RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017	-0536	1
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20071215
SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Small Arms Repairer/Technician, medically separated for “post-traumatic stress disorder [PTSD]” with a disability rating of 10%.
CI CONTENTION: The VA provided a higher rating for the PTSD. 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 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 – 20070920	VARD – 20080523	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	10%	PTSD with Alcohol Dependence, Flashbacks, Insomnia, Sleep Disorder, Nightmares, Memory Loss and Depression	9411	50%	20080229	
Alcohol Dependence	Cat IV					
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 experienced multiple traumatic combat exposures while deployed to Iraq from 2004 2005, and he started to have flashbacks, intrusive memories, dreams, irritability with angry outbursts and sleep problems which worsened and eventually included symptoms of depression. He began to drink heavily and was diagnosed with alcohol dependence. Despite the intensity of his PTSD symptoms, he never required psychiatric hospitalization or emergency room (ER) treatment.

The 15 September 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of PTSD symptoms which included avoidance behavior, emotional distancing, sleep difficulty, irritability, and angry outbursts. He also reported decreased concentration and energy as well as loss of interest in activities, and drank heavily to “get rid” of the memories and feel

better. The mental status examination (MSE) was unremarkable with the exception of “down mood.” Judgment was intact and alcohol dependence was noted to be in early remission.

At the 29 February 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported depressive and intrusive thoughts, hyperarousal, avoidance of reminders of the war, and a 6-year history of sleep difficulties with no regular bedtime and early awakening. He had not received psychotherapy for PTSD within the past year, and had not been prescribed medication for his symptoms. The CI had difficulty finding work after separation, was not in a relationship, and had very few friends. The MSE was unremarkable with memory and concentration intact, and unimpaired judgment. There was no history or report of suicidal or homicidal ideation.

The 13 May 2008 psychiatric admission note, 5 months after separation, indicated that the CI was admitted to a 3-month treatment program for PTSD and alcohol dependence on referral from his primary care provider. He was enrolled primarily in the substance abuse track, and was offered combat programming while completing the addiction treatment. The MSE showed that he was somewhat guarded and slightly defensive about his drinking history. He was mildly hypervigilant, and his mood was depressed and affect restricted.

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%, analogously coded 9411, based on the C&P examination, citing 4.130 criteria for a 50% rating. Panel members first considered the provisions of VASRD §4.129 (mental disorders due to traumatic stress), and determined that the PTSD was due to a “highly stressful event,” and that 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. The panel agreed there was no evidence to support a rating higher than 50% rating at the time of TDRL placement, and then turned to its permanent rating recommendation at the time of TDRL removal. Panel members noted that C&P examination documented the absence of panic attacks, memory problems, or significant mood symptoms, and that the CI was not receiving any form of treatment for his condition with no history of psychiatric hospitalization or ER visits. The MSE was unremarkable with intact judgement and no cognitive impairment; he had not be unable to find work at that time. The May 2008 admission note for the inpatient treatment program documented an MSE showing mild hypervigilance, depressed mood, and restricted affect, but that the CI had not received any treatment for PTSD symptoms since separation and had not sought any ER care. The panel concluded that the evidence demonstrated the condition was most reflective of a 10% level of disability 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.” 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 10% for the PTSD.

Contended PEB Condition: Alcohol Dependence. The panel noted that at the time of separation, alcohol dependence did not constitute a physical disability and was therefore was not compensable IAW DoDI 1332.38.E4.13.1.4.

BOARD FINDINGS: In the matter of the PTSD, the panel recommends an initial TDRL rating of 50% in retroactive compliance with VASRD §4.129 as DoD directed; and a 10% permanent rating at 6 months IAW VASRD §4.130. In the matter of the contended alcohol dependence, the panel agrees it cannot recommend it for additional disability rating. 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	
Post-Traumatic Stress Disorder	9411	50%	10%	

The following documentary evidence was considered:

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

Ill REPLY R!:FER TO:
1850
CORB: 003
10 Sep20

From: Director, Secretary of the Navy Council of Review Boards To:

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.