RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04206
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051231

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Signal Support Systems Specialist, medically separated for “posttraumatic stress disorder (PTSD)” with a 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 - 20051013	VARD - 20060321	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD 	9411	50%	20051214	
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’s mental health (MH) disorder began in January 2005 after a sexual assault.  The assailant was convicted of the crime in May 2005.  Initially after the rape she took six or seven showers because she constantly felt dirty and isolated herself in her room, resulting in social impairment and inability to work for 2 months.  She self-referred to behavioral health for frequent nightmares related to the assault.  

The 10 August 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of frequent nightmares and recurrent and intrusive thoughts related to the assault.  She reported feeling on edge, near constant anxiousness and easy startle.  The anxiety prevented sleep and she felt uneasy around male soldiers.  Occasionally she experienced panic attacks with increased heart rate and shortness of breath, which occurred every 3 days.  Seeing male figures that resembled the assailant precipitated feelings of panic.  After the assault, she sought the comfort of a male friend, which led to pregnancy.  She had a history of childhood sexual molestation at ages 4-7, but denied symptoms of PTSD prior to enlistment.  Prior to pregnancy, she was prescribed Zoloft (anti-depression).  She declined medication during pregnancy but continued individual therapy with a psychologist.  The mental status examination (MSE) showed a pregnant female, who described herself as “anxious.” Mood was labile with periods of tearfulness while describing the rape.  The examination was otherwise normal.  A diagnosis of PTSD was rendered with a Global Assessment of Functioning (GAF) score of 60 (mild impairment).

At the 14 December 2005 VA Compensation and Pension (C&P) examination, 1 month prior to separation, the CI reported symptoms of obsession and compulsion that were assault related.  She was in outpatient treatment from January through December 2005 and found it helpful.  Nightmares had significantly diminished and in the past 2 months she only had about two of them.  She had daily intrusive recollections of the assault and occasional flashbacks, if she sees men who favor her assailant.  She spent most of her time in her room and became hyper vigilant in public.  She had withdrawn from all but one friend.  Anger and irritability had improved with treatment.  Sleep remained disrupted, in part due to her pregnancy.  She continued to wash her sheets on a daily basis to stay clean.   She was residing in the officer’s barracks where she felt safer but planned to move to New York and live with her parents with the ultimate goal of going to medical school.  The MSE showed an appropriate affect but occasional disruptions in her focus and concentration.   Diagnoses of PTSD and obsessive compulsive disorder due to military trauma were rendered with a GAF score of 62 (mild impairment).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MH disorder 10%, coded 9411 (posttraumatic stress disorder), citing a history of abuse as a child and discontinuance of anti-depressant medication due to pregnancy. The VA rated the MH disorder 50%, coded 9411, based on the C&P examination, citing the VASRD criteria for a 50% rating.  IAW DoD guidance, VASRD section §4.129 (mental disorders due to traumatic stress) is applied when PTSD is an unfitting condition.  Therefore, as a matter of policy, the PDBR must recommend placement of the CI on a period of constructive TDRL with a minimum rating of 50% IAW §4.129 with reassessment after six months. Disability associated with any MH disorders, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 (general rating formula for MH disorders).  The panel then considered if there was evidence for a §4.130 rating higher than the §4.129 50% minimum at time of TDRL placement.  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% TDRL placement rating is applicable.

The most probative source of comprehensive evidence on which to base the permanent rating is the C&P examination.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” a 30% rating requires evidence of “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while the criteria for a 50% rating requires evidence of “occupational and social impairment with reduced reliability and productivity.  The C&P noted the CI improved with treatment but still had daily intrusive thoughts and anxiety when seeing men who looked like her assailant.  She remained isolative, had sleep difficulties and developed obsessive-compulsive symptoms.  Panel members agreed her symptoms most closely approximated the criteria for 30% rating.  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 rating for the constructive period of TDRL IAW VASRD §4.129 and a 30% permanent disability.  

BOARD FINDINGS:  In the matter of the MH disorder, 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 30% 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	
PTSD	9411	50%	30%	

The following documentary evidence was considered:

AR20190006850, 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 recharacterize 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 recharacterization 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.