RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03256
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050808

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Light Wheeled Vehicle Mechanic, medically separated for “conversion disorder, manifested by episodes of unresponsiveness and without clonic/tonic activity,” with a disability rating of 10%.

CI CONTENTION:  The CI requests review of all conditions in their application.  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 on 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 - 20050714	VARD - 20050816	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Conversion Disorder	9424	10%	Conversion Disorder	9424	10%	20050803	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:  

Conversion Disorder.  According to the narrative summary (NARSUM), performed 3 months prior to separation, the CI reported periodic outbursts of violence in childhood.  He was evaluated by psychiatrists and treated with Ritalin which was of no benefit.  He was seen in September 2002 for problems thought to be seizure related.  He received supportive counseling until December 2002.  The “seizures” continued resulting in multiple trips to the emergency room and several hospitalizations.   Neurological follow up on February 2005 noted the CI had been hospitalized October 2004 for evaluation of “spells.” Neuroimaging and electrical study of brain waves were unremarkable.   The CI reported it was difficult to articulate an anxiety attack with extreme akathisia, feeling jittery with non-vertigo dizziness, feeling irritable, no loss of consciousness, and no bowel or bladder incontinence.  In March 2005, Neurology referred the CI to mental health (MH) since they could find no evidence of neurological dysfunction.  Psychological testing suggested somatoform disorder.  During outpatient treatment his MH declined, becoming withdrawn, not sleeping for up to 3 days, became dissociative, wept uncontrollably and then stared into space.  His work deteriorated drastically and he was hospitalized on March 30 and discharged April 7 with a diagnosis of “conversion disorder with seizures or convulsions manifested by seizure-like behaviors.”  He responded minimally to an anti-depression medication.  He was relieved of supervisory duties.  After removal from stressors that led to these episodes, he had no further episodes.  The CI reported the episodes began by his having “something like an anxiety attack” during which he could not control his emotions.  He would begin shaking and blacked out with no memory of what had occurred.  He felt a sense of exhaustion, fear, anger and disorientation.  Psychosocial stressors included the stress of supervisory responsibilities and frustrations with his former chain of command.  He was married and had a stepson.  Mental status exam showed agitation, anxiety, depression, and he reported he felt irritable and angry.  Speech was slow and choppy, poor eye contact, sad mood, flat affect, and some psychomotor retardation.  He denied suicidal ideation.  As an outpatient, he did not respond well to psychotherapy.  He was removed from duty and continued to experience anxiety attacks and periods during which he could not control his emotions.  His medication reduced his tendency toward frustration slightly, but removing him from stressful situations interrupted the episodes.   A diagnosis of conversion disorder with seizures or convulsions was rendered with a Global Assessment of Functioning score of 60 (moderate bordering on mild symptoms, impairment.)  Impairment for social and industrial adaptability was definite.  

At the MEB exam (recorded on DD Forms 2807 and 2808) dated June 2005, 2 months prior to separation, the CI reported depression, anxiety, loss of memory, and trouble sleeping and a diagnosis of conversion disorder was listed.   Two commander statements, completed the same day by the same commander, noted the CI occasionally completed a full shift, and his limitations and restrictions were too great for deployment.  Even with assignment limitations he scored well on his PT test December 2004. His medical condition caused prolonged profiles and/or missed performance of duty but he had excelled as a non-commissioned officer despite his physical limitations.  The VASRD rating appeared to be based on the NARSUM exam findings.  

The Board directed its attention to its rating recommendation based on the above evidence.  Both the PEB and the VA rated the conversion disorder with seizure like episodes condition 10%, coded 9424 (conversion disorder.)   The §4.130 criteria for a 10% rating is “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.”  Outpatient notes indicated the episodes resolved with removal of the stressors.  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 condition.  

BOARD FINDINGS:  In the matter of the conversion 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 20140606, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record
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 XXXXXXXXXXXXXXXXXXXXXXX AR20160011319 (PD201403256)

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