RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03414
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050407

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Helicopter Repairer, medically separated for “schizophrenia, paranoid 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 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 - 20050215	VARD - 20051209	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizophrenia, Paranoid Type	9203	10%	Schizophrenia, Paranoid Type	9203	50%	VA TR*	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Schizophrenia, Paranoid Type.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) mental health (MH) narrative summary (NARSUM) the CI presented to MH in May 2003 with the report that someone laced his beverage.  It was noted that at the time of first presentation, he was diagnosed with an adjustment disorder with depressed mood and schizotypal personality disorder.  In August 2003, he was seen for a mental status evaluation for the purpose of an administrative discharge.  Treatment records were silent going forward until his admission to the local VA inpatient psychiatry unit on 29 March 2004 for evaluation of paranoid delusions and depressed mood.  The discharge summary noted that the CI’s problems began in February 2003 when he rejoined the military for a second time.  Following advanced individual training (AIT) the CI reported he experienced escalating harassment by fellow soldiers that included rumors that he was homosexual, although he had no direct knowledge of such.  On one occasion he believed that his bagel was laced with chlorine because after eating the bagel, a strong smell of chlorine was coming off his body.  The CI also expressed other bizarre beliefs consistent with paranoid thinking.  In August 2003, he went absent without leave (AWOL) and returned home to live with his parents.  After he returned home, he experienced depressive symptoms.  In November 2003, he was involved in a hit and run motor vehicle accident, went home and shaved his head with the expectation that he would be taken to jail and could avoid the lice problem in jail.  About 30 minutes later, the police showed up to his house and took him to jail.  The CI also expressed concern that he feared being abused if he returned to the military.  With regards to his hit and run incident, the CI went to court and was fined and placed on probation.  The psychiatrist noted that despite treatment with antipsychotic medications before and during his inpatient stay, he continued to display paranoid delusions, although his delusions had improved significantly with medication.  A CT brain scan was normal.  At the time of discharge from the hospital (2 months after admission), his Global Assessment of Functioning (GAF) score had improved by 40 points to 60 for borderline mild to moderate impairment and or symptoms.  He returned to the base with medication.

The MH NARSUM was conducted on 21 September 2004, 7 months before separation.  The CI reported that during his 8 months of being AWOL, he went to New Orleans to get his fortune told before returning home to Michigan.  While home, he received pressure from his family that he needed to get MH treatment.  He had demonstrated paranoia and feared leaving the house.  He eventually sought treatment at the VA for a 3-month period before he was hospitalized.  The CI was discharged on 29 May 2004 with an antipsychotic and antidepressant medication.  At the time of the NARSUM, he reportedly no longer exhibited overt psychotic symptoms but had many” negative symptoms of psychosis” not described by the examiner.  The mental status examination (MSE) recorded a somewhat constricted mood and affect but noted he was able to show a full range of appropriate emotions at different times during the interview.  His speech was normal, and evidence of psychosis was absent.  All other aspects of the examination were unremarkable.  The diagnosis of schizophrenia, paranoid type was assessed and a GAF of 45 for serious symptoms and or impairment was recorded.

On 22 December 2004, approximately 4 months before separation, the MEB psychiatrist submitted a memorandum to the PEB in response to the PEB’s initial determination that the MH condition had existed prior to service.  It was noted that the CI’s condition of schizophrenia, paranoid type was in partial remission, and that his condition had not existed prior to service.  The CI was non-attendant to the VA Compensation and Pension (C&P) examination.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition of schizophrenia, paranoid type at 10%, coded 9203 (schizophrenia).  The VA used a MH assessment conducted in May 2005 to grant a 50% disability based on the report of depressed mood, unemployment, and flattened affect.  It was noted that the CI was doing odd jobs around his house, and was sleeping 6-7 hours per night.  There was no indication that his condition had deteriorated and very few symptoms were recorded.  The VARD also noted that the 50% rating was decreased to 10% based on treatment records after May 2005.  Thus, in October 2005, 6 months after separation, the 10% disability rating was assigned based on the 5 October 2005 follow-up examination.  The VARD noted that despite having failed to attend C&P examinations, the records indicated that he appeared for regular routine follow-up appointment. 

The Board first noted there was no specific, highly stressful service related event to invoke §4.129 for a mental disorder due to traumatic stress.  The Board proceeded to rate under §4.130.  The higher rating of 30% requires demonstration of impairment in occupational and social functioning that result in occasional decrease in the ability to perform duty due to significant MH symptoms.  The Board noted the memorandum from the NARSUM examiner, presented to the PEB 4 months before separation, indicated that the CI’s condition was in partial remission.  As noted above, the CI was non-attendant to both scheduled C&P exam and although he was initially awarded a higher evaluation, the rating was decreased based on treatment records in the 6 months after separation.  The 5 October 2005 examination noted that the CI reported he was doing well at work, getting good evaluations and was being treated well by his supervisors/company.  He noted that he was getting more comfortable again, very happy with a family who he stated had “adopted him.”  He was sleeping well most nights, visiting church and optimistic about his future.  He was no longer taking antipsychotic medications and noted that he had continued to do better without the medications.  It appeared that the condition that had been considered in partial remission 4 months prior to separation had fully remitted 6 months after separation.  All Board members agreed there was no justification for the 30% disability rating.  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, paranoid type condition.  

BOARD FINDINGS:  In the matter of the schizophrenia, paranoid type 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 20131202, 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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018208 (PD201403414)

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: