RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02034
BRANCH OF SERVICE:  Army	BOARD DATE:  20141029
SEPARATION DATE:  20040203

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1 (Cannon Crewmember) medically separated for a mental health (MH) condition.  The condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty.  He was issued a permanent S3 profile and referred for a Medical Evaluation Board (MEB).  The MH condition, characterized as “schizoaffective disorder bipolar type” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “schizoaffective disorder, bipolar type” as unfitting, rated 10%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please Consider All Conditions.”

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 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/Naval 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 IPEB – Dated 20031203	VA – Based on Service Treatment Records (STR)*	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizoaffective Disorder	9211	10%	Schizoaffective Disorder; Bipolar Type	9211	NSC	STR*	
Other x 0  (Not in Scope)	Other x 0 (Not in Scope)		
Rating:  10%	Rating:  NSC	
* The CI “Failed to Report” for his mental health disorder VA Compensation and Pension (C&P) exam scheduled for 20050608 and was therefore rated “not service connected (NSC)” by the VA Rating Decision (VARD) dated 20050818.  This was upheld by the 20071109 VARD after additional service records were received.  However, the subsequent 20080213 VARD determined that this was a “clear and unmistakable error” and a rating of 100% was assigned effective 20050525, the date his claim was received.

ANALYSIS SUMMARY:

Schizoaffective Disorder Condition.  There is a paucity of information prior to separation regarding the MH condition.  The narrative summary (NARSUM) was dated 20 October 2003, just over 3 months prior to separation and provided most of the detail regarding the pre-separation history.  The CI reported the onset of symptoms in late 2001 when he experienced increasingly confused thoughts and difficulty organizing his behavior in routine daily tasks.  He was missing formations and had poor work performance.  By spring/early summer 2002, he had expansive thoughts, needed less sleep, experienced paranoia about his chain of command and other soldiers, and noted that his thoughts were “real fast.”  Around 12 August 2002 he went absent without leave (AWOL).  In January 2003, he was involved with the police in the civilian community on multiple occasions for assaultive behavior which lead to an involuntary MH admission and subsequent return to his unit.  Within a few weeks of return, he became overtly disorganized and expansive.  The CI was seen in the emergency room (ER) on 3 February 2003 for a pre-confinement examination after being returned from AWOL for “5-6 months.”  He was cleared for incarceration with the recommendation of MH evaluation in jail.  This record was not in evidence, but he was then transferred to the VA for inpatient care on 7 February and discharged on 18 February 2003.  These records were also not in evidence.  Following discharge from the hospital, he was non-compliant with his medications and again had legal issues which lead to pre-trial confinement from February 2003 until August 2003 when he was determined to be not criminally responsible secondary to the MH condition.  After release, he was returned to his unit and was compliant with his medications leading to stabilization of his symptoms.  He had limited insight into his illness.  At the MEB examination on 19 August 2003, the CI reported that he was on an anti-psychotic medication, for a schizoaffective disorder.  The examiner noted that the MH examination was abnormal without further detail.  On 26 August 2003, he had a command-directed MH competency evaluation.  It was noted that he had been an inpatient twice that year for the MH diagnosis “schizoaffective disorder, bipolar type.”  He was compliant with treatment and had normal behavior, full alertness and orientation, clear thinking, normal thought content, and unremarkable mood/affect.  His memory was good and he was determined to be mentally competent.  At the NARSUM examination, he was appropriately dressed in a well maintained uniform with good hygiene.  He was alert, oriented, cooperative, and interactive.  Speech was normal.  Eye contact was limited and mood described as “not good.”  Affect was restricted and congruent with mood.  Thought processes were intact without suicidal or homicidal ideation.  Auditory or visual hallucinations were absent.  There was no evidence of paranoia, active manic behavior or obsessive-compulsive behavior.  Judgment was fair and insight limited.  Higher cortical functioning was grossly normal.  He was diagnosed with a schizoaffective disorder, bipolar type, and assigned a global assessment of function (GAF) of 55, indicative of moderate symptoms or impairment.  The next record in evidence was an outpatient evaluation in the VA on 18 August 2004, just over 6 months after separation.  He had stopped taking his medications and felt stable although he endorsed being slightly depressed.  He continued to abuse alcohol and drugs.  Two days later, he was seen in MH.  He reported new history with symptom onset at age 16 manifested by irritability, punching walls and abuse of alcohol and marijuana as well as discipline and academic problems in high school.  There was a history of domestic violence with his daughter’s mother in 2002 (prior to treatment) and a suicide attempt in 2003.  On examination, he was uninterested and distant with poor motivation towards sobriety.  Speech was slowed and affect blunted.  Judgment and insight were impaired.  He was thought to have a chronic psychotic illness since age 16 complicated by substance abuse with low motivation towards sobriety.  The examiner diagnosed chronic schizophrenia and assigned a GAF of 60, at the cut off between moderate and mild symptoms or impairment.  He was seen again 3 weeks later and thought to be stable or with some improvement with poor compliance with his medications.  He then had no further treatment until 29 January 2005, just less than a year after separation, when he was admitted to a local hospital for acute psychosis and drug abuse with transfer to the VA hospital 5 days later on 2 February 2005.  The CI “failed to report” for his MH VA C&P exam scheduled for 8 June 2005.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the schizoaffective disorder, bipolar type, as 9211 (schizoaffective disorder) and rated it at 10%.  The VA initially determined the condition to be NSC, but this was later determined to be a clear error on the 13 February 2008 VARD that assigned a 100% rating using the code 9211. The determination was retroactive to 25 May 2005, the date of his initial application for benefits, approximately 15 months after separation.  This rating was based on both the service treatment records and post-separation care in the VA system.  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 Board then considered the appropriate rating in accordance with the provisions of VASRD §4.130.  The Board determined that the disability in evidence exceeded the criteria for a 10% rating, but did not support a 70% rating at the time of separation.  The Board then considered if the disability was better described by the 30% or 50% rating.  The MEB NARSUM noted disturbances in affect and mood, but no impairment of thought content was present.  The CI was well groomed with good hygiene.  Insight was limited but judgment fair.  There had been a history of domestic violence and assaults; but this was all apparently prior to treatment.  The Board observed that the CI was doing pretty well proximate to separation; he was on medications, in treatment, and in a structured environment.  At the time of separation, his level of function was thought to be best described by the 30% rating, “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal).” After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority recommends a disability rating of 30% for the schizoaffective 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 schizoaffective disorder bipolar type, the Board by a majority vote, recommends a disability rating of 30%, coded 9211 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 and, that the discharge with severance pay be re-characterized 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	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140505, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB																		

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXX, AR20150018389 (PD201402034)

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.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

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

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

			      
						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA