RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05930
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20050414

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, medically separated for “posttraumatic stress disorder (PTSD)” with a disability rating of 10%.  

CI CONTENTION:  Review the rating for the PTSD and several other conditions not identified by the Medical Evaluation Board (MEB) or 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 - 20050222	VARD - 20050818	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Stress Disorder (PTSD)  	9411	10%	PTSD with Depression	9411	50%	20050628	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%  	

ANALYSIS SUMMARY:  

Posttraumatic Stress Disorder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s PTSD began in January 2004 during his deployment to Iraq where he witnessed 22 civilians “blown away.”  He developed nightmares, flashbacks, sleep difficulty, decreased concentration, psychomotor retardation and suicidal ideation which led to an unwitnessed suicide attempt with a gun in his mouth, but he couldn’t pull the trigger.  In August 2004, he was admitted to an inpatient psychiatry unit following a suicide attempt after returning from a 15-month deployment.  He was diagnosed with PTSD and major depressive disorder (MDD).  The CI reported multiple traumatic exposures while deployed to Iraq between January 2003 and July 2004 and the development of PTSD symptoms.  He reported marital discord and family stressors, and was in the process of getting a divorce.  During the mental status examination (MSE), the CI was slumped over the chair and was difficult to engage with consistent poor eye contact.  Speech was soft at a slow rate and he displayed evidence of psychomotor depression.  Mood was depressed with congruent dysphoric affect.  He improved with medications and suicidal ideation remitted with support and psychotherapy.  At discharge, 14 days post-admission, he was referred to the Army Substance Abuse Program.  

The 26 October 2004 MEB NARSUM, 6 months prior to separation, noted improved mood, improved level and comfort of interpersonal interaction and stability of thought content.  He was stable on his medication regimen of Zoloft, Seroquel (anti-psychosis), Trazodone (sleep aide), Prazosin (anxiolytic) and clonazepam (anxiolytic).  Diagnoses of PTSD and MDD were rendered with a Global Assessment of Functioning (GAF) score of 55 (moderate symptoms, impairment).

At the 28 June 2005 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported anxiety, depression, thoughts of death but no suicidal ideation, flashbacks, nightmares, occasional auditory and visual hallucinations of rockets, insomnia, feelings of guilt and low self-esteem and anhedonia on a constant basis.  Medications included Ambien (sleep aide), Trazodone, Prazosin, Zoloft, Seroquel and Clonazepam with good response.  He was in psychotherapy for the past year as often as one time per week.  He was enrolled at a technical college studying to become a mechanic.  He was not employed since he was a full-time student.  He was divorced but engaged to remarry.  He was able to engage in activities of daily living but was isolative and less likely to socialize.  He reported self-medication with alcohol due to anxiety and insomnia, drinking several alcoholic beverages per night during weekdays and a 12-pack of beer on Friday and Saturday nights.  The MSE showed flattened affect, depressed mood, episodes of unprovoked irritability, slowed and soft speech and panic attacks in response to PTSD triggers (crowds or loud noises).  The attacks were preceded by intense hypervigilance, peaked within two to three minutes and lasted up to 15-30 minutes.  He experienced intense fear of losing control, dizziness, tremors, increased heart rate and breathing, a sense of de-realization and mild nausea during the attacks.  Hallucinations were present on an intermittent basis.  He had mild memory difficulties with forgetting names, directions and recent events.  He had passive thoughts of death.  He had no difficulty understanding simple or complex commands.  Diagnoses included PTSD, MDD and alcohol abuse with a GAF score of 52 (moderate symptoms, impairment).  The examiner noted alcohol abuse was secondary to the PTSD and depression.  

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 occupational and social impairment with reduced reliability and productivity.  The panel, IAW DoD guidance, determined VASRD section §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.  The panel next considered if the §4.130 rating at TDLR placement exceeded 50%.  The criteria for the next higher 70% rating is “occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood.”  The panel agreed that the 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, 2 months post-separation.  The CI reported anxiety, depression, panic attacks, isolation, memory difficulties and excessive drinking of alcohol despite multiple medications at significant doses.  The MSE was abnormal as the CI reported occasional hallucinations and showed signs of depression and anxiety.  When a veteran's alcohol or drug abuse disability is secondary to or is caused or aggravated by a primary service-connected disorder, the veteran may be entitled to compensation. (Allen v. Principi, 1368, 1381 (Fed. Cir. 2001).  He had previously been a model soldier with no prior history of substance abuse or mental illness.  The panel agreed the CI met the criteria for 30% disability at the time of TDRL removal.  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 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 as of the date of the prior medical separation:  

UNFITTING CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Posttraumatic Stress Disorder	9411	50%	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170918, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008257, 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 re-characterize 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 re-characterization 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 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 
Sincerely,					      
						      					
Enclosure