RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-01824
BRANCH OF SERVICE:  navy	BOARD DATE:  20140430
SEPARATION DATE:  20040115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty HN/E-3 (HN/Hospital Corpsman) medically separated for schizoaffective disorder, bipolar type.  His condition could not be adequately rehabilitated to meet the requirements of his rating.  He was referred for a Medical Evaluation Board (MEB).  The MH condition, characterized as “schizoaffective disorder, bipolar type, manic with psychotic features” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB forwarded no other conditions to the PEB.  The Informal PEB adjudicated “schizoaffective disorder, bipolar type” as unfitting, and rated it at 10%. The CI made no appeals and was medically separated.

CI CONTENTION:  “Left knee surgery. Left shoulder dislocation. Schizo-affective disorder.  Rating at 70% disability.”

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting schizoaffective disorder is addressed below.  No other conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Naval Records.

RATING COMPARISON:

Service IPEB – Dated 20031112	VA – (3 mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizoaffective Disorder, Bipolar Type	9211	10%	Schizoaffective Disorder	9211	70%	20040413	
                                     Combined:  10%	Combined:  70%	
Derived from VA Rating Decision (VARD) dated 20040526 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  The Board acknowledges the knee and shoulder conditions which are contended by the CI.  It is noted for the record that the Board is subject to the same laws for disability entitlements as those under which the Disability Evaluation System (DES) operates.  While the DES considers all of the CI's medical conditions, compensation can only be offered for those conditions that cut short a member’s career, and then only to the degree of severity present at the time of separation.  The Department of Veterans Affairs however, is empowered to compensate for all service-connected conditions and to periodically re-evaluate conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment change over time.

Mental Health (MH) Condition.  It is unclear exactly when this CI started having MH symptoms.  In 1999, he was diagnosed with depression while serving overseas in Okinawa, Japan.  Then in October 2001, he was hospitalized for psychiatric care, stemming from a domestic incident with his wife.  The discharge diagnosis was personality disorder, not otherwise specified.  Subsequently, there were other events involving behavioral issues.  In May 2002 he was taken into custody at the Mexican border due to a weapons violation.  In July 2002, he was again hospitalized for in-patient psychiatric care following some unusual behavior.  He was making bizarre gestures and claiming to be an Aztec spirit.  This inpatient hospitalization was lengthier, and lasted about a month.  He was treated with medication and he improved.  However, due to his MH condition, an MEB was initiated.  The first MEB narrative summary (NARSUM) was dated 30 July 2002.  The Axis I diagnosis was schizoaffective disorder, bipolar type.  The Global Assessment of Functioning (GAF) score was 60, indicating mild-to-moderate difficulty in functioning.

The MEB recommendation was that the CI’s case be referred to the PEB.  However, it appears that the MEB/PEB proceedings may have been halted at that time.  In December 2002, the CI was convicted by Special Courts Martial and sentenced to confinement.  In August 2003, after his incarceration, a second MEB NARSUM was dictated.  At that time, the CI was being treated with psychotropic medication and was doing quite well.  He denied any symptoms of mania, depression, or psychosis.  His mental status exam was essentially unremarkable.  The examiner stated, “His schizoaffective disorder symptoms (primarily psychosis and mania) are now well controlled with antipsychotic medication which may also have a mood stabilizing property.  He is presently without symptoms of depression, mania, or psychosis.  However, if his medications were discontinued, he would be at significant risk for recurrent manic and psychotic symptoms, which would place him at risk for harming himself or others.”  The Axis I diagnosis was schizoaffective disorder, bipolar type.  The Axis V GAF score was 85 (indicating absent or minimal symptoms, with good functioning in all areas).

In the “Impairment” section of the clinical evaluation, the MH examiner wrote, “The degree of industrial and military impairment related to the diagnosis of Schizoaffective Disorder is deemed severe.  The patient has manifested significant paranoid delusions and manic behavior. He has exhibited very poor judgment and poor impulse control.  If he again develops manic or psychotic symptoms, he is at significant risk for harming others and possibly himself.  The degree of civilian performance impairment from Schizoaffective Disorder is deemed severe if the patient’s symptoms are poorly controlled, but is deemed mild if the symptoms are in remission, as they are at the present time.”  The examiner also opined, “The prognosis for return to full functional status is poor, due to the chronic nature of his Schizoaffective Disorder with risk for recurrent symptoms.”

As noted above, the CI was separated from military service on 15 January 2004.  Three months later, on 13 April 2004, he had a VA Compensation and Pension (C&P) exam.  The examiner noted several recent incidents involving bizarre behavior.  The CI had disrobed in public.  He had appeared naked in front of his wife and child.  The wife obtained a restraining order and the CI moved out of the home and into a hotel.  When the CI’s father came to visit him, it appeared as if the CI did not recognize his own father.  It was unclear whether or not the CI was taking his prescribed medications.  The CI reported that he was hearing voices.  GAF score at the time of the C&P exam (April 2004) was 39, indicating major impairment in several areas.  Based on the results of that exam, the VA assigned a disability rating of 70%.

The Board carefully reviewed all available evidence and directs attention to its rating recommendation.  As noted above, the CI had a MH evaluation in August 2003 and again in April 2004.  After a thorough review of the record, it was clear that the CI’s condition worsened during the period from August 2003 to April 2004.  He separated from service in January 2004.  Unfortunately, no comprehensive MH evaluation was performed at the time of separation, so the Board must use the best evidence available.  The April 2004 C&P exam was closer to the DOS and therefore carries significant probative value.  The events and behaviors described at that exam had occurred during the weeks and months preceding the evaluation, so they are reflective of the CI’s condition during the timeframe of his DOS.

All Board members agreed that schizoaffective disorder can be an extremely disabling condition.  From the evidence, and based primarily on the April 2004 C&P exam, the Board determined that at the time of separation, it was more likely than not that the CI was not functioning well and was significantly impaired by MH symptoms.  Specifically, there was occupational and social impairment, with deficiencies in most areas; such as work, family relations, judgment and thinking.  The impairment was due to psychotic symptoms and inappropriate behaviors such as disrobing in front of others.  After due deliberation, considering all of the evidence and mindful of the VA Schedule for Rating Disabilities (VASRD) §4.3 (reasonable doubt), the Board recommends a disability rating of 70% for the MH condition (schizoaffective disorder).

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 schizoaffective disorder, the Board unanimously recommends a disability rating of 70%, coded 9211, IAW VASRD §4.130.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Schizoaffective disorder, bipolar type	9211	70%	
COMBINED	70%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130919, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
		   DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:   (a) DoDI 6040.44
       (b) PDBR ltr dtd 26 Feb 15 ICO XXXXXXXXXXXXXXXXX 
	 (c) PDBR ltr dtd 21 Jan 15 ICO XXXXXXXXXXXXXXXXX 
	 (d) PDBR ltr dtd 13 Jan 15 ICO XXXXXXXXXXXXXXXXX
	 (e) PDBR ltr dtd 5 Feb 13 ICO XXXXXXXXXXXXXXXXX
	 (f) PDBR ltr dtd 28 Feb 15 ICO XXXXXXXXXXXXXXXXX
          
1.  Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (f).

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXX, former USN: Disability separation with final disability rating of 10 percent (increased from 0 percent) effective date of discharge.

     b. XXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.

     c. XXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 70 percent disability rating effective date of discharge.

     d. XXXXXXXXXXXXXXX, former USMC:  Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.

     e. XXXXXXXXXXXXXXX, former USMC: Disability separation with final disability rating of 10 percent (increased from 0 percent) effective date of discharge.

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are completed.