RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02626
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030829

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “delusional disorder,” with a disability rating of 10%.

CI CONTENTION:  The applicant contends his counselor recommended retirement but his doctor did not.  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 based upon a 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 - 20030507	VARD - 20030821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Delusional Disorder	9208	10%	Delusional And Dysthymia Disorder (also Claimed as
Posttraumatic Stress Disorder)	9299-9208	70%	20030711	
Dysthymic Disorder	Not Unfitting					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Delusional Disorder Condition.  According to service treatment records (STR) and the Psychiatric addendum, the CI first presented to mental health (MH) on 6 August 2001 for a sniper school evaluation and admitted to a suicidal history with daily suicidal ideation.  He stated he had been abused as a child, tied a rope to a tree when he was 6, had thoughts about flipping his car about 5 years previously, and held a sword to his throat in late 2002.  He denied past psychiatric treatment.  He reported he had two PhDs, a doctorate in Medicine and planned to practice medicine in the Philippines.  He reported he studied over the internet, including gross anatomy, and wanted a medical residency at the hospital to be ready for internship.  Psychological testing noted he was likely to have a thought disorder.  He was not sure he wanted to be in treatment.  He was seen in the emergency room (ER) in September 2002 for suicidal ideation.  He reported he had violent nightmares and symptoms of posttraumatic stress disorder (PTSD) in February 2003.  He had deployed to Korea and Iraq and had a combat action badge.  Treatment with medication was not beneficial.  He was married to a woman from another culture but was rooming with a close friend until his wife came to the United States.  He did not have an active social life.  Mental status examination (MSE) showed a flat affect, poor insight, and the delusion of being a qualified doctor.  Diagnoses of delusional disorder and dysthymic disorder, existing prior to service (EPTS) was rendered with a Global Assessment of Function (GAF) of 78 (transient symptoms, slight impairment.)  The psychologist examiner noted his function was not markedly impaired and his behavior was not obviously odd or bizarre. 

The commander’s statement noted the CI had reported suicidal ideation with his sergeant, stating he had these feelings since he was a child but with the help of MH clinic on Post he was able to effectively control them.  However, the CI continued to have suicidal tendencies and was diagnosed with bipolar disorder.  The narrative summary (NARSUM), dated April 2003, noted the CI had not worked in his occupational specialty since February 2003 and was in Medical Hold, assisting with paperwork.  He still had the belief that he was a medical doctor through internet courses.  The CI reported he was diagnosed with bipolar disorder and treated with medication that he took for 1 month since he did not find it helpful.  He had “about 20 speeding tickets.”  He reported normal mood and denied depression.  Plans post-military were to become a mercenary counterterrorist.

At the VA Compensation and Pension (C&P) examination performed 2 months before separation, the CI reported his suicidal thoughts had changed to homicidal thoughts.  He began to have homicidal tendencies after he completed sniper school.  This was after he witnessed the traumatic death of one of his friends in Korea in 1999.  He reported traumatic nightmares nightly about combat, avoidance, “bad road rage,” problems with sleep, concentration and memory, and paranoia.  The medical board had taken away his gun.  He married a Filipino woman in Korea who did not speak English.  He only cared about his friend and his wife, but not his parents.  He reported he had not taken medication for the past 6 months.  He reported he was trying to work for the Federal Bureau of Investigation (FBI) but had a job waiting in a prison.  MSE noted psychomotor retardation, blunted and bizarre affect, blank stares, impaired cognition, grandiose and delusional thought process, and homicidal preoccupation, problems with concentration and poor insight and judgment.  The psychologist examiner opined that he needed help with managing his funds due to his psychological problems and history of poor financial management.  Diagnoses of delusional disorder, dysthymia, and PTSD were rendered with a GAF score of 50 (serious symptoms, impairment bordering on moderate)

The Board directed its attention to its rating recommendation based on the above evidence.  Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for MH conditions.  However, the Board first considered if the definition of §4.129 was met for any psychiatric condition resulting in medical separation; i.e., “a mental disorder that develops in service as a result of a highly stressful event.”  Board members agreed that the requisite §4.129 link that the condition occurred “as a result of a highly stressful event” was not satisfied in this case.  There was no evidence that any of his symptoms were related to traumatic military events.  Although the VA examiner rendered a diagnosis of PTSD, there was no confirmation of traumatic experiences that could be associated with development of psychiatric symptoms and he did not fulfill DSM-IV Criteria for PTSD, i.e. Criteria C.  The Board therefore will consider only the VASRD §4.130 impairment present upon separation.  The PEB assigned a 10% rating under the 9208 code (delusional disorder), citing non-bizarre delusions, mild.  The VA assigned a 70% rating using essentially the same code (delusional and dysthymia disorder) based on the VA C&P examination 2 months before separation, citing occupational/social impairment with deficiencies in most areas.)  The §4.130 criteria for a 10% rating is “Occupational and social impairment due to mild or transient symptoms; symptoms controlled by continuous medication,” for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  The C&P examination was most proximal to separation and documented an abnormal MSE.  The CI displayed a disturbance of affect, impaired judgment, and problems with his memory.  Board members agreed that he had several 50% threshold symptoms at separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 50% for the delusional disorder condition.  

Contended PEB Conditions:  Dysthymic Disorder.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The psychiatric addendum noted the CI had a chronic level of depression that was worse at times, not affected by medication or impairing to social/occupational functioning.  The dysthymic disorder condition was included in the S4 profile but the CI reported to his commander that he was able to control sad feelings/urges and was not judged to fail retention standards.  It was reviewed and considered by the Board.   There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the delusional disorder condition, the Board recommends a disability rating of 50%, coded 9208 IAW VASRD §4.130.  In the matter of the contended dysthymic disorder condition, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.   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 the prior medical separation:  

CONDITION	VASRD CODE	RATING	
Delusional Disorder 	9208	50%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140524, 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 XXXXXXXXXX, AR20160011121 (PD201402626)

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 re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 50% 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 50% 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