RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03679
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20080115

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

CI CONTENTION:  The CI requests the Board consider all conditions.  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 - 20071105	VARD – 20090821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizophreniform  Disorder	9299-9205	10%	Schizophreniform Disorder	9205	10%	STR	
Pregnancy	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:  

Schizophreniform Disorder.  According to the service treatment records and the Medical Evaluation Board (MEB) mental health (MH) narrative summary (NARSUM), the CI presented to MH in December 2006 and was diagnosed with adjustment disorder with anxiety.  She was considered fit for duty.  On 11 December 2006, the CI presented to the medical department with the complaint of inability to sleep.  She reported that she had multiple life stressors and had not been able to sleep well for the past 6 days.  She was provided a prescription for sleep medication.  
The CI sought additional assessment with a civilian psychiatrist and reported a history of auditory, visual and olfactory hallucinations over a period of several months.  The psychiatrist prescribed medications and recommended that she not return to the ship.  Due to the recommendation, the CI underwent another MH evaluation with the service and was diagnosed with schizophreniform disorder, and it was noted that the CI was pregnant.  At the 29 June 2007 MH visit, the CI reported depressive and psychotic symptoms that had occurred in the context of stress with her step-daughter.  She had command hallucinations that involved a male voice telling her “to run away.”  She indicated she felt she was being followed.  

The MH NARSUM was conducted on 5 July 2007.  The CI reported she had experienced psychotic symptoms over several months and had a history of intermittent insomnia.  She noted that her symptoms significantly decreased with medication.  The CI indicated that her paranoid thoughts had continued and she felt that she was being watched by unknown persons for unknown reasons.  She denied a history of suicidal or homicidal ideation.  It was noted that the CI had never been hospitalized psychiatrically.  At the time of the NARSUM, she had continued the prescribed psychotropic medications.  The mental status examination noted her hair was unkempt but otherwise her appearance was unremarkable.  She reportedly described her mood as “confused and concerned.”  However, there was no evidence of a formal thought disorder or psychosis.  The diagnosis of schizophreniform disorder was recorded with a Global Assessment of Functioning (GAF) score of 55 for moderate symptoms and or impairment.  It was noted that her symptoms had responded well to medication, and medication was required to control the psychotic symptoms.

The CI failed to present at 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 schizophreniform disorder at 10%, coded analogously 9299-9205.  The VA initially denied the CI’s claim, noting that she had not appeared for the MH exam and had withdrawn her claim.  Approximately 2 years after separation, the VA assigned a 10% rating in the 2010 VARD for the condition of schizophreniform disorder, coded 9205.

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 NARSUM did not comment on degree of impairment, but did note she had responded well to medication and that medications were required to control her symptoms.  The non-medical assessment noted that the CI was able to perform her duties without limitations, but was unable to function in her rate until cleared by a medical officer.  There was no mention of inability to perform tasks due to fatigue, distraction, poor concentration, impaired judgment, or disturbance in thinking, or mood, psychotic or anxiety symptoms.  The Board also considered the absence of hospitalization, emergency room visits, and the absence of psychotic symptoms during the NARSUM evaluation.  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 schizophreniform disorder condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination related to fitness.  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 MEB listed the pregnancy as “incidental.”  The CI was found unfit for her non-physical condition of schizophreniform disorder.  The Board reviewed all available records.  There were no documented complications during the pregnancy that would have rendered her unfit.  The limited duty was not available; however, the Board opined the pregnancy was likely profiled IAW military medical standards to ensure proper care and attention to the mother and the child.  The condition was not judged to fail retention standards.  There was no performance based evidence from the record that this condition significantly interfered with satisfactory duty performance.  After due deliberation 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 contended conditions and so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the Schizophreniform Disorder condition and IAW VASRD §4.130 the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended pregnancy condition, 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, 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 20140625, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 23 Mar 17

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN