being released from his reserve obligation. His mood was irritable and dysphoric with congruent affect. He denied suicidal ideation, flashbacks, recollections or hallucinations, and memory and cognition appeared intact. Diagnoses included Axis I PTSD and Axis II Adult Antisocial Behavior, with the examiner recording a moderate level of military and social impairment seemed moderate and the CI reporting difficulty maintaining employment in the civilian sector. From January 2006-March 2006, STR notes documented regular attendance at PTSD group therapy sessions. In May 2006, the CI requested a general evaluation, during which he reported various maladies, including having a combat related dream. There were no MH examinations found in the STR after May 2006 and 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 PTSD 10%, coded 9411 (PTSD), citing delayed onset. The VA rated the PTSD 100%, coded 9411, based on the STR, citing findings from four examinations which showed total occupational and social impairment. Panel members determined 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. There was no evidence to support a rating higher than 50% at the time of TDRL placement, and the most proximate source of comprehensive evidence on which to base the permanent rating recommendation in this case was the NARSUM examination, which noted contradictions and inconsistencies between CI reporting and the medical records. While he denied direct exposure to combat, he later stated that he participated in active combat. He was diagnosed with delayed onset PTSD after previous denials of MH problems with no history of hospitalizations, legal involvement or emergency room visits prior to separation. The CI also reported he was isolated, detached and without intimate relationships, yet he married in August 2006 and remained so at the 2008 C&P examination. The STR noted a beneficial response to medications but the CI disagreed, and during the MSE he reported symptoms of depression and showed signs of antisocial behavior. Panel members agreed the preponderance of evidence indicated the CI did not meet criteria for a rating higher

than the 10% adjudicated by the PEB. 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 the 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; 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%	10%	

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

IN REPLY REFER TO,
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:	XXXXXXXXXXXX
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.