RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02744
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050503

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Automated Logistical Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “…schizophrenia, paranoid type…” with a disability rating of 0%.  

CI CONTENTION:  The applicant requests that all conditions be considered.  His 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 – 20000128/20061212	VARD - 20010607	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Schizophrenia, Paranoid…	9203	50%	0%	Schizophrenia, Paranoid…	9203	30%	30%	
COMBINED RATING:  50% → 0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Paranoid Schizophrenia.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) mental health (MH) narrative summary (NARSUM), in March 1999, the CI was taken to the emergency room (ER) after he reportedly took a hot light bulb into his hands and placed it up against his forehead, receiving second degree burns to his hands and face.  The CI reported that he heard the voice of God commanding him to rub the light bulb “up and down his face.”  The CI was evaluated and admitted to the inpatient psychiatry unit.  The ER noted that the CI had used marijuana and mushrooms the night before.  He was found on the steps of the church saying he was likely the devil and the devil was out to get him.  The CI was discharged from the inpatient unit with the diagnosis of brief psychotic reaction, felt to be secondary to substance abuse.  The NARSUM noted that this incident was preceded by a history of auditory hallucinations with voices telling the CI he was incompetent and other derogatory things.  He was also preoccupied with religion.  He began to believe that he was possessed by a demon and was able to speak in tongues.  

In late April 1999, the CI was re-admitted to the psychiatry unit when the voices became louder and more derogatory.  The discharge summary noted that the CI had done well after the March admission, but he continued to have paranoia.  By 3 weeks his symptoms had resolved and he discontinued his medications.  Since stopping his medications, his symptoms returned, and he was admitted for the second time.  The diagnosis of paranoid schizophrenia was assessed.  He was recommended to the MEB for disposition.

The MH NARSUM was accomplished at the outpatient clinic on 3 June 1999, 10 months prior to TDRL placement.  The examiner noted that the CI had an unblemished record prior to March 1998 when his wife left him during his deployment to Japan.  His wife left her daughter with a neighbor, and moved in with the person she was having an affair.  The child was not his biological child.  He had to assume full responsibility of the child.  In July 1998, the CI was charged with larceny after he attempted to cash a check which did not belong to him.  In February 1999, he was found to have marijuana in his urine.  The mental status examination (MSE) recorded the presence of psychomotor retardation (mental and physical slowing), and flattened affect.  The CI denied active hallucinations or delusion, and indicated he was compliant with his antipsychotic medications.  There was disturbance in his cognition, primarily with concentration and short-term memory.  His judgment and insight was thought to be poor.  The psychiatrist opined that the CI was functioning in “a borderline fashion” in an outpatient setting with no significant responsibilities while on medication; however, noted that he was able to function as a clerk in the occupational medicine clinic under close supervision.  It was noted that the auditory hallucinations (voices) were under control.  The diagnosis of schizophrenia, paranoid type was recorded with a Global Assessment of Functioning (GAF) score of 35 for major impairment in several areas.  

The VA Compensation and Pension (C&P) mental examination was accomplished in May 2000, approximately 3 weeks after TDRL placement.  The examiner noted that the CI reported he was hospitalized a 3rd time for about one week in October 1999.  Prior to admission, he had discontinued his medications and started hearing voices.  One day the voices told him to throw his television away and he complied.  At the time of the C&P examination, the CI reported he worked at a discount automobile store.  The work was stressful because of “customer’s attitudes.”  He occasionally went to the park with his family but mostly stayed home and watched television.  MSE documented mildly dysthymic mood and blunted affect.  He denied suicidal or homicidal thoughts, and noted that when he hears voices he takes extra medication and this controls the voices.  His insight and judgment were not impaired.  A GAF score of 55 for moderate symptoms and or impairment was recorded.

The Report of TDRL dated 11 August 2006, noted the CI was placed on the TDRL in 2000 and had undergone two prior TDRL examinations.  At the time of the examination, the CI noted that he had not experienced any mood or psychotic symptoms since 2002.  He reportedly indicated that he was “very happy at this time.”  He had remarried a year ago, and he and wife had a 1-year-old daughter.  He was in college studying to become a paralegal and was about to graduate.  The CI reported that he had moved to a different State in 2002, and was under the care of a psychiatrist.  The psychiatrist discontinued all medications and monitored him, revised his diagnosis to depression with psychotic features.  Since that time he has not had any symptoms and has done very well.  The MSE was unremarkable.  The diagnosis of major depressive disorder with psychotic features was recorded with a GAF score of 55 was assessed.  

The Board directed attention to its recommendations based on the above evidence; and, first considered whether the provisions of VASRD §4.129 for any “mental disorder that develops in service as a result of a highly stressful event” were applicable to this case.  The Board first unanimously agreed that VASRD §4.129 was not applicable in this case.  At the time of TDRL placement, the PEB rated the condition of schizophrenia disorder coded analogously as 9203 at 50%.  The VA granted a 30% disability rating under the 9203 code for schizophrenia, paranoid type, based on the C&P examination, 3 weeks after TDRL placement.  All members agreed that at the time of placement of the TDRL, the VASRD §4.130 threshold for a 50% rating was met.  Board members agreed, there was insufficient evidence to support a 70% rating, and therefore, the condition at TDRL placement supported the 50% level of disability for “Occupational and social impairment with reduced reliability and productivity.  

The Board next determined the most appropriate fit with VASRD §4.130 criteria at the end of TDRL for its permanent rating recommendation.  The PEB rated the condition at 0%, citing there was no industrial impairment but that the CI had a “high risk of recurrence of psychosis “ which prevented return to active duty.  The Board noted the CI had no hospitalizations in the 4 years prior to TDRL removal and was not treated in the ER.  By the CI’s report, he had not taken medications for 4 years, and was completing a paralegal program.  The CI had remarried, was the father of a 1-year-old and indicated that he was happy with his life.  His MSE at the removal NARSUM was unremarkable and he did not report any MH symptoms.  Board members agreed, the record demonstrated, at the time of permanent separation, the CI’s condition was stable, and if he had symptoms, his symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication.  Thereupon, 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 schizophrenia condition at TDRL placement and removal.

BOARD FINDINGS:  In the matter of the schizophrenia, paranoid type condition and IAW VASRD §4.130, the Board 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 20140606, 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

17 NOV 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
AR20160016971 (PD201402744)

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