RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03453
BRANCH OF SERVICE:  Army
DATE OF PLACEMENT ONTO TDRL:  20011221            DATE OF REMOVAL FROM TDRL:  20060925

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Combat Documentation/Production Specialist, medically separated from the Temporary Disability Retired List (TDRL) for schizophreniform disorder, with a disability rating of 10%.

CI CONTENTION:  Please 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 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 – 20011017/20060828	VARD - 20020702	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Schizophreniform Disorder	9299-9205	30%	--	Schizophrenia, Paranoid Type	9203	50%	70%	
Schizophrenia, Residual Type	9205	--	10%					
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Mental Health.  Service treatment records (STR) indicated that in July 2001, the CI reported to the mental health clinic in Korea with a report of homicidal ideation towards his command and suicidal ideation after he felt ridiculed and laughed at by coworkers and church members.  The command reported that for the 6 months he had been in Korea he was considered a loner, his work performance had deteriorated, he was unable to comprehend his workplace duties and was in constant need of redirection and instruction.  The CI’s chain of command found him to have extremely focused on religion and sexuality and had delusions (false beliefs) related to these topics.  Due to disorganized thoughts, paranoia and harmful threats towards self and others, he was admitted to inpatient psychiatry.  He gave a history of emotional, sexual, and physical abuse by his father and a history of family mental illness.  The CI reported a severe depression in 1994 after failing in school, but did not receive treatment.  In 2000 he was seen by MH and underwent psychotherapy and psychological testing.  The STR noted he may have been in outpatient treatment for a few months at some point prior to deployment and he was already taking a medication for psychosis.  He would not accept medication on the inpatient unit but was generally cooperative.  The CI was air evacuated 30 July 2001 to Walter Reed for further evaluation and a Medical Evaluation Board (MEB).

At the narrative summary (NARSUM) examination, dated 03 August 2001, performed the day after admission to Walter Reed and 5 months before TDRL placement, the CI reported he needed help controlling his fear and anger.  His mental status examination (MSE) showed he was guarded and sat throughout the entire interview with eyes closed, slowed speech, mild psychomotor slowing, flat and inappropriate affect and delusions.  He denied suicidal ideation.  He was treated with a variety of therapies and eventually accepted a medication to treat psychosis.  He began to improve but still had confused thoughts, related superficially to patients, and had difficulty forming friendships due to occasional unpredictable displays of emotion.  The examiner opined that he would likely progress to paranoid schizophrenia, and could be employable at a job with structure and minimal stress and responsibility.  A diagnosis of schizophreniform disorder was rendered with a Global Assessment of Functioning (GAF) score of 35 (impairment in reality testing or impairment in several areas).  He received a S4 profile.

The VA Compensation and Pension (C&P) examination dated 24 June 2002, 6 months after TDRL placement, noted the CI was seeing an outpatient psychiatrist prior to transfer to Korea where his symptoms deteriorated severely.  CI’s diagnosis was officially changed to schizophrenia, paranoid type in May 2002.  He was enrolled in the psychiatric outpatient clinic, attended regularly and was compliant with medications, an anti-psychotic and an antidepressant.  He reported on his last visit 20 June 2002 that he heard voices and had paranoid ideation occasionally.  He was living with his mother and was close to extended family.  He had been discharged for 6 months and had worked the last month in telemarketing but was asked to leave because he was missing too many days.  A diagnosis of schizophrenia, paranoid type was rendered with a GAF score of 50-52 (serious bordering on moderate impairment, symptoms.)

The CI was hospitalized by the VA in August 2002 due to threats to hurt himself and his mother. He had thoughts of jumping off a bridge or jumping in front of a car and was having auditory and visual hallucinations.  He was unemployed.  He was readmitted to the VA hospital November 2002 for 3 weeks with similar suicidal and homicidal ideation.  His mother decided to move in with her aunt, and he had thoughts to stab her in the stomach and hang himself.

At the first TDRL evaluation, dated July 2006, performed 2 months prior to TDRL removal, the CI reported he had been working odd jobs while on TDRL status and was currently working on call with two personnel groups.  He was feeling better and was not hearing voices but had stopped his medications in June 2005.  He was seeing a counselor weekly.  He kept busy with chores at home, worked when called and visited friends occasionally.  He lived with his mother and sister.  Most of his activities were limited to the home.  He reported he was last hospitalized in 2002.  The MSE showed him to be distant with a constricted affect.  He denied suicidal or homicidal ideation.  A diagnosis of schizophrenia, residual type, was rendered.  Impairment for military duty was marked and impairment for social and industrial adaptability was considerable.

At the VA C&P examination, dated February 2007, 4 months after TDRL removal, the CI reported he had three hospitalizations during his TDRL period and the most recent was in December 2006.  He was frightened he would be killed and had a friend call the ambulance to take him to the hospital for an emergency room visit and he was admitted.  He had attended school in January 2006 and passed some courses but failed math and photography.  He lived alone in his apartment and did some housekeeping.  He was not social and had been laid off from his last job.  For the previous 2 weeks he had worked as a busboy with a good relationship with his supervisor and an okay relationship with coworkers.  He had lost some time from work due to being late and being overwhelmed.  He was taking a medication for psychosis.  The MSE showed an anxious mood, constricted affect, loose associations and some autistic logic.  Answers to proverbs and similarities were personalized and complicated.  A diagnosis of schizophrenia, paranoid type in fair remission was rendered with a GAF score of 40 (some impairment in reality testing or impairment in several areas).

The Board directed its attention to its rating recommendation based on the above evidence.  At TDRL placement, the PEB rated the schizophrenia condition at 30%, coded at 9299-9205 (Schizophrenia, residual, other and unspecified type) while the VA rated the condition at 50%, coded 9203 (Schizophrenia, paranoid.)  The Board next considered whether the provisions of VASRD §4.129 were applicable for the unfitting MH condition.  Regardless of final PEB diagnosis, §4.129 does not specify a diagnosis of PTSD, rather it states “mental disorder due to a highly stressful event,” and its application is not restricted to PTSD.  Members agreed that the requisite §4.129 link that the condition occurred “as a result of” an in-service traumatic stressor(s) which resulted in service discharge was not adequately satisfied; and therefore concluded that application of §4.129 was not appropriate in this case.

Regarding the rating at the time of placement on TDRL, Board members considered if there was evidence to support a rating higher than the 30% assigned by the PEB.  The §4.130 criteria for the 30% rating are “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.”  The next higher 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  A 70% rating requires occupational and social impairment, with deficiencies in most areas.  The Board considered that over a 6-month period prior to hospitalization, the CI was isolated and was unable to perform his duties without additional supervision and guidance.  He had symptoms of delusions, paranoia and hallucinations through two hospitalizations 3 months prior to discharge.  At discharge, thoughts remained confused and he had difficulty establishing relationships and unpredictable emotional outbursts.  Since the initial hospitalization, he was assigned to a Medical Holding Company and did not appear able to resume his duties.  The Board agreed there was evidence of chronic mental instability affecting most areas of function, and was consistent with a 70% rating.

As regards to the permanent rating recommendation, the Board considered if a rating higher than the PEB’s 10% was warranted.  The 10% rating specifies “occupational and social impairment due to mild or transient symptoms which decrease work efficiency … only during periods of significant stress, or; symptoms controlled by continuous medication.”  VA MH notes documented post discharge hospitalizations in August and November 2002, and both were associated with suicidal and homicidal ideation with other psychotic features.  Both TDRL re-evaluations noted the CI retained symptoms of psychosis with abnormal MSEs, and the schizophrenia was only in partial remission.  Despite occasional odd jobs, the CI remained isolated, only associated with family members and limited most activities to home.  He did not seem able to sustain long term employment.  The C&P examination within months of discharge revealed the presence of suicidal ideation, impairments in thinking and a seriously impaired level of function.  The Board agreed that his symptoms were neither mild nor transient but were chronic and were not fully controlled by continuous medication.  He had remained in treatment with regular psychiatric follow-up but was in a chronic state of psychosis despite ongoing treatment.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board recommends a TDRL placement rating of 70% and permanent disability rating after TDRL removal of 50% for the schizophrenia condition, coded 9203.

BOARD FINDINGS:  In the matter of the schizophrenia condition, the Board unanimously recommends a TDRL placement rating of 70%, and a 50% permanent rating at TDRL removal IAW §4.130.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Schizophrenia, Paranoid Type	9203	70%	50%	
RATING	70%	50%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140722, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

AR2016000809i , XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to constructively place you on the Temporary Disability Retired List {TDRL) at 70% disability rather than 30% for the period December 21, 2001 to September 24, 2006 and then following this period recharacterize your separation as a disability retirement with the combined disability rating of 50%.  Enclosed is a copy of the Board's recommendation and record of proceedings for your information.

The correction will result in an adjustment to your pay providing you 70% retired pay from the original effective date of your placement on the TDRL and then 50% disability retired pay effective the date following the TDRL period, 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,