RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03543
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030429

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Field Artillery Firefinder Radar Operator, medically separated for “conversion disorder…” with a disability rating of 10%.

CI CONTENTION:  The CI stated he should have received a medical retirement.  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 - 20030305	VARD – 20030924	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Conversion Disorder…	9424	10%	Conversion Disorder and Anxiety Disorder	9434	30%	20030826	
Anxiety Disorder Not Otherwise Specified...	Not Unfitting					
Alcohol Dependence…	Not Unfitting	No VA Placement	
Borderline Personality Disorder…	Not Unfitting	No VA Placement	
Movements, Involuntary, Body…	Not Unfitting	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Conversion Disorder.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed symptoms of panic attacks (characterized by increase heart rate, chest pressure, increased respiratory rate, a sense of nervousness, claustrophobia),  self-mutilation, and tremors and feeling overwhelmed in 2002.  The symptoms were accompanied by declining duty performance and he presented for care August 2002.  At the time of initial evaluation, the CI re was no history of traumatic stress which may have caused his symptoms; however the CI noted that he had difficulty accepting the loss of a friend.  Clinical evaluations (laboratory and magnetic resonance imaging) for identification of an organic source for the CI’s symptoms were negative and he was diagnosed with conversion disorder, anxiety disorder, dysthymia, and personality disorder, not otherwise specified (NOS).  The MEB NARSUM examination dated November 2002, 5 months prior to separation was performed during a 15-day psychiatric hospitalization for further evaluation and stabilization of conversion disorder, panic attacks, and anxiety symptoms.  He denied reported fleeting suicidal ideations without a plan and daily desire for self-mutilation.  He denied homicidal ideations.  The mental status examination (MSE) showed a depressed mood and variable affect; occasional tangentially, but redirectable thought process; and variable rate, tone, and volume of his speech.  Judgement and impulse control were noted as fair.  Insight was poor and impaired.  The examiner noted nearly constant shaking of the right arm, shoulder and hand, and occasional tapping of the right foot which could be voluntarily stopped, but was exacerbated when addressing emotionally laden subjects.  At an emergency department visit dated 22 November 2002, 10 days after the NARSUM examination the CI reported anxiety, memory loss, and disassociation (“could think but could not act on thoughts”).  He was evaluated and released without readmission.  At the time of the VA mental health Compensation and Pension (C&P) examination, in August 2003, performed 4 months after separation, the CI reported depression with suicidal thoughts,· feelings of hopelessness, anxiety, difficulty interacting with others, and loss desire to socialize, work, or participate in activities he used to enjoy..  There was no recurrence of his “seizure” since April 2003.  He also reported cessation of his psychiatric medications.  Diagnoses of major depressive disorder, recurrent; conversion disorder; manifested by generalized shaking that simulates grand mal seizures; alcohol abuse in remission, and anxiety disorder NOS were rendered.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 9424 code (conversion disorder).  The VA assigned a 30% rating using the 9434 code (major depressive disorder) based on the VA C&P examination 4 months after separation.  All Board members first agreed that the preponderance of evidence did not support the application of §4.129 (Mental disorders due to traumatic stress).  The Board noted following inpatient treatment in November 2002 at the time of initial presentation, the CI followed-up with psychiatric treatment including an adult day treatment program and medication. There was one emergency department visit 2 weeks after being discharged from the hospital.  The Board noted the CI’s symptoms (anxiety, depression, social avoidance, and tremors) persisted from the time of the NARSUM 5 months before separation, to the time of the C&P examination 4 months after separation.  The 30% rating is supported based on the general description for a §4.130 rating of 30%, “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily) which were noted in both the MEB and C&P examinations.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the conversion disorder condition, coded 9424.  

Contended PEB Conditions: Anxiety Disorder Not Otherwise Specified (NOS), Alcohol Dependence, Borderline Personality Disorder, Involuntary Body Movements, Relational Difficulties, Occupational Discord, Living with Abnormal Voluntary Movements.  The Board’s main charge is to assess the fairness of the PEB’s determination that anxiety disorder NOS, alcohol dependence, borderline personality disorder, involuntary body movements, relational difficulties, occupational discord, living with abnormal voluntary movements were not unfitting.  The anxiety disorder NOS and borderline personality disorder conditions were profiled, but were not judged to fail retention standards.  The Board noted the PEB indicated that the alcohol dependence in remission and the borderline personality disorder were not separately unfitting or rated.  Alcohol dependence (as a primary condition not due to mental illness) and personality traits are not disabilities which are subject to rating but may form the basis for administrative separation when they interfere with duty (DoDI 1332.38 Enclosure 5).The involuntary body movements and relational issues were subsumed in the social and occupational impairments rating of the conversion disorder condition.  All were reviewed and considered by the Board.  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 any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the conversion disorder condition, the Board unanimously recommends a disability rating of 30%, coded 9424 IAW VASRD §4.130.  In the matter of the contended anxiety disorder NOS, alcohol dependence, borderline personality disorder, involuntary body movements, relational difficulties, occupational discord, living with abnormal voluntary movements conditions, the Board unanimously recommends no change from the PEB determinations 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; 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	PERMANENT RATING	
Conversion Disorder	9424	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140622, 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, AR20160017508 (PD201403543)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to re-characterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA