RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04250
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070629

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 “posttraumatic stress disorder (PTSD)” with a disability rating of 10%.  

CI CONTENTION:  The CI contends that his PTSD and depression have prevented him from working in the military or civilian employment sectors.  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 - 20070409	VARD - 20070920	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	50%	20071217	
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 reported being in a constant state of fear due to various incidents during his first deployment in 2003.   However, it was during his second deployment when he experienced his most intense combat experiences.  During his second deployment he wished he would get killed. After his return from deployment, he reported symptoms of PTSD and was removed from recruiting duties due to anxiety.  He had low self-esteem and significant symptoms of depression and was hospitalized in 2006 due to suicidal ideation.  

During the 12 March 2007 MEB psychiatric NARSUM evaluation, 4 months prior to separation, the CI reported recurrent thoughts of his activities in Iraq and felt badly about many of his actions.  Sleep had improved with medication and mood improved when taken off recruiting duty.  Medications included an anti-depressant, anti-anxiety and sleep aide.  Mental status examination (MSE) showed psychomotor retardation, dysphoric mood and a sad and restricted affect.  The CI denied suicidal ideation.  Diagnoses of PTSD, major depression and dysthymic disorder were rendered with a Global Assessment of Functioning (GAF) score of 55 (moderate symptoms, impairment.)

At the 17 December 2007 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported poor short-term memory, nightmares, weekly panic attacks, interrupted sleep (slept 6-8 hours), avoidance behavior, irritability towards his wife’s children, intrusive thoughts, verbal aggression and a tendency to isolate from others.  Psychological testing showed severe levels of depression, anxiety and hopelessness with some suggestion of exaggeration.  He planned to seek psychiatric care through the VA.  He was employed in a full-time position, was performing his duties in a competent manner and preferred to work alone.  He reported significant financial difficulties.  He lived with his wife and children, had a fairly stable marriage and reported no close friends, but kept in touch with his mother and siblings.  He engaged in various activities with his wife’s children and periodically rode his motorcycle with his wife.  The MSE showed a well-groomed, well-nourished man.  He denied suicidal ideation, but had difficulty with concentration.  The examiner opined the mental health symptoms appeared to result in occupational and social impairment with occasional decreases in work efficiency and intermittent periods of an inability to perform occupational tasks.  A diagnosis of PTSD with associated depression was rendered with a GAF score of 53 (moderate symptoms, impairment.)

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD 10%, coded 9411 (PTSD), citing mild industrial impairment.  The VA initially rated the PTSD 50%, coded 9411, based on the C&P examination, citing the provision of 38 CFR 4.129 and then changed per VARD, dated 20080303 to 30% effective 17 December 2007.  

The panel noted that IAW DoD guidance, VASRD §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 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 psychiatric condition, 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 mental health disorders).  

The panel considered the §4.130 rating at TDLR placement.  The §4.130 criteria for a 70% rating is “occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood,” and for a 50% rating, “occupational and social impairment with reduced reliability and productivity.”  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 is applicable.

The most proximate source of comprehensive evidence on which to base the permanent rating is the C&P examination 6 months post-separation.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” and for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  Although the CI reported continued symptoms with nightmares and panic attacks, he was working full time, living in a stable relationship and enjoyed some leisure activities.  He continued to take medication for his PTSD symptoms and the STR showed he continued to seek treatment.  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 30% permanent rating thereafter for the PTSD.  

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 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:

AR20190004347, 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 Disabili y 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.