RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02655
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20150716
SEPARATION DATE:  20070815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Rifleman) medically separated for conversion disorder.  The conversion disorder condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was placed on limited duty and referred for a Medical Evaluation Board (MEB).  “Conversion disorder,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB also identified and forwarded two other conditions (major depressive disorder [MDD], single episode, moderate degree; and panic disorder without agoraphobia) for PEB adjudication.  The Informal PEB adjudicated “conversion disorder with pseudoseizures” as a Category I unfitting condition, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be Category II, (contributing to the unfitting condition).  The CI made no appeals and was medically separated.

CI CONTENTION:  The applicant requests the Board consider all conditions.  His complete submission is at Exhibit A.

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 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:

IPEB - Dated 20070628	VA* - (~3 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Conversion Disorder …	9424	10%	MDD, Anxiety Disorder with Panic Attacks with Pseudoseizures (To Include Claim for Conversion Disorder)	9434	50%	20071103	
Panic Disorder…	Cat II					
MDD, Single Episode,…	Cat II					
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 4	
RATING:  10%	RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20071227 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Conversion Disorder with Pseudo-seizures (and MDD and Panic Disorder).  The CI was first evaluated for what was thought to be heat exhaustion in May 2005.  He had several more episodes and was found to have a normal body core temperature in July 2005.  A cardiology evaluation was normal, but his symptoms persisted.  The diagnosis of a possible seizure disorder was then considered in January 2006.  He was evaluated by both neurology and neurosurgery.  The record then falls silent until he was seen for panic attacks in primary care in September 2006.  At a psychiatric evaluation on 30 October 2006, he reported that he had not had mental health (MH) issues until 3 months earlier when he was subjected to harassment by members of his unit.  He also had stress with his father and had lost a friend to suicide; however, he was newly married (3 months) and had a good relationship with his wife.  He was diagnosed with a panic disorder, but continued to have the spells (possible seizures) despite treatment.  In-patient monitoring was diagnostic for pseudo-seizures.  He was diagnosed with a conversion disorder and referred for MEB.  The record also shows that he had more difficulty with physical fitness training after he injured his knee and reported that his unit thought that he was avoiding training.  The commander’s statement dated 21 May 2007 noted that the CI was able to provide general support duties for his platoon, but could not meet the requirements of an active duty Marine.  The narrative summary was dated 23 May 2007, 3 months prior to separation.  It noted that the CI had ongoing problems with his father and financial difficulties.  However, he enjoyed a good relationship with his wife and they were trying to have a child.  The mental status examination (MSE) showed a restricted range of mood, but appropriate intensity.  His sense of humor was “not retained.”  Thought processes and memory were intact.  Neither suicidal nor homicidal ideation was present.  His coping skills were diminished and he was unable to manage even minor stress.  He was diagnosed with a conversion disorder, MDD, and panic disorder without agoraphobia (fear of open or crowded environments).  All were thought to have moderate impact on occupational functioning.  At the General VA Compensation and Pension (C&P) examination performed on 29 October 2007, 2 months after separation, the CI reported that he was on no treatment for his pseudo-seizures and that he had one episode the prior 7 months.  The MSE (non-psychiatrist) was normal.  The MH C&P was performed on 5 days later on 3 November 2007.  It noted that he had no pseudo-seizures from February to August 2007 and that he had three the previous week.  The examiner noted that the service treatment records were not available.  The CI planned to look for work, but intended to obtain a “low stress job.”  He reported an average childhood with below average grades.  He described his marriage as wonderful and “close” relationships with his family of origin.  He endorsed depressed mood, tearfulness/crying spells, loss of pleasure in normally pleasurable activities, decreased motivation, decreased appetite, hopelessness and worthlessness, decreased concentration, indecisiveness, and disrupted sleep.  He reported the onset as August 2006, 3 months after return from deployment while training for his next deployment.  He also reported anxiety related to his family’s safety and felt on edge.  He socialized with his neighbors (limited due to financial limitations).  On examination, his affect was constricted and mood anxious and dysphoric (a sense of unease or dissatisfaction).  He reported an occasional nightmare associated with his combat experience.  Subjective memory loss was present, but not shown objectively.  The remainder of the mental status examination was normal.  He reported unemployment which was attributed to his recent separation.  He was thought to have reduced reliability and productivity due to the mental health diagnoses.

The Board directed attention to its rating recommendation based on the above evidence.  It was first considered if the provisions of VASRD §4.129 (MH disorders secondary to traumatic stress) were applicable.  The CI reported occasional nightmares due to his combat experiences.  However, he first was treated in MH due to harassment at work, stress with his father, loss of a friend, and financial difficulties.  The evidence does not support the application of VASRD §4.129.  The Board then considered the rating IAW VASRD §4.130 (mental disorders).  The PEB determined that the conversion disorder was the primary diagnosis with contributing diagnoses of panic disorder and MDD.  It rated the MH conditions at 10%, coded 9424 (conversion disorder).  The VA, using the C&P examination, rated MDD, anxiety disorder with panic attacks with pseudo-seizures (including conversion disorder) at 50%, coded 9434 (major depressive disorder).  The Board first observed that even though the PEB and VA both combined the MH disorders into a single condition for adjudication, this had no impact on adjudications since the CI was rated by both for the total impairment.  The Board then considered the rating.  The disability described by the VA C&P examiner supports a 50% rating.  However, it was made without benefit of the service medical records.  The commander noted that the CI was performing most of the demands of his support activities in-Garrison.  The CI reported to both mental health examiners, that he was in a good marriage and that they were attempting to start a family.  Although he was not working at the time of the VA examination, this was not attributed to an inability to work; rather, it was noted that he had recently separated.  The Board determined that the impairment in evidence did not support a 50% rating at separation.  The Board then considered if a 30% rating was supported at separation.  The criteria for a 30% rating are: 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).  Other than time lost for medical appointments, the CI was apparently meeting his alternate duty requirements at separation.  He was unable to meet duty requirements when he had a pseudo-seizure, but had not had any for 6 months leading up to separation until the month of separation.  The Board majority determined that the level of function at separation was better described by the criteria for a 10% rating.  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 conversion 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 conversion disorder with pseudo-condition and IAW VASRD §4.130, the Board, by a majority vote, recommends no change in the PEB adjudication.  
There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  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 20140424, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 1 Dec 15

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

- XXXXXXXXXXXXXXXXXXX, former USMC  
- XXXXXXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)