RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
 BRANCH OF SERVICE:  ARMY  
NAME:  XXXXXXXXX 
 DATE OF TEMPORARY RETIREMENT:  20081227  
CASE NUMBER:  PD1200152 
BOARD DATE:  20130102                                          DATE OF PERMANENT SEPARATION:  20091125  
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty,  SSG/E-6,  (25F/Information  Technology),  medically 
separated  for  posttraumatic  stress  disorder  (PTSD).    His  psychiatric  symptoms  developed  in 
association with two temporally proximate deployments to Iraq (January 2004 – February 2005 
and  November  2005  –  October  2006).    He  underwent  a  trial  of  medications  and  outpatient 
therapy, but failed to improve adequately to meet the operational requirements of his Military 
Occupational Specialty.  He was consequently issued a permanent S3 profile and referred for a 
Medical Evaluation Board (MEB).  The PTSD condition was forwarded to the Physical Evaluation 
Board (PEB) as medically unacceptable IAW AR 40-501.  Obstructive sleep apnea (OSA) was also 
identified  by  the  MEB  and  forwarded  as  failing  retention  standards.    Five  other  conditions 
(identified in the rating chart below) were addressed by the MEB, and forwarded as medically 
acceptable.    The  PEB  adjudicated  PTSD  as  unfitting,  rated  50%  with  reference  to  Veterans 
Administration  Schedule  for  Rating  Disabilities  (VASRD)  §4.129;  and,  placed  the  CI  on  the 
Temporary Disability Retired List (TDRL).  The OSA and remaining conditions were determined 
to be not unfitting.  After 11 months on TDRL, the PTSD condition was considered to be stable 
but  still  unfitting.    The  CI  was  consequently  removed  from  TDRL  in  2009;  and  permanently 
separated, without appeal, with a 10% disability rating citing criteria of the VASRD. 
 
 
CI CONTENTION:  The application states simply, “It should be rated according to VASRD instead 
of DODI 1332.39.”  He does not elaborate further or specify a request for Board consideration 
of any additional conditions.   
 
 
SCOPE  OF  REVIEW:    The  Board  wishes  to  clarify  that  the  scope  of  its  review  as  defined  in 
Department of Defense Instruction (DoDI) 6040.44 (Enclosure 3, paragraph 5.e.2) is limited to 
those conditions which were determined by the PEB to be specifically unfitting for continued 
military  service;  or,  when  requested  by  the  CI,  those  condition(s)  “identified  but  not 
determined  to  be  unfitting  by  the  PEB.”    The  ratings  for  the  unfitting  PTSD  condition  are 
addressed below.  The OSA and remaining conditions (adjudicated as not unfitting by the PEB) 
were  not  alluded  to  in  the  CI’s  request,  and  thus  are  not  within  the  DoDI  6040.44  defined 
purview  of  the  Board.    Those,  and  any  other  conditions  or  contention  not  requested  in  this 
application,  remain  eligible  for  future  consideration  by  the  Army  Board  for  Correction  of 
Military Records.  
 
 

 

RATING COMPARISON:  
 

Code 
9411 
6847 
7101 

Rating 
70% 
50% 
0% 

NSC 
NSC 
10% 

Sep. 
10% 

Rating 
Code 
TDRL 
9411 
50% 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 

VA (13 Mo. Prior to Adjudication Date*) – Effective 20081227 
Exam 
Condition 
PTSD w/ Alcohol Abuse 
20081027 
20081030 
OSA 
20081030 
Hypertension 
20081030 
Not ratable by VASRD 
7599-7522 
Erectile Dysfunction 
20081030 
20081030 
7999-7913 
Impaired Glucose Tolerance 
20081030 
Hiatal Hernia ... Alcoholic Hepatitis 
7346 
Not Service Connected (NSC) X 4 Additional 
20081030 
Rating: x0% 

Final Service PEB - 20091027 
On TDRL – 20081227 
Condition 
PTSD 
OSA 
Hypertension 
Hyperlipidemia 
Erectile Dysfunction 
Impaired Glucose Tolerance 
Hepatic Steatosis... 
No Additional MEB/PEB Entries 
Rating:  50% → 10% 
*Represents VA rating proximate to TDRL placement; no VA rating proximate to permanent separation. 
 
 
ANALYSIS SUMMARY:  The “it” cited in the application logically refers to PTSD; and, the Board 
must assume that the CI surmises that the PEB rating was derived from DoDI 1332.39; however, 
the  PEB’s  DA  Form  199  specifically  references  VASRD  §4.129  for  the  TDRL  rating,  and  cites 
specific criteria of VASRD §4.130 for the permanent rating.  The Board’s charge in this case is 
therefore limited to satisfying itself that the TDRL rating did not fairly exceed the 50% minimum 
derived from §4.129, based on the evidence proximate to TDRL placement; and, assessing the 
fairness  of  the  permanent  rating  IAW  §4.130  criteria,  based  on  evidence  proximate  to 
permanent separation.   
 
Posttraumatic  Stress  Disorder  (PTSD).    The  CI  was  treated  for  depression  prior  to  his  first 
deployment.    All  mental  health  records  make  clear  that  his  cardinal  Criterion  A  stressor 
occurred in April 2004 during his first Iraq deployment.  This involved the proximate combat 
death of a friend and exposure to the mutilated remains.  Although there are no mental health 
encounters in the service treatment record (STR) until after the second deployment, numerous 
subsequent notes document that psychiatric symptoms developed in the aftermath of the 2004 
incident.  The CI first sought psychiatric care in January 2007.  Typical symptoms for PTSD were 
elaborated  which  included  irritability,  hypervigilance,  nightmares  and  sleeplessness;  and,  an 
Axis I diagnosis of PTSD was recorded.  The CI underwent extensive outpatient psychotherapy 
and  pharmacotherapy  over  the  ensuing  18  months,  for  which  numerous  STR  entries  are  in 
evidence.  No hospital admissions were required and no acute symptoms (suicidality, psychosis, 
delusions,  etc.)  were  documented.    There  were  active  personal  stressors  (divorce,  financial) 
during this period.  Global Assessment of Functioning (GAF) scores were consistently in the 51-
60  range,  connoting  moderate  impairment.    The  last  outpatient  entry  (initiating  the  MEB) 
stated  that  he  was  “making  significant  progress”,  but  “his  condition  remains  essentially 
unchanged,  and  is  unfitting...”    Alcohol  use  was  denied  per  numerous  STR  entries,  and 
“occasional”  use  was  noted  in  the  narrative  summary  (NARSUM).    The  NARSUM  psychiatrist  
documented,  “He  uses  the  following  words  to  characterize  his  PTSD  symptoms  ‘Fear, 
hypervigilance, paranoid, helpless, despair, sadness, sense of impending doom and isolation.’”  
The  CI  was  prescribed  3  psychotherapeutic/sleep  medications,  plus  Prazosin  for  nightmares.  
The NARSUM characterized severity as, “On a good day, PTSD symptoms are rated 1/10, a bad 
day is 10/10 with full-blown panic attack.”  The NARSUM mental status exam (MSE) noted a 
depressed mood  and  constricted affect;  without  suicidal  ideation, delusional or hallucinatory 
symptoms,  speech  disturbance,  cognitive  impairment  or  other  abnormalities.    At  the  VA 
psychiatric  Compensation  and  Pension  (C&P)  exam  (2  months  prior  to  separation),  the 
examiner noted similar symptoms (and technical nomenclature) as those documented in the 
NARSUM.    The  VA  examiner  (3  months  after  the  NARSUM)  recorded  twice  weekly  “alcohol 
abuse” and a pattern of same since the first deployment.  The VA MSE was equivalent to that 

   2                                                           PD12-00152 

 

recorded in the NARSUM.  Social functioning was notable for some isolation and estrangement, 
but tolerance for public environments; and, the divorce had been settled.  The VA psychiatrist’s 
description of occupational functioning is excerpted below.   

He  states  that  currently  he  is  working.  ...  His  relationship  with  his  supervisor  is  fair  and  his 
relationship with his co-workers is fair.  While performing this job he has not lost any time from 
work, however it was deemed, per military records, that he was unable to perform assigned job 
duties to severity of trauma symptoms. 

The  VA  psychiatrist’s  GAF  assignment  was  40,  suggesting  major  impairment;  although,  the 
action officer does not find support for a score that low from the examiner’s recorded history 
and MSE.  
 
During the 11 month period of TDRL, there are no treatment notes for the first 4 months.  A VA 
intake note at that time noted continued symptoms (more typical of depression than PTSD), 
and an escalation of alcohol use to 3-4 times weekly.  It documented full time employment in 
human resources at a military facility.  There was a VA consult for evaluation of traumatic brain 
injury (TBI) on the same day, documenting a history of numerous concussive exposures during 
the  Iraq  deployments.    There  is  no  corroboration  of  such  events  or  complaints  in  the  STR, 
NARSUM or prior to separation C&P.  There are only two cursory outpatient notes from the VA 
after the above encounters for the balance of the TDRL period.  There are no formal MSE’s or 
GAF assignments for the period of TDRL.  There are two no-show entries in July 2009 (4 months 
preceding  permanent  separation),  and  there  are  no  further  entries  until  the  final  TDRL 
evaluation in September 2009.  The TDRL psychiatrist noted hypervigilance, sleep disturbance, 
continued  nightmares,  anxiety,  hyperstartle,  “avoidance  behaviors”  (crowds,  etc.),  and 
“difficulties  with  social  attachment.”    Medications  were  changed,  but  similar  to  the  regimen 
when entering TDRL.  Alcohol use 4 times weekly (in six beer quantities) was documented, with 
comments that this was coming under better control; and, no Axis diagnosis of alcohol abuse 
was  made  (unlike the  VA  psychiatric  opinion).   The examiner  commented  on the  CI’s  lack  of 
interim  treatment.    The  MSE  recorded  the  CI’s  mood  description  as  “whatever”  with  a  “full 
ranging”  affect.    The  MSE  was  otherwise  normal  without  gross  cognitive  deficit.    No  GAF 
assignment  was  made,  although  the  “impairment  for  social/industrial  adaptability”  (DoDI 
1332.39  defined)  was  assessed  as  “definite.”   Occupationally,  the  TDRL  examiner  made  note 
that the CI had quit his aforementioned employment quoting the explanation “there were too 
many  people  around  and  it  was  too  military;”  and  related the  CI’s  report  that  he  “has  been 
unable  to  work  due  to  psychiatric  symptoms  and  that  his  disability  rating  was  increased  to 
100% by the VA.”  The examiner concluded with, “Without treatment, is it not likely that he will 
be  able  to  secure  and  maintain  employment  in  the  civilian  sector.”    There  is  in  evidence  a 
probative VA psychiatric C&P re-evaluation performed a month after permanent separation.  It 
documented  that  the  CI  “has  not  been  to  MH  [Mental  Health]  yet,  because  he's  not 
comfortable talking to people about how he is feeling.”  The stated symptoms were similar to 
those at the TDRL re-evaluation; although, the examiner noted an additional symptom of panic 
attacks “not full blown ... 2-3 times per week.”  The exam stated that the CI had “quit his job in 
May  due  to  stress.”    The  GAF  assignment  was  50.    That  examiner  also  commented  on  the 
limitations  imposed  by  the  CI’s  abandonment  of  treatment;  and,  concluded  that  with  this 
limitation he was “employable but only under limited conditions and low stress.”  There is a 
conflict  with  the  CI’s  employment  status  at  the  time  of  permanent  separation  based  on  the 
history recorded in the VA and TDRL psychiatric evaluations, and that from a VA C&P evaluation 
for  OSA  performed  a  month  after  permanent  separation.    The  latter  described  details  of 
adverse  consequences  of  that  condition  on  present  employment,  stating  that  the  CI  was 
working  “fulltime”  in  a  human  resources  position  which  he  had  held  “less  than  1  year.”  
Independent inquiry by the Board confirmed that the CI had held the post-separation human 
resources position from March – May, 2009; and, the basis for the conflicting history remains 
unresolved.   

 

   3                                                           PD12-00152 

 

The  Board  directs  attention to  its  rating  recommendation  based  on  the  above  evidence.    All 
members  agreed  that  the  §4.130  criteria  for  a  TDRL  rating  higher  than  50%  at  the  time  of 
placement on TDRL were not met; since the CI was occupationally functional and none of the 
threshold  symptoms  for  a  70%  rating,  such  as  suicidal  ideation  or  significant  cognitive 
impairment,  were  present.    In  regards  the  permanent  rating  recommendation,  a  significant 
factor in this case is the fact that the CI was not compliant with recommended treatment during 
the rating interval; and, in fact may have been self-medicating with alcohol.  Since alcohol or 
substance abuse is recognized as a feature of the psychiatric illness itself, any direct impairment 
from its use is not fairly immune from disability rating; but, non-compliance with available and 
recommended treatment options is an issue which the members agreed should be considered 
with  regard  to  the  Board’s  recommendation  in  this  case.    Both  the  TDRL  and  the  VA 
psychiatrists  caveated  their  conclusions  regarding  occupational  impairment  with  the  opinion 
that  better  prospects  were  in  the  offering  with  treatment.    A  permanent  disability  rating 
reasonably should reflect the severity of a condition after stabilization with an expectation that 
reasonable  treatment  options  have  been  exhausted.    Since  non-compliance  imposes  a 
significant  degree  of  speculation  as  to  what  potential  benefit  has  been  forfeited,  members 
agreed that no formal deduction could be approximated; but, concluded that some tempering 
of the severity reflected by the evidence was a fair variable to entertain in the Board’s decision 
making. 
 
The members first deliberated if the PEB assigned 10% rating was reasonable as a permanent 
rating  recommendation.    The  §4.130  description  for  a  10%  rating  is  “occupational  and  social 
impairment  due  to  mild  or  transient  symptoms  which  decrease  work  efficiency…only  during 
periods  of  significant  stress,  or;  symptoms  controlled  by  continuous  medication.”    With  or 
without treatment, the evidence supports a conclusion that the symptoms were neither mild 
nor transient; and, they were not controlled by continuous medication even during a protracted 
period  of  compliance  with  aggressive  treatment  measures.    Likewise  the  occupational 
impairment  was  logically  constant,  not  episodic  or  stress  dependent.    The  compliance  factor 
would go to severity of impairment, but continuing treatment (more likely than not) would not 
have eliminated occupational impairment or rendered it sporadic.  Members agreed, therefore, 
that the §4.130 criteria for a 10% rating were exceeded in this case.  Members next deliberated 
if  a  70%  permanent  rating  recommendation,  as  initially  conferred  by  the  VA,  could  be 
supported by the evidence.  The §4.130 rating description for 70% is “occupational and social 
impairment, with deficiencies in most areas, such as work, school, family relations, judgment, 
thinking,  or  mood;”  referencing  (among  others)  such  symptoms  as  suicidal  ideation,  illogical 
speech, “near continuous panic or depression,” spatial disorientation, and neglect of hygiene.  
All members agreed that the evidence, even without considering the compliance factor, did not 
draw a disability picture as bleak as the one described in the 70% criteria.  The members then 
settled  on deliberations  for  a  50%  vs.  a  30% permanent  rating  recommendation.    The  rating 
description  for  50%  is  “occupational  and  social  impairment  with  reduced  reliability  and 
productivity;”  referencing  typical  symptoms  of  flat  affect,  stereotyped  speech,  frequent 
(greater  than  weekly)  panic  attacks,  deficits  in  comprehension  and  memory,  impaired 
judgment,  mood  disturbance,  and  difficulty  with  establishing  relationships.    The  rating 
description for 30% is “occupational and social impairment with occasional decrease in work 
efficiency  and  intermittent  periods  of  inability  to  perform  occupational  tasks  (although 
generally  functioning  satisfactorily  …);”  referencing  typical  symptoms  of  depression,  anxiety, 
suspiciousness, panic attacks (less than weekly), sleep disturbance, and mild memory loss.  The 
reduced  reliability  and  productivity  cited  for  a  50%  rating  was  arguably  supported  by  the 
evidence;  although,  also  arguably  adversely  affected  by  the  absence  of  treatment.    Panic 
attacks (frequency not elaborated), mood disturbance and relationship problems were clearly 
present; although none of the other symptoms exampled under 50% were in evidence.  The 
decreased  work  efficiency  and  lapses  in  occupational  capacity  encompassed  in  the  30% 
language  were  supported  by  the  employment  history  if  it  is  assumed  that  the  CI  remained 
unemployed after May 2009; although, it could be argued that the CI’s lapse in employability 

   4                                                           PD12-00152 

 

may well have been avoided with full treatment.  Virtually all of the typical symptoms exampled 
in the 30% description were to be found in the evidence.  After due deliberation, considering all 
of  the  evidence  and  conceding  reasonable  doubt,  the  Board  recommends  a  permanent 
disability rating of 30% for the PTSD condition.   
 
 
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.    The  Board  did  not 
surmise  from  the  record  or  PEB  ruling  in  this  case  that  any  prerogatives  outside  the  VASRD 
were exercised.  In the matter of the PTSD, the Board unanimously recommends no change in 
the  disability  rating  of  50%  under  code  9411  for  the  period  of  temporary  retirement,  IAW 
VASRD  §4.129;  and,  a  30%  permanent  rating,  IAW  VASRD  §4.130.    There  were  no  other 
conditions within the Board’s scope of review for consideration.  
 
 
RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as 
follows; with a permanent 30% disability retirement as indicated below. 
 

 

VASRD CODE  RATING 
9411 
COMBINED 

PERMANENT 
30% 
30% 

UNFITTING CONDITION 
Posttraumatic Stress Disorder 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120210, w/atchs. 
Exhibit B.  Service Treatment Record. 
Exhibit C.  Department of Veterans Affairs Treatment Record. 
 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXX 
           Director 
           Physical Disability Board of Review 

   5                                                           PD12-00152 

 

 

 

 

 

 

 

 

 

 

b.  Providing orders showing that the individual was retired with permanent 

SFMR-RB 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
for XXXXXXXXXXXXXX, AR20130001976 (PD201200152) 
 
1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the 
enclosed recommendation of the Department of Defense Physical Disability Board of 
Review (DoD PDBR) pertaining to the individual named in the subject line above to 
recharacterize the individual’s separation as a permanent disability retirement with the 
combined disability rating of 30% effective the date of the individual’s original medical 
separation for disability with severance pay.   
 
2.  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: 
 
 
a.  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. 
 
 
disability effective the date of the original medical separation for disability with 
severance pay. 
 
 
account for recoupment of severance pay, and payment of permanent retired pay at 
30% effective the date of the original medical separation for disability with severance 
pay. 
 
 
and medical TRICARE retiree options. 
 
3.  I request that a copy of the corrections and any related correspondence be provided 
to the individual concerned, counsel (if any), any Members of Congress who have 
shown interest, and to the Army Review Boards Agency with a copy of this 
memorandum without enclosures. 
 
BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 
 
Encl 
 
 
 

     XXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards) 

c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will 

d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

   6                                                           PD12-00152