RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05217
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080612

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Intelligence Analyst, medically separated for “anxiety disorder” with a disability rating of 10%. 

CI CONTENTION:  In addition to contending that his mental health (MH) disorder should not have been changed from PTSD, the CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 – 20080422	VARD - 20090106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Anxiety Disorder	9413	10%	PTSD	9411	10%	20081208	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Anxiety Disorder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI sought medical attention in October 2007 after returning from a deployment to Iraq.  The CI reported a 6-month history of anxiety, fear, hopelessness, helplessness, worthlessness, emptiness and stress.  He also felt depressed and had problems with sleep that included nightmares almost nightly.  He reported seeing providers in theater for symptoms associated with PTSD, for which he was diagnosed.  The events of the last deployment bothered him the most due to shooting a combatant and this was the main focus of his nightmares.  He reported the nightmares were so bad he was removed from his assignment.  Symptoms became problematic during his deployment in September 2006 to Iraq.  He also reported flashbacks and nightmares.  During the evaluation a detailed assessment for PTSD was significant.  He was treated with anti-depression and sleep medication, and had several crisis appointments.  There were frequent calls to his therapist and initially he required several quarters slips to lower his level of anxiety.  The CI had a deployment history to Afghanistan in 2001 and to Iraq in 2003 and 2006.  

The 21 December 2007 MEB NARSUM examination, 6 months prior to separation, noted complaints of anxiety.  He was treated with Eye Movement Desensitization Reprocessing (EMDR), to help with his intrusive recollections.  He remained on anti-depression and sleep medications, noted less irritability and was showing improvement while being assigned to the Warrior Transition Unit.  A diagnosis of PTSD was rendered with a Global Assessment of Functioning (GAF) score of 50 (moderate impairment).  The mental status examination (MSE) showed initial psychomotor agitation with motor restlessness, okay mood and anxious affect.  He appeared uncomfortable when the phone rang in another office.  In response to a PEB query, his commander submitted a statement dated 17 April 2008, which verified the CI’s deployment history and exposure to dangerous incidents.  

During the 14 July 2008 VA Compensation and Pension (C&P) psychiatric examination, 1 month after separation, the CI reported anxiety and hypervigilance.  He was working as a government contractor and reported having plans to return to school.  He was married, had no close friends but enjoyed social activities including yard work, photography, movies and playing games with his children.  He reported some concern with memory loss and impairment, decreasing panic attacks, low motivation and periods of mild depression.  A diagnosis of cognitive disorder was rendered with a GAF score of 70 (mild impairment) and the MSE was unremarkable.  

At the 8 December 2008 C&P PTSD examination, 6 months after separation, the CI reported mild symptoms with marked improvement since EMDR therapy.  He was worked full time and traveled 90% of the time.  He had friends from work and the military.  He denied panic attacks or problems with military, and the MSE was unremarkable.   A diagnosis of PTSD was rendered with a GAF score of 75 (mild impairment).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MH disorder 10%, coded 9413 (anxiety disorder, not otherwise specified), citing PTSD was not confirmed by stressors and was rated for symptoms controlled with continuous medications.  The VA rated the MH disorder 10%, coded 9411 (PTSD), based on the C&P examination, citing occupations 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 medications.  

Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnosis, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for MH disorders.  The panel considered if application of VASRD §4.129 with a 6-month (50% minimum) period on the TDRL was indicated in this case.  Panel members agreed the provisions of VASRD §4.129 were applicable in this case due to combat stressors.  The CI’s commander identified CI exposure to several dangerous incidents.  The panel then considered if there was evidence for a §4.130 rating higher than the §4.129 minimum mandated 50% at time of constructive 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% initial TDRL rating is applicable.

The most proximate source of comprehensive evidence on which to base the permanent rating was the 6-month post-separation C&P examination for PTSD.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  The CI reported mild symptoms with marked improvement.  He was working full time as a contractor while he pursued a college degree, was married, had friends and enjoyed social activities.  The panel concluded there was no evidence of occasional decrease in work efficiency and intermittent inability to perform occupational tasks to achieve a rating of 30%.  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 MH disorder. 

BOARD FINDINGS:  In the matter of the MH disorder, the panel unanimously 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.  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	
Anxiety Disorder 	9413	50%	10%	

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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.  Inquiries 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.