RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-03215
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20080331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Logistics Specialist) medically separated for schizoaffective disorder, rated at 10%.  

CI CONTENTION:  “Consider all conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  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 (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 20080131	VA* - (~1 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizoaffective Disorder, Degenerative Type	9211	10%	Schizoaffective Disorder	9211	70%	20080425	
Conditions x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  70%	
*Derived from VA Rating Decision (VARD) dated 20080619 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Schizoaffective Disorder Condition.  The CI was hospitalized for 5 days (9-14 November 2007) in Japan.  At the time of admission he was noted to display symptoms consistent with a psychotic disorder and was prescribed antipsychotic medication with good results.  By the fourth day of admission his symptoms improved and he was medically evacuated to the US for definitive care.  The CI began the MEB process during his 2-week psychiatric inpatient treatment from 22 November to 4 December 2007.  The discharge summary documented that prior to the initial hospitalization, the CI presented to his command’s medical staff stating, “Everyone here is out to get me and watch me fail.”  He had been in Japan for 5 days at that point and was diagnosed with adjustment disorder with anxiety and personality disorder NOS.  Administrative separation was recommended.  The following day he reported suicidal ideations and was admitted to the Naval Hospital (Japan).  It was noted that he had called the Red Cross seeking their help and guidance for relief of his anxiety and to assist him in his desire to separate from the service.  While discussing his situation with the Red Cross employee, he expressed thoughts of self-harm.  He also reportedly stated he was going to “hurt somebody.”  

At the time of the NARSUM on 22 November 2007 (4 months before separation), the CI reported he had abused an over-the-counter weight loss supplement and “it made me crazy.”  He reported remembering that he was paranoid with regard to his coworkers and his command; he felt they were plotting against him.  Additionally, he endorsed symptoms of anxiety, binge eating, sadness, decreased concentration and fluctuating motivation.  He denied current paranoid ideations, and auditory or visual hallucinations.  He denied suicidal or homicidal ideations or a history of suicide attempts.  Hospital course noted that his antipsychotic medication was increased based on his continued paranoia and disorganized thinking.  He was also started on Prozac for depressive, OCD and eating disorder symptoms.  His paranoia symptoms improved and his thoughts became more organized.  After additional adjustment to the antipsychotic medication, the examiner noted that his paranoia was well controlled, but he developed side effects that required the addition of a beta blocker (Inderal).  The physician noted that collateral history obtained from the CI’s girlfriend and family suggested that his psychotic symptoms had occurred prior to his use of weight loss medication.  While in boot camp, he did well at first but afterwards while he was on leave, his family and friends noticed significant paranoia and odd behavior; this became so severe in the following weeks that the girlfriend’s mother did not want her daughter to be alone with him because she feared for her safety.  He reportedly began carrying a knife in his car out of fear that people were out to get him.  The physician stated that as the CI cleared during hospitalization, he was able to corroborate the story.  His diagnosis was adjusted to schizoaffective disorder, depressive type.  At the time of discharge, depressive, manic, or psychotic symptoms were absent.  The discharge mental status examination documented normal motor activity, normal speech, good eye contact, blunted affect, no evidence of psychosis, no evidence of impaired cognitive functioning, no evidence of impaired judgment, and absence of suicidal or homicidal ideation.  The examiner opined that his condition required ongoing psychotropic medication use to control his symptoms and behavior, and noted that his condition was chronic and would likely require lifelong medication and therapy.  However, it was documented that his condition “manifests itself with moderate to severe interference with social and civilian adaptability…may not be able to handle a 40-hour work week without sufficient continuing treatment.”  A Global Assessment of Functioning score of 60 (cusp of mild and moderate) was recorded.  

The VA Compensation and Pension (C&P) mental evaluation was accomplished 4 weeks after separation.  The CI reported that he wanted to work but keeping a job was difficult.  He would work for someone a couple of days and “they do not want him to come back.”  He denied hallucinations, but noted he continued with paranoia and depression.  He felt like everyone was watching him and stated that he carried a pipe in his car, and bought a rifle, “just in case anyone gets near my car.”  He had a good relationship with his girlfriend of 3 years, and they spent time playing video games together; he also enjoyed lifting weights and running.  He denied any legal problems.  The MSE documented absence of suicidal ideations, hallucinations, or cognitive deficits.  His affect was noted as guarded, dysphoric and anxious.  His grooming was appropriate and he was fully oriented.  The examiner noted the report of intermittent violent impulses; however, he noted he had no plan or intent to act on the impulses.  The examiner wrote, “Paranoid ideation and mild thought disorganization were present.”  The diagnosis of schizoaffective disorder was assessed with a GAF of 30 (on the cusp of behavior considerably influenced by delusions or hallucinations and major impairment in several areas).  The psychologist opined that his condition had affected family relations due to paranoia and violent ideation towards family and others; his judgment was impaired due to poor reality testing, and his thinking was affected due to paranoia and disorganization.  The CI reported his medications were helpful, but that he ran out a month prior to his visit.   He expressed no interest in restarting them right away.

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 (as mandated by DoD).  The Board first unanimously agreed that VASRD §4.129 was not applicable. The PEB rated the condition of schizoaffective disorder, “degressive” [sic] type coded 9211 at 10%.  Likewise, the VA used the same code; however, granted a 70% disability rating.  All members agreed that at the time of separation, the VASRD §4.130 threshold for a 10% rating was met.  The Board considered the 70% rating which requires evidence that his condition caused “Occupational and social impairment, with deficiencies in most areas, such as work, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships.  The C&P examiner opined that the CI’s judgment was impaired due to poor reality testing.  The Board found the opinion curious given that he was fully oriented and was aware that his intermittent violent impulses must be contained, and therefore, had no plans or intent to act on them. His understanding and awareness clearly demonstrated his thought process was organized, and judgment was intact. Although he reported paranoid ideations, there was no evidence that his thoughts disturbed his thinking, mood, sleep, appetite, energy, or behavior.  Despite his report of being isolated at home, he noted he enjoyed running and weight lifting (activities outside of the home), and apparently often left the home since he reported having a pipe in his car for protection.  All Board members agreed, based on the evidence in the record, the 70% rating criteria was not approached.  The Board next proceeded to evaluating criteria for the 50% and 30% disability rating, and concluded neither the 50% or 30% criteria were met.  The CI’s only symptoms were his report of paranoid ideation and thoughts of violence.  As noted above, there were no associated behaviors or noted consequences to his symptoms.  At the time of separation, his symptoms were well-controlled with medication.  In the weeks after separation, the CI noted that he had not had medications since separation and acknowledged that medication had been helpful.  Despite not having medications, he reported no disturbance in sleep, panic attacks, hallucinations, memory loss, or significant anxiety.  Although he reportedly stated he felt depressed, he was not suicidal, was not seen in the emergency room for mental health issues and he was not hospitalized for any mental health condition.  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 20140710, 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 2 Feb 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 USMC
- XXXXXXXXXXXXXXX, former USMC 
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC   
- XXXXXXXXXXXXXXX, former USMC 

				XXXXXXXXXXXXXXX
	     		Assistant General Counsel
			(Manpower & Reserve Affairs)