RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXX	CASE:  PD-2019-00082
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041021

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Cook, medically separated from the Temporary Disability Retired List (TDRL) for “posttraumatic stress disorder [PTSD]” with a disability rating of 0%.   

CI CONTENTION:  Review requested of the mental health (MH) and scar conditions as well as an additional condition (back) 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 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 - 20041008	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
PTSD	9411	0%	No VA Examination Proximate to Separation in Evidence	
Facial Scars	Not Unfitting		
Right Arm Scars	Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

PTSD.  According to the service treatment record and MEB narrative summary (NARSUM), the CI received 13 surgeries as a result of burns to her face and arms when an M2 burner exploded in a mobile kitchen trailer during a deployment in March 1996.  She subsequently presented with depressive symptoms and reported nightmares, and was diagnosed with depressive disorder which was treated with anti-depressants.  In July 1997, she was diagnosed with PTSD.   She was not able to perform her military duties and was separated and placed on the TDRL on 21 July 2000 with a disability rating of 30%.

During the 13 May 2002 TDRL re-evaluation, 2 years prior to TDRL removal, the mental status examination (MSE) showed an “OK” mood with a mildly restrictive affect.  The CI denied suicidal/homicidal ideations or auditory/visual hallucinations, and memory was grossly intact, with good insight and judgement.  The examiner opined that the MH condition was not stable as she continued to experience significant symptoms that interfered with her daily life.  PTSD was diagnosed with a Global Assessment of Function (GAF) score of 65 (mild symptoms).

The 24 March 2004, TDRL re-evaluation, 7 months prior to TDRL removal, noted CI complaints of a “down” mood most of the time and trouble with sleep, although medication helped.  She reported low energy and constant tiredness, as well as decreased focus, concentration, and interest.  She had low self-esteem and irritability, and experienced flashbacks of the kitchen explosion 3-4 times per week, as well as nightmares.  She denied suicidal ideation but had thoughts of death.  She lived with her two teen sons, adopted granddaughter and baby, and a friend’s 19-year-old daughter.  She attended church regularly and took college courses; her activities were primarily limited to home and school.  She saw a VA psychotherapist weekly who also monitored her psychotropic medication which included an anti-depressant and sleep aid.  She did not required hospitalization in the previous 2 years.  During the MSE, the CI looked tired and had a serious and briefly tearful affect.  Her mood was down and vital sense was low, and she stated that “sometimes I feel I could do more, I should be over explosion memories.”  She had thoughts of death but not suicide, delusions, or hallucinations.  The CI had obsessive-compulsive phenomena as she repeatedly checks door locks and the stove, and she was fearful of bridges.  She considered cooking her true vocation, but was afraid she could not handle a kitchen work setting.  The examiner opined that the MH condition seemed somewhat improved from 2 years earlier, but for the last 18 month she had been in major depression with considerable impairment for social and industrial adaptability.  The diagnoses included PTSD and major depression with a GAF score of 75 (transient symptoms).  

During the 27 July 2004 TDRL re-evaluation, which was requested by the PEB and performed over the telephone 3 months prior to TDRL removal, the CI reported working at a chemical plant for 2 months but was not able to return to her preferred work as a cook.  She had to finish two more college courses before she received her business administration degree, remained in psychiatric therapy, and continued to take medications for depression and sleep.  The examiner opined that her MH symptoms seemed somewhat improved, although she still had flashbacks and nightmares about the kitchen explosion.  She was not hypervigilant, did not experience excessive anxiety or panic symptoms, and did not wake up from sleep in a state of fright.  She was dealing with her traumatic stress and life situation with the desire to work in a kitchen setting, and although her impairment for social and industrial adaptability was considerable, her potential for growth and recovery were more positive after being overshadowed by major depression for the previous 18 months.  The CI was diagnosed with PTSD and major depressive episode and assessed with a GAF score of 75.  There was no VA examination proximate to TDRL removal in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the PTSD 0%, coded 9411 (PTSD), citing the CI “reports receiving psychiatric care and medications however the up to date pharmacy record submitted from Fort Bragg does not support this report.”  The panel agreed that application of §4.129 was appropriate in this case the minimum 50% rating for the period on the TDRL was warranted as there was no evidence to support a rating higher at the time of TDRL placement.  The panel next considered the §4.130 rating at the time of separation, and noted that the TDRL re-evaluations documented the CI’s ongoing PTSD and depression diagnoses which required psychiatric therapy and medications.  Although her social and industrial adaptability impairment was noted to be considerable, she was able to perform all activities of daily living without interference, care for multiple children, work, and attend church and college.  Thus, the panel agreed that the MH condition was best characterized by a 10% disability for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  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, coded 9411. 

Contended PEB Conditions:  Facial Scars and Right Arm Scars.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no current performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at TDRL removal.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determinations for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the PTSD, the panel recommends an initial TDRL rating of 50% and a 10% permanent rating IAW VASRD §4.130.  In the matter of the contended facial and right arm scars, 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 the date of medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Post-Traumatic Stress Disorder	9411	50%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20190105, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20200005933

XXXXXXX

Dear XXXXXXX:

	In the initial response to your application to the Department of Defense Physical Disability Board of Review (DoD PDBR) I accepted the recommendation 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 payment and then following this six month period re-characterize your separation with the combined disability rating of 10%.  My previous decision was forwarded to the United States Army Physical Disability Agency (USPDA) for implementation on 8 September 2020.

	The DoD PDBR has amended their recommendation and Record of Proceeding (copy enclosed) and found you should have been constructively placed on the TDRL at 70%. The TDRL period will result in an adjustment to your pay providing you 70% disability for six months effective the date of your original medical separation for disability with severance payment and then no re-characterization of your separation or modification of the permanent disability rating which will remain at 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. Any inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 1835 Army Boulevard, Bldg. 2000, JBSA, Fort Sam Houston, TX. 78234

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

Sincerely,