RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
NAME: BRANCH OF SERVICE: army
CASE NUMBER: PD0900008 COMPONENT: reserve
BOARD DATE: 20090609 SEPARATION DATE: 20060803
_________________________________________________________________
SUMMARY OF CASE: This covered individual (CI) was an Army 2LT/O1E
medically separated from the Army in 2006 after 7 years of active service.
The medical basis for the separation was chronic right hip pain and Post
Traumatic Stress Disorder (PTSD). CI was an enlisted Army reservist (SSG)
medically evacuated from Iraq for a right hip injury. CI had abnormal
imaging studies and arthroscopic surgery did not resolve his pain. Due to
his hip profile, CI could not attend Officer Basic Course and it appears
that as the MEB evaluation started, multiple symptoms of PTSD and
depression came to light and PTSD with major depression was diagnosed. CI
was referred to the PEB, found unfit and separated at 10% disability for
his hip and 0% for his PTSD. Both the PEB and VA rated the right hip at
10%. The PEB specifically noted that non-compensable diagnosis (alcohol
dependence) and family issues were considered in the final 0% rating of
PTSD. The VA rated PTSD as 50%. The VA also rated non-unfitting
conditions of hypertension and left shoulder impingement each at 10%. The
CI contends that PTSD and Major Depression were not rated, or rated at 0%
by the PEB, and that the VA rated him at 50% (for PTSD/depression).
_________________________________________________________________
BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department
regulations or guidelines relied upon by the PEB will not be considered by
the Board to the extent they were inconsistent with the VASRD in effect at
the time of the adjudication. Hypertension and left shoulder impingement
are rated by the VA, but neither would be unfitting and are not contended.
The VA rated the CI’s right hip at 10% under a similar code to the PEB, and
this is not contended.
Regarding PTSD, the PEB specifically mentioned ‘non-compensable diagnosis
and family issues which are considered in the final rating.’ There was
likely heavy reliance on the commander’s comments indicating disagreement
with adding PTSD and depression to the board proceedings and that CI was
trying to end his career due to marital issues, depression and substance
abuse. The commander noted that no physical issues interfered with CI’s
duties. CI clearly met the diagnostic criteria for both PTSD and
depression and they were found to be unfitting by the PEB. Marital issues,
depression and substance abuse as noted by the commander are frequent
manifestations of PTSD and both military and VA psychiatrists opined that
CI’s alcohol abuse was self-medication for the CI’s mental health
conditions. The Board therefore did not support rating deductions for
either alcohol dependence (non-compensable diagnosis) or family issues.
Appling the VASRD General Rating Formula for Mental Disorders, the signs
and symptoms noted in the military records validate between a 30% and 50%
rating. Applying the signs and symptoms from the VA detailed psychiatric
examination of 20070301 (~7 months following service discharge) the VA
rated the CI at 50% by schedule criteria alone. The VA did not rely on
§4.129, Mental disorders due to traumatic stress, which calls for an
initial minimum 50% rating on Service discharge until a follow-up
evaluation. The Board unanimously agreed that the 20070301 evaluation was
the best indicator for CI’s disability at 6-months post-service discharge.
The Board did not agree with the VA’s 50% rating of that evaluation. The
Board independently rated the VA mental health evaluation and by a majority
rated the CI under code 9411 at 30%. The single voter for dissent
(recommended rating PTSD/depression at 50%) elected not to submit a
minority opinion.
_________________________________________________________________
RECOMMENDATION: The Board recommends that the CI’s prior determination be
modified as follows; TDRL at 60% for 6 months following the CI’s prior
medical separation (PTSD at minimum of 50% IAW §4.129 and DoD direction),
and then a permanent PTSD rating of 30% for a combined 40% disability
retirement as below.
|Unfitting Condition |VASRD Code |TDRL |Permanent |
| | |Rating |Rating |
|Chronic Right hip pain due to labral |5009-5003 |10% |10% |
|tear, onset while deployed to Iraq | | | |
|PTSD associated with depression arising |9411 |50% |30% |
|from wartime duty in Iraq | | | |
|COMBINED |60% |40% |
_________________________________________________________________
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20090114, w/atchs.
Exhibit B. Service Treatment Record.
Exhibit C. Department of Veteran's Affairs Treatment Record.
MICHAEL F. LoGRANDE
President
Physical Disability Board of Review
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AF | PDBR | CY2010 | PD2010-01039
The CI made no appeals, and was medically separated with a permanent 10% disability rating. As noted above, the July 2008 PEB found the PTSD stable for final rating, and the CI was permanently separated from the Army with a 10% disability rating. Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.
AF | PDBR | CY2010 | PD2010-00196
He met criteria for a depressive disorder, largely related to his combat trauma experiences in Iraq, although there is likely some previous depression, which was exacerbated by his experiences in Iraq. The second descriptor is only partially met as his PTSD symptoms had affected social relationships but he was working and work was noted to be “therapeutic.” At the 70% level he did manifest two descriptors, expressing suicidal thoughts but stated that he would never act on those thoughts. ...
AF | PDBR | CY2010 | PD2010-00209
The PEB’s unfitting determination under the PTSD diagnosis is considered administratively final for the Board, and the Board focused on adjudicating the CI’s mental health disability under Veterans Administration Schedule for Rating Disabilities (VASRD) coding for PTSD 9411. The most proximate source of comprehensive evidence on which to base the permanent rating recommendation in this case is the VA examination 4 months after separation, summary of psychiatric hospitalizations in Nov 2008...
AF | PDBR | CY2013 | PD-2013-01130
The VA C&P general medical examination obtained in March 2007 (a month post-separation), documents that the CI’s PTSD condition was stable with medications. The VA rated the condition of PTSD coded as 9411, at 50%. Providing orders showing that the individual was separated with a permanent combined rating of 20% effective the day following the six month TDRL period with no recharacterization of the individual’s separation.
AF | PDBR | CY2012 | PD-2012-01075
Service treatment records (STR) confirm that the predominant mental health condition was the bipolar disorder and the MEB narrative summary (NARSUM) in rendering a PTSD diagnosis, noted CI report of a traumatic stressor while deployed and that at times he has experienced symptoms consistent with PTSD. In accordance with DoDI 6040.44 and DoD guidance the Board is obligated to apply current VASRD §4.129 to Board cases with PTSD where appropriate, and recommend a minimum 50% PTSD rating for a...
AF | PDBR | CY2011 | PD2011-00813
Psychiatric Condition . I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum: Providing a correction to the individual’s separation document showing that the individual was separated by reason of temporary disability effective the date of the original medical separation for disability with severance pay.
AF | PDBR | CY2009 | PD2009-00715
CI CONTENTION : The CI states: ‘’I was separated with a 10% disability rating as indicated by the 19 November 2007 Physical Evaluation Board finding. At the time of the VA PTSD C&P examination on 17 September 2008, seven months after separation, the CI was working full time, remained on medication, and was in treatment for his mental health condition. Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
AF | PDBR | CY2010 | PD2010-00407
No evidence of a thought disorder. RECOMMENDATION : The Board recommends that the CI’s prior separation be re-characterized to reflect that, rather than discharge with severance pay, the CI was placed on the TDRL at 50% for a period of six months (PTSD at 50% IAW §4.129 and DoD direction) and then permanently retired by reason of physical disability with a final 30% rating as indicated below. Exhibit C. Department of Veterans' Affairs Treatment Record.
AF | PDBR | CY2009 | PD2009-00611
The VA compensation and pension (C&P) examination (mental examination) on 30 September 2008, six months after separation, noted Axis I diagnoses of MDD, panic disorder without agoraphobia, and somatoform disorder. RECOMMENDATION : The Board recommends that the CI’s prior separation be recharacterized to reflect that rather than discharge with severance pay, the CI was placed on constructive TDRL at 50% for six months following CI’s medical separation (PTSD at minimum of 50% IAW §4.129 and...
AF | PDBR | CY2009 | PD2009-00177
The CI was medically separated by the PEB at 10% disability for depression with elements of PTSD. The case should have been adjudicated IAW VASRD §4.129 and the Board must therefore recommend a 50% TDRL rating at separation, coded 9434-9411. TBI was alluded to in the VA psychiatric rating examination, but the condition has yet to be coded and rated by the VA.