RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04675
BRANCH OF SERVICE: MARINES	SEPARATION DATE: 20071130

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E1, Rifleman, medically separated for “posttraumatic stress disorder (PTSD), delayed onset” with a 10% disability rating.

CI CONTENTION: “The US Marine Corps discharged me with a 20% severance pay (which I had to pay back to the US Department of Veterans Affairs) for my combat related PTSD. While in combat in Al Anbar, Iraq, I was knocked unconscious by an Improvised Explosive Device (IED). This IED explosion resulted in Traumatic Brain Injury (TBI), Tinnitus, Chronic headaches and PTSD. The United States Marine Corps (USMC) only considered the PTSD and none of the other underlying conditions, and, on top of that they rated the PTSD under “mild impairment”. I was immediately rated 70% by the VA (50% PTSD, 30% Migraines, 10% Tinnitus). This rating was later increased to 100% from December 1, 2007, which was 1st day after. I have been rated 100% disabled through the VA from December 1, 2007 to Present. My USMC separation at 20% was, I feel, significantly low and unjust.” [Sic] 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 - 20070906	VARD - 20080314	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD (Delayed Onset)	9411	10%	PTSD	9411	50%	20080220	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

PTSD. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s PTSD began after his re-deployment from Iraq in March 2005 where he had been exposed to intense combat, constant indirect fire, convoys being hit by IEDs and loss of fellow Marines. The CI received a Purple Heart and a Combat Action Ribbon. After redeployment, he reported feeling relatively well for the first few weeks but then experienced decreased sleep, intrusive thoughts of combat, inappropriate anger outbursts, and intermittent suicidal ideation. His anger/irritability interfered with his work and he was referred for a mental health (MH) evaluation in July 2005.

The CI revealed he had been on unauthorized absence (UA) for about 20 days and had twice jumped in front of moving vehicles with an unclear intent. He recalled he felt extremely detached and did not care if he lived or died due to the losses he had experienced in Iraq. Psychological testing in 2005 revealed longstanding personality pathology and he was recommended for administrative separation in August 2005. However, the CI wanted to remain in the Marines and decided to go UA. He worked on boats and lawns in Florida for 18 months but decided to turn himself in. He faced the possibility of a court martial. He felt remorse and acknowledged he was being “difficult” during the evaluation and regretted not being open and honest with the evaluator. On 23 May 2007, the CI endorsed problems with insomnia, dreams of combat, intrusive images of combat experiences, detachment, hypervigilance and other symptoms of PTSD. He was diagnosed with PTSD and a treatment plan was devised that included individual and group psychotherapy. He declined referral for psychotropic medication. Leadership did not pursue court martial. He was treated with Ritalin for ADHD but discontinued it on his own.

The 13 July 2007 MEB NARSUM examination, 5 months prior to separation, noted symptoms of PTSD unchanged from his initial session on 24 May 2007. He was determined not capable of performing duties consistent with his military occupational specialty due to the severity of his symptoms. The CI reported he drank heavily following his deployment to include a case of beer per night. He cut back but occasionally binge drank. He had a girlfriend who resided in Florida. The relationship was supportive and he denied any abuse. The CI was working in a limited duty capacity with some restrictions. Mental status examination (MSE) showed limited insight and fair judgment. An Axis I diagnosis of PTSD, delayed onset was rendered and the Global Assessment of Functioning (GAF) score was 60 (moderate bordering on mild). The examiner opined moderate impairment in civilian capacity on the basis of PTSD.

At the 20 February 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported psychiatric admission for 3 days in November 2007. He was prescribed Haldol (psychosis), Ativan (anxiety), Seroquel (psychosis) and Celexa (depression, anxiety). He was living with friends when a friend died 17 December 2007. He felt extremely upset and guilty. He had increasing bouts of depression and sleeplessness and began attending the MH clinic 2 days after his friend’s death. The CI reported depression and continued problems with anxiety, irritability, sleep, and intrusive thoughts, including images of his combat experiences and of his friend who died. The CI reported bad dreams of his friend and other people dying, of being fired at, seeing explosions, low energy, and poor short-term memory. He reported he was often anxious and nervous and became upset easily. The CI reported recurrent thoughts of suicide and hopelessness at times. He was unemployed and living with a male friend with whom he shared an apartment. He spent time mostly to himself and going to church. He visited his aunt who was very supportive. His relationship with his girlfriend was “on and off.” He planned to return to school.

MSE showed the CI appeared sad, downcast and quite withdrawn. He became quite emotional when he described the traumatic events in Iraq, albeit with a sense of detachment at times. He admitted to feeling paranoid at times and claimed he felt confused, down and depressed. He reported recurrent thoughts of suicide but denied any serious plan or intent. An Axis I diagnosis

of PTSD was rendered and Axis II diagnoses were deferred with a GAF score of 55-60 (moderate symptoms, impairment). The examiner opined the CI remained socially isolated and had not been able to maintain positive and effective relationships. His response to therapy was good and he seemed quite motivated to remain in treatment.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the PTSD 10%, coded 9411 (PTSD). The VA rated the PTSD 50%, coded 9411, based on the C&P examination, citing the VASRD rating criteria. 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. Members agreed the §4.130 criteria for a rating higher than 50% at the time of TDRL placement were not met; and, the minimum 50% TDRL rating prescribed by §4.129 is applicable. The panel then turned to its permanent rating recommendation at the time of TDRL removal. The most proximate source of comprehensive evidence on which to base the permanent rating recommendation in this case, is the C&P PTSD examination, performed 3 months after TDRL placement. The CI continued to endorse symptoms of PTSD. The MSE documented sadness, tearfulness and withdrawal. He reported depression and thoughts of suicide, although he was motivated for and compliant with treatment. The panel members agreed the CI most closely met criteria for 30% disability. 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 30% for 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 30% 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%	30%	

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

IN REPLY REFER TO,
1850
CORB:003
12 Oct 20

From:	Director, Secretary of the Navy Council of Review Boards To:	
Subj:	PHYSICAL DISABILITY BOARD OF REVIEW {PDBR) Ref:	{a) DoDI 6040.44
{b) PDBR ltr of 12 Aug 19

1.	Pursuant to reference {a), the PDBR reviewed your case and forwarded its recommendation {reference {b)) to the Department of the Navy for appropriate action.

2.	On 5 October 2020, the Assistant Secretary of the Navy took action in your case by accepting the correct recommendation of the PDBR.	Accordingly, your records will be corrected to reflect your assignment to the Temporary Disability Retired List for six months with a 50 percent disability rating followed by placement on the Permanent Disability Retired List with a final rating of 30 percent.

3.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the Office of the Deputy Commandant {Manpower and Reserve Affairs), for correction of your records as stated above.	You will be notified once those changes are complete.