RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04513
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20080326

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

CI CONTENTION:  “Review of 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 - 20080225	VARD - 20081022	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD	9411	50%	20080923	
Memory Lapses	Not Unfitting	Traumatic Brain Injury	Unknown	10%	20081210	
Mild Bilateral Hearing Loss	Not Unfitting	Bilateral Hearing Loss	Unknown	NSC	20081210	
Headaches	Not Unfitting	No VA Placement	
Bilateral Knee Pain	Not Unfitting 		
Chronic Low Back Pain	Not Unfitting	Chronic Lumbar Strain	Unknown	10%	20081210	
Front Tooth Injury	Not Unfitting	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Posttraumatic Stress Disorder (PTSD).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health (MH) symptoms began several months after he returned from deployment in June 2005.  During his 2004-2005 deployment, he witnessed casualties from an IED attack on his fellow soldiers during a mounted patrol.  The CI did not seek MH care until October 2007 for his reported symptoms of nightmares, irritability, depressed mood, loss of interest in activities and avoidance behaviors.  He was prescribed psychotropic medication that was beneficial.  He began to sleep better, but his anxiety continued.  The CI had no history of psychiatric hospitalization or treatment in the emergency room (ER) for MH issue while in the military.
  
The 20 December 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of irritability, insomnia and depression.  The CI also reported experiencing nightmares, hypervigilance, loss of interest in significant activities and exaggerated startle responses.  He avoided talking about his combat experiences and avoided situations that reminded him of them.  The CI had never married but had a girlfriend who was pregnant with his child.  The girlfriend was a source of emotional support.  The mental status examination (MSE) showed exaggerated startle response and hypervigilance.  He also had a depressed and anxious mood and affect.  All other aspects of the examination were unremarkable.  The diagnosis of anxiety disorder not otherwise specified was recorded and the examiner opined that the CI’s symptoms were mild or transient “which decrease his work efficiency and ability to perform occupational tasks during periods of significant stress and will require continuous medication to control his symptoms.”

During the 29 January 2008 case management weekly visit, 2 months prior to separation, the CI reported that he had continued working at the transportation section and was doing well.  He was worried about not having furniture for his new apartment and he still planned to leave the military.  On 25 February 2008, the psychiatrist changed the CI’s diagnosis to PTSD.  

At the 23 September 2008 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported that he stopped taking psychotropic medication after leaving the military.  He had not worked since leaving the military and gave no further explanation.  He complained of being angry and irritable, and his concentration was poor.  He reported “severe” depressed mood and that he enjoyed very little like going out or being with friends.  He felt guilty about things that occurred during deployment.  He felt sluggish and slowed down.  The CI noted that he had never been to the ER or hospitalized for MH issue.  He also reported nightmares about three times a week, had an occasional flashback and did not feel comfortable in crowds.  He had married and had one child, but he recently learned that he had fathered a child during a past relationship.  He stated that he slept only about 4 hours per night and that his wife no longer shared the bed with him since he “thrashes about and can hit during his sleep.”  The MSE was unremarkable with the exception of a sad mood and blunted affect.  The examiner opined that the CI’s prognosis was fair if he could get appropriate psychotherapy and pharmacotherapy for his condition and that his current functioning was “quite poorly on a day to day basis.” 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD 10%, coded 9411 (PTSD) citing mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress; symptoms controlled by continuous medication.  The VA rated the PTSD 50%, coded 9411, citing occupational and social impairment with reduced reliability and productivity.  

The panel determined VASRD section §4.129 (mental disorders due to traumatic stress) applied because PTSD was the 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% with reassessment after six months.  The panel considered the rating at TDLR placement and agreed the §4.130 criteria for a rating higher than 50% were not met near the time of separation, and therefore the minimum 50% TDRL rating is applicable.

The most proximate and only source of evidence on which to base the permanent rating is the C&P examination 6 months post-separation.  Panel members noted the CI was not receiving any form of MH treatment and was not taking psychotropic medication.  He reported problems with sleep and concentration, and although he reportedly described having had panic attacks, he was never treated in the ER, and frequency of attacks was not documented.  The CI also reported depressed mood and irritability, and had discontinued his antidepressant medication for unknown reasons.  Anxiety symptoms were not documented during the examination.  During the MSE, his concentration was not impaired, judgment was not impaired and there was no documented issue with his thinking or memory.  Although the examiner stated the CI’s functioning was “quite poorly on a day to day basis,” the examiner did not detail the CI’s daily activity, nor was there evidence documented in the examination that supported an opinion that the CI was functioning “quite poorly on a day to day basis.”  The CI was not employed; however, there was no evidence that his MH condition would have interfered with employment since there was no mention that the CI was seeking employment.  He did indicate that he would occasionally go out with friends but did not enjoy going out much.  He was married and living with his wife and young child, there was no report of domestic violence, or violence in the community.  His symptoms were stable and despite the absence of medication, his condition did not require emergency care or hospitalization, and the C&P examiner opined that the CI’s prognosis would be fair with treatment.  Panel members concluded, at the time of separation, 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, or; symptoms controlled by continuous medication.”  After due deliberation, considering all of 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. 

Contended PEB Conditions: Memory Lapses, Mild Bilateral Hearing Loss, Headaches, Bilateral Knee Pain, Chronic Low Back Pain (LBP) and Front Tooth Injury.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The memory lapses and front tooth injury were not profiled, and although the conditions of hearing loss, LBP and knee pain were listed on the profile as “2,” none of the conditions were implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions 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 any of the contended conditions and so no additional disability ratings are 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 contended memory lapses, mild bilateral hearing loss, headaches, bilateral knee pain, chronic LBP and front tooth injury, the panel recommends no change from the PEB determinations 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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Posttraumatic Stress Disorder	9411	50%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170522, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180006666 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 recharacterization 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 recharacterization of your separation or modification of the permanent disability rating of 10% following the constructive six month TDRL period. 
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	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), XXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure