RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00891
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20081216

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Basic Trainee, medically separated for “psychotic disorder,” with a disability rating of 10%.

CI CONTENTION:  The CI contended for his mental health condition and hearing loss.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20081204	VARD - 20030528	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Psychotic Disorder	9210	10%	Generalized Anxiety	9413	NSC	20090616	
COMBINED RATING:  10%	NO SERVICE CONNECTED (NSC) VA CONDITIONS	

ANALYSIS SUMMARY:  

Psychotic Disorder, Not Otherwise Specified (NOS).  According to service treatment records (STR), the CI began basic training 24 September 2008 and was hospitalized 7 October 2008.  He spent 2 days at one facility but was transferred to another hospital for 69 days, and discharged 16 December 2008.  He reported there were problems his first night in the barracks; a party was occurring and there were girls in the room and people running through the room.  He reported anxiety and reported hearing noises, conversations, and sometimes a single word.  There was no previous psychiatric history.  Stressors included travel from home and the rigors of basic training.  

The narrative summary (NARSUM), dated 24 October 2008 was based on serial mental status examinations through the CI’s psychiatric hospitalization, which was current.  The CI did not understand what was going on with him but felt the problem was that he was talking in his sleep.  He did not want to leave the Army; enlisting was a long term goal.  Mental status exam (MSE) on admission showed his mood was anxious and affect was blunted.  He was suspicious and there was a paranoid trend in thought content, but no delusional thinking in evidence.  He reported perceptual abnormalities consistent with auditory and visual hallucinations.  Medications included medicines for psychosis and for anxiety.  MSE on the day of the NARSUM was essentially normal with constricted affect.  Physical exam and lab studies were normal.  His anxiety improved, he showed no signs of psychosis and wished to return to training.  A diagnosis of brief psychotic disorder was rendered.  There was definite impairment for social and industrial adaptability and the examiner noted he did not meet retention standards.  

At the VA Compensation and Pension (C&P) examination, dated June 2009, performed 6 months after separation, the CI reported he was receiving outpatient mental health care that included a psychiatrist and a therapist.  He was taking medications for depression, anxiety and for sleep.  The CI reported that after he arrived at boot camp, a soldier committed suicide by hanging.  He had two nightmares about this but denied other symptoms of posttraumatic stress disorder (PTSD).  He had panic attacks while an inpatient and reported he was having at least four panic attacks per month, but with medication the symptoms were controlled.  He believed problems with sleep developed while he was taking the medicine for psychosis.  He was currently sleeping 6-7 hours per night, played golf and spent time with friends, including his girlfriend.  He exercised and enjoyed going to movies and to concerts.  He was hired by his previous employer and was pleased.  He was living with his parents but planned to move out.  MSE was unremarkable.  Diagnoses of panic disorder without agoraphobia (stable on meds) and a history of brief psychotic disorder, resolved.  Global Assessment of Functioning (GAF) score was 65-70 (mild symptoms, impairment).  The psychiatry examiner noted the CI did not appear to have residual effects from the brief psychotic disorder, and his anxiety/panic attacks and insomnia were well controlled on medications.  

The Board directed attention to its rating recommendation based on the above evidence.  Application of VASRD §4.129 is considered by the Board for all cases of service connected psychiatric conditions resulting in separation; but, all members agreed that the ‘highly stressful event’ requisite for §4.129 was not satisfied in this case.  The PEB rated the psychotic disorder 10% (coded 9210) citing symptoms controlled by continuous medication.  The VA determined the generalized anxiety was not service connected (coded 9413, anxiety disorder NOS) citing no in-service event related to onset of his mental health condition.  The Board agreed the CI’s condition was stable and symptoms were well-controlled with medication.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the psychotic disorder condition.    

BOARD FINDINGS:  In the matter of the psychotic disorder condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140220, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20160005870 (PD201400891)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA