RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03344
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070523

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Multiple Launch Rocket System Fire Direction Specialist, medically separated for “schizoaffective disorder, bipolar type” with a disability rating of 10%.

CI CONTENTION:  The CI requests that all conditions be considered.  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 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 - 20070406	VARD - 20071220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizoaffective Disorder…	9211	10%	Schizoaffective Disorder…	9299-9211	30%	20070625	
Attention Deficit Hyperactivity Disorder	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Schizoaffective Disorder, Bipolar Type.  According to service treatment records (STR), the CI deployed to Iraq from March to November 2003.  He denied combat or traumatic exposures though he did experience occasional mortar fire.  Command referred the CI to the emergency room (ER) 13 October 2006 for evaluation of bizarre behaviors.  The CI reported his girlfriend had just had a baby but they were not staying together.  He demonstrated loose associations, confused talk, and reported auditory hallucinations to his command.  He had stayed up all night with racing thoughts.  He was admitted to the inpatient unit and the CI was noted to be disorganized, clearly hallucinating, and responding to internal stimuli.  He was treated with anti-psychotic medication and psychotic symptoms resolved but he was transferred to Walter Reed Inpatient Psychiatry Service on 22 October 2006 for further management and to initiate a Medical Evaluation Board (MEB).

The MEB psychiatric narrative summary (NARSUM) dated December 2006, 6 months before separation, documented the CI’s intentional display of psychotic symptoms (rambling, jumping from topic to topic, using bizarre metaphors) to receive help for anxiety and nightmares.  He did well and was transferred to the day program for continued monitoring and treatment on 25 October 2006.  However, staff noted the return of psychotic symptoms and he was readmitted to inpatient psychiatry on 3 November 2006.  He demonstrated grandiose delusions, thought blocking and irritable mood and again received anti-psychotic medication.  He was transferred for continuity services 10 days later for further care.  A week later he was found at a hotel to be confused and in a stupor with an elevated Tylenol level.  He was admitted to intensive care and transferred to psychiatry inpatient 21 November.  He admitted he had discontinued his medication so he was started on a course of long acting anti-psychotic medication every 2 weeks, and a daily anti-depression medication and a sleep medication.  Psychological testing showed depressive, dependent, and avoidant personality traits along with significant anxiety.  Mental status exam showed an agitated state, mildly perseverative stare, mildly pressured speech, paucity of speech, intermittent thought blocking, grandiosity, and clearly response to internal stimuli though he denied auditory and visual hallucinations.  He denied suicidal ideation.  A diagnosis of schizoaffective disorder was rendered with a Global Assessment of Functioning (GAF) score of 30 (behavior is considerably influenced by delusions or hallucinations, inability to function in almost all areas, serious impairment).  The commander’s statement noted the CI assisted with daily administrative functions for a short period of time and had been enrolled in a rigorous treatment program.  A letter from the CI, dated March 2007, denied the NARSUM’s references to his delusions, hallucinations, and responses to internal stimuli and he noted the report should be redone.

The VA Compensation and Pension (C&P) examination in June 2007, performed a month after separation, documented a review of the C-file.  The psychiatrist reviewer agreed with the diagnosis of schizoaffective disorder and noted the CI did not currently manifest any psychotic symptoms as he did at discharge.  An additional diagnosis of posttraumatic stress disorder, based on VA outpatient treatment notes, was rendered with a GAF of 50 (serious symptoms) for both disorders.  Much difficulty with social and occupational functioning was noted.  According to follow up VA treatment notes, the CI was re-admitted to the hospital in July 2007, with notation that he was too psychotic to participate in groups.  He had recurring psychosis related hospitalizations in 2008.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 9211 code (schizoaffective), citing outstanding military bearing and good interactions with peers and seniors as well as assistance to platoon by performing administrative tasks when available.  The VA assigned a 30% rating using the same code based on the VA C&P examination, citing occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  A 10% rating indicates symptoms are controlled by continuous medications.  The STRs show the CI had three hospitalizations and two ER visits within 7 months prior to his separation, a hospitalization 2 months after separation, and frequent recurring hospitalizations.  All hospitalizations were due to his significant recurring psychosis and persisting belief that he did not have a mental illness that required treatment with medication.  According to the commander and to the STRs, he required day treatment post hospitalizations and was not often available to assist with administrative functions.  Both the NARSUM and the C&P exams determined that he had serious symptoms and impaired function.  The Board considered a 50% disability rating (reduced productivity and reliability) but agreed that a 70% rating (deficiencies in most areas, work, school, family relations, mood, thinking, judgment) best reflected his status at discharge.  After due deliberation, and in consideration of all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommended a disability rating of 70% for the schizoaffective condition, coded 9211.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that attention deficit hyperactivity disorder (ADHD) was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The ADHD was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.   This condition was reviewed and considered by the Board.  There was no performance-based evidence from the record that ADHD significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the ADHD, so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the schizoaffective condition, the Board unanimously recommends a disability rating of 70%, coded 9211 IAW VASRD §4.130.  In the matter of the contended attention deficit hyperactivity disorder, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Schizoaffective Disorder	9211	70%	
COMBINED	70%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140629, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160007978, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 70% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board's recommendation and record of proceedings for your information.

The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.

The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.   Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXX.

A copy of this decision has also been provided to the Department of Veterans Affairs and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXXX.

Sincerely,