RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04192
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070906

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated for “PTSD” and “status post [S/P] second degree burns to bilateral upper extremities,” rated 10% and 0%, respectively, with a combined disability rating of 10%.   

CI CONTENTION:  Review all conditions. 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 – 20070713	VARD - 20081114	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	30%	20080917	
S/P Second Degree Burns to Bilateral Upper Extremities	7801	0%	Burns, Bilateral Hand Dorsum	7805	0%	20080916	
Facial Burns	Not Unfitting	Facial Scars Residuals of Burns	7800	NSC	20080916	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

PTSD.  According to the service treatment record (STR) and MEB mental health (MH) narrative summary (NARSUM), the CI’s MH disorder resulted from a car bomb explosion on 16 July 2006 while deployed.  The CI reported anxiety and nightmares since the incident.  He also reported other symptoms of PTSD.  The CI’s condition was treated with psychotropic medication.  The 4 April 2007 MEB NARSUM psychiatric examination, 5 months prior to separation, noted complaints of inability to tolerate crowds of people.  The mental status examination (MSE) was unremarkable with the exception of irritable mood and affect.  Memory was intact and judgement was good.  The CI did not have a history of suicidal or homicidal ideation, panic attacks, chronic sleep impairment, significant memory problems or psychiatric hospitalization.

At the 17 September 2008 VA Compensation and Pension (C&P) examination, 12 months after separation, the CI reported not taking psychotropic medication for over a year.  The CI voiced no complaints.  The CI had been employed full-time for 1 year as a security officer.  He reported that he was getting along well with the people on the job but did not feel that “the corporation was adequate.”  The CI had no visits to the ER and reported good sleep.  The CI was single, had a girlfriend and lived with his parents.  The CI avoided activities and places that reminded him of the event and had irritability, anger outburst and difficulty concentrating, at times.  There was no history of alcohol or substance abuse.  The MSE was unremarkable.  The examiner assessed PTSD, mild chronic, and assigned a Global Assessment of Functioning score in the mild range for mild symptoms and or impairment.  The examiner stated that the CI’s “psychiatric symptoms are not severe enough to interfere with social and occupational functioning or to require continuous medication.”

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 30%, coded 9411, based on the C&P examination, citing the 30% evaluation was “warranted for symptoms of anxiety, suspiciousness, depression and flattened affect that [had] little interference with [the CI’s] social and occupational functioning.” 

The panel determined, IAW DoD guidance, that VASRD section §4.129 (mental disorders due to traumatic stress) applied because PTSD was an unfitting condition.  Therefore, as a matter of policy, the PDBR must recommend constructive placement of the CI on the Temporary Disability Retired List (TDRL) with a minimum rating of 50% IAW §4.129 with reassessment after 6 months. The panel considered the §4.130 rating at TDRL placement.  The STR showed that the CI had no chronic sleep impairment, significant impairment in concentration, memory impairment or panic attacks.  His MSE was unremarkable, except that he presented with irritable mood and affect.  There was no report of suicidal or homicidal ideation, no visits to the ER and no psychiatric hospitalizations.  There was no evidence of impairment in thinking or judgment. The commander’s performance statement noted the CI remembered the technical aspects of his MOS but would have had difficulty physically performing many of the assigned duties and he was not able to carry or fire a weapon.  However, the CI was able to work 40 hours per week providing support to the Soldier and Family Assistance Center.  He restocked supplies, answered phones and assisted visitors with finding information.  There was no mention of performance interference due to PTSD symptoms.  The panel agreed that the §4.130 criteria for a rating higher than 50% were not met near the time of separation, and therefore the minimum 50% initial TDRL rating was applicable.  

The panel next considered the rating at TDRL removal.  The VA C&P examination was the sole document available for consideration and documented a fairly normal MSE.  The CI did report he had occasional anger outbursts and irritability, but he noted good relationships at work.  He had maintained employment as a security officer for a year.  He had not received any mental health treatment for over a year.  There had been no psychiatric hospitalizations, visits to the ER, suicidal or homicidal ideation or panic attacks.  He continued to report nightmares related to Iraq.  He had a startled response and avoided situations and activities; however, there was no indication that his symptoms interfered with social or occupational functioning.  The MSE was unremarkable and the examiner opined, the psychiatric symptoms were not severe enough to interfere with social and occupational functioning or require continuous medication.  Panel members concluded, at the time of separation, the preponderance of evidence supports that the CI’s disability was most reflective of the 10% level for “occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress.”  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 50% for 6 months of constructive TDRL and a 10% permanent rating thereafter for the PTSD, coded 9411.

Status Post Second Degree Burns to Bilateral Upper Extremities.  The PEB combined the right and left upper extremity burn conditions under a single disability rating, coded 7802 (scars, other than head, face or neck that are superficial and do not cause limitation of motion) and rated 0%.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

According to the STR and MEB NARSUM, the CI’s bilateral upper extremity burns were a result of a car bomb exploding next to his vehicle on 16 July 2007.  The April 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, revealed facial burns with residual scars and hypersensitivity in both hands.  The 13 April 2007 MEB NARSUM examination, 5 months prior to separation, noted complaints of burns to the upper extremities.  All facial burns had healed.  Physical examination showed a 1x1 cm healed erythematous area on both the left and right hands.  There was patch of hypopigmentation that was about 9x8 cm at the dorsal right hand and a 6x5 cm hypo-pigmented area at the proximal right upper extremity.  Muscle strength was 5/5 in all digits.  Bilateral thumb met all fingers and tips of fingers met proximal transverse crease of the palm.

At the 16 September 2008 C&P examination the CI reported absence of symptoms from the burns, and absence of functional impairment.  Physical examination showed normal motor and sensory function in the bilateral upper extremities.  The examiner described the burn scars as numerous scattered small spots of hypopigmentation over the dorsum of both hands, with some of the spots confluent, and others separated by normal skin.  “Taking all of these spots in the aggregate; however, the total size for both hands would fall in the approximate range of 6 cm by 6 cm.”

The panel directed attention to its rating recommendation based on the above evidence.  As noted above, the CI was placed on constructive TDRL.  The PEB rated the bilateral upper extremity burn condition 0%, coded 7802 (scars, other than head, face or neck that are superficial and do not cause limitation of motion), citing left hand 1 sq. cm and right upper extremity 103 sq. cm, rated at less than 929 sq. cm.  The VA also rated the bilateral hand burn condition 0%, coded 7805 (scars, other), based on the C&P examination, citing a non-compensable evaluation for scars which were not considered disabling because of limitation of function of the affected part.

Panel members considered the objective findings and associated disability for each hand were identical with minimal pathology.  Panel members next proceeded with the rating recommendation at constructive TDRL placement and removal.  A 10% rating under code 7801 is granted for area or areas exceeding 6 sq. inches (39 sq. cm.); and the panel agreed that a non‑compensable rating was justified for both hands since neither met the 10% criteria.  There was no evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45).  There were no additional codes that would result in a compensable rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 0% for the right hand condition and 0% for the left hand condition.  As these result in no rating benefit to the CI, the panel recommends no re-characterization of the PEB adjudication for the bilateral upper extremity conditions at TDRL placement or removal. 

Contended PEB Condition:  Facial Burns.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the 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 the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS: In the matter of the PTSD, the panel recommends a disability rating of 50%, coded 9411 IAW VASRD §4.129 for 6 months from the time of discharge consistent with a constructive period of TDRL and then a permanent separation rating of 10% IAW VASRD §4.130.  In the matter of the bilateral upper extremity condition, the panel recommends no change in the PEB adjudication at the time of constructive TDRL placement or removal.  In the matter of the contended facial burns, the panel recommends no change from the PEB determination 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, effective the date of medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
PTSD	9411	50%	10%	
S/P Second Degree Burns to Bilateral Upper Extremities	7802	0%	0%	
COMBINED	50%	10%	

The following documentary evidence was considered:

AR20190004303, 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
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. 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.