RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2014-02892
BRANCH OF SERVICE:  NAVY 		SEPARATION DATE:  20021204

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

CI CONTENTION:  “Please 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 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 PEB – 20021101	VARD - 20030903	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizoaffective Disorder	9211	10%	Depression/Schizoaffective Disorder	9211	10%	20021107	
Major Depressive Disorder, Resolved	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Schizoaffective Disorder.  The narrative summary (NARSUM) recorded that the CI had been treated for major depression a year prior to the onset of psychotic symptoms.  Clinic entry dated 20 June 2000 noted the CI began treatment with Sertraline (antidepressant) 3 months prior and had shown some improvement. Evidence showed his depressive symptoms had been present for 2-3 years.  Other than a history of two break-ups with girlfriends in the past and missing his family, there were no traumatic stressors documented in the treatment record.  At the time of his initial diagnosis, the CI had also experienced thoughts of paranoia, specifically he had thoughts that the Navy would murder him and fake his death as a suicide.  He did not disclose his paranoid thoughts to his doctor.  The CI continued to take the antidepressant for 2 years with limited benefit.  During the second year of treatment, he began to experience auditory hallucinations of a derogatory nature.  He heard voices commenting on his actions, calling his name.  He also reported symptoms consistent with ideas of reference with bizarre themes (in this case:  CI thought “they” were trying to kill him).  The NARSUM indicated that although his depression improved over time his psychotic symptoms persisted.  Due to his apparent lack of improvement, his mother encouraged him to seek help.  He presented to sick call and received a provisional diagnosis of schizophrenia.  The NARSUM was conducted in July 2002, approximately 5 months before separation.  It was noted that the CI joined the Navy at age 19.  Family history of mental illness was generational; however, history of completed suicide was absent.  The mental status examination (MSE) recorded that his affect was constricted in the neutral range and he reported an angry and down mood.  Speech was normal.  The examiner noted that although the CI was aware that some of his thoughts were delusional, such as his co-workers were against him and were talking about him, he believed this was true.  He denied suicidal and homicidal ideations, and his judgment and cognition were not impaired.  The examiner diagnosed schizoaffective disorder, recommended antipsychotic medication and noted that his condition significantly impaired his ability to perform his duties.  The last mental health (MH) entry dated 29 July 2002 noted the CI was prescribed Olanzapine (antipsychotic) for his diagnosis of schizoaffective disorder.

A general psychiatric evaluation conducted by a civilian physician dated 7 November 2002, a month before separation, served as the source document for the VA Compensation and Pension (C&P) decision.  At the evaluation, the CI recounted his mental health history, and noted that he had continued to take sertraline and olanzapine.  He had concerns about being able to find a job or attending school, and noted that he had enjoyed the military, disappointed that he was being discharged.  His MSE was normal with the exception of flattened affect.  The diagnoses of schizoaffective disorder, depressive type and panic disorder without agoraphobia were recorded.  The psychiatrist noted that his condition had improved with antipsychotic medication.

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 not applicable to this case.  Both the PEB and VA rated the condition of schizoaffective disorder, coded 9211 at 10%.  The PEB adjudicated the condition of major depressive disorder, which was resolved as a Category II condition that contributed to the unfitting schizoaffective disorder.  Regardless of diagnosis, VASRD 4.130 rating criteria is based on occupational and social impairment due to symptoms; therefore, symptoms attributable to his depression were considered in the overall rating of his mental condition.  All members agreed that at the time of separation, the VASRD §4.130 threshold for a 10% rating was met.  The Board considered the 30% rating which requires evidence that his condition caused “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks chronic sleep impairment, mild memory loss.”  The commander’s statement noted that because of the side effects of his medication, he was unable to maintain concentration, was extremely lethargic and sluggish, both diminished his situational awareness, making it dangerous for him and others to work around aircraft.  He also had difficulties interacting with others.  The Board noted that at the time of the NARSUM, the CI was not taking any antipsychotic medication; symptoms recorded were related to psychosis.  One month before separation, the VA examiner noted that his psychotic symptoms had improved with medication and his sole symptom on MSE was a flattened affect.  No psychotic symptoms were recorded during the MSE, and no evidence was presented of active psychosis in the year before separation.  There was no report of chronic sleep impairment, loss of memory, panic attacks, or significant depression in the months prior to separation.  The NARSUM noted that he understood his paranoid delusion were not likely founded in reality but he continued to believed them; however, his understanding and awareness of them clearly demonstrated his thought process was organized.  The Board noted that his delusions did not lead to any negative consequences (aggression, irritability, confrontations) which demonstrated that his judgment was not impaired. There was no evidence that his thoughts disturbed his thinking, mood, sleep, appetite, energy, or behavior.  Furthermore, the CI was not hospitalized psychiatrically, there were no visits to the emergency room for MH issues, and at the time of separation, his symptoms were well-controlled with medication.  The commander’s statement indicated he had difficulty with concentrating associated with his medication, which is one of the most common side effects of antipsychotic medications; especially in naïve persons and this tend to dissipate over time.

All Board members agreed, based on the evidence in the record, the 30% rating criteria was not approached.  The record demonstrated that his condition was best reflected in the 10% disability rating for mild symptoms controlled by 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 schizoaffective disorder condition.

BOARD FINDINGS:  In the matter of the schizoaffective 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 20140610, 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 18 Apr 16

      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:

		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN