RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03793
BRANCH OF SERVICE:  Army	
DATE PLACED ON TDRL:  20011121
DATE REMOVED FROM TDRL:  20030915

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Systems Control Repair, medically separated from the Temporary Disability Retired List (TDRL) for “schizophrenia, unspecified” with a disability rating of 10%.

CI CONTENTION:  “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 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 - 200111121/20030915	VARD - 20031205	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Schizophrenia	9205	50%	10%	Schizophreniform Disorder	9299-9204	50%	70%	
COMBINED RATING:  50% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Schizophrenia.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was not able to provide a timeframe regarding the onset of his schizophrenia condition.  He enlisted in the service in August 1999 and his performance was described as “very good” by his command.  In Spring-Summer 2001 he “lost my common sense” when he found out his cousin had changed his name.  His internal distress worsened on July 12 when he saw violent scenes on television and interpreted the stories as related to him.  He began to think his gaze “might cause some fighting” and believed others could read his thoughts.  He “broke down” and was taken to the emergency department, became agitated and required chemical and mechanical restraints.  He was released but command and peers noticed continued unusual behavior and he was reevaluated at mental health on July 23 and admitted to a civilian psychiatric unit due to psychotic symptoms.  Despite treatment with medications he continued to display psychotic signs and was medically evacuated for further evaluation and inpatient treatment on 5 August 2001.  The MEB forwarded “schizophreniform disorder” for PEB adjudication.

The MEB NARSUM examination on 5 August 2001, 3 months prior to separation, and conducted as an inpatient on the psychiatry unit, noted complaints of delusional beliefs, depressed mood and a history of auditory hallucinations.  He admitted to problem behaviors as early as age 5 but denied a previous psychiatric symptoms or treatment.  Mental status examination showed mild psychomotor retardation, tangential thought process with mild derailment, and a continued bizarre delusion, and poverty of thought.  He was preoccupied with ending the interview.  Mood was “anxious” and affect was mildly anxious and blunted.  He gave abrupt brief answers.  He did seem to recognize the delusions and hallucinations were abnormal and believed medications were helping.  Neuroimaging revealed a cyst in the left posterior part of the brain with mild displacement of the left cerebellum.  Neurology consult determined it was insignificant.  He continued to display negative psychotic symptoms.  His condition was noted to be fairly stable.  He was taking anti-psychosis medication twice daily.  A diagnosis of schizophreniform disorder was rendered with a Global Assessment of Functioning (GAF) score of 40 (impairment in reality testing/major impairment in several areas.)  Impairment for social and industrial adaptability was severe.

The TDRL reevaluation, dated 19 March 2003, performed 6 months prior to TDRL removal, noted the CI was lost to follow-up until August 2002, where he presented to the local VA with his mother who felt he could no longer care for himself.  Shortly before he had been arrested for unusual behavior at a check cashing facility.  He had not been taking his medication so it was restarted, resulting in a remission of symptoms.  He was living with his girlfriend and able to attend classes and was taking a near full load of courses.  He was taking an anti-psychotic medication and denied current psychotic symptoms.  The mental status examination showed his speech was slow and non-pressured, non-spontaneous.  He did not appear to respond to internal stimuli.  Affect was blunted.  A diagnosis of schizophrenia, in partial remission was rendered with a GAF score of 75 (mild symptoms, impairment.)  The examiner noted his condition had not changed significantly since his MEB NARSUM examination in August 2001.

At the 12 November 2003 VA Compensation and Pension (C&P) evaluation, performed 2 months after TDRL removal, the CI reported he had been arrested twice for disorderly conduct; 2 months previously and in a casino in August 2003.  He was incarcerated both times for 4 days.  He lived with an ex-girlfriend, was unemployed but did household chores, went to the store, visited with mother and father with whom he had a joint account.  He traveled to China for 7 days in August by credit card and visited two states in the western US.  He was noncompliant with medication.  Most recent symptoms included confusion, withdrawal, halting and blocked speech, paranoia, blunted affect and insecurity.  Some people said he acted irrational.  The mental status examination showed impairment of thought process with decrease in comprehension and bizarre thinking.  He had paranoid delusions, though less due to medication.  He denied current hallucinations but showed perseveration of thoughts.  He had poor social judgment related to impaired-impulse control that lead to inappropriate behavior at times.  He was easily confused and described a motivation and apathy.  The examiner opined that it was unlikely he was capable of living independently; he needed others to watch out for him e.g. his family who seemed very supportive.  Due to problems with confusion and with comprehension he was not competent to handle his monetary benefits.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the schizophrenia 10%, coded 9205 (schizophrenia, residual type), citing partial remission. The VA rated the schizophrenia 70%, coded analogously 9204 (schizophrenia, undifferentiated type) based on the VA C&P examination 3 months after TDRL separation, citing continued symptoms of psychosis, impaired thought process, motivation and poor social judgment.  Application of VASRD §4.129 is considered by the Board for all cases of service connected psychiatric conditions resulting in separation; but, all members agreed that the ‘highly stressful event’ requisite for §4.129 was not satisfied in this case.

The Board considered if there was evidence for a §4.130 rating higher than the 50% assigned at time of TDRL placement.  A 70% rating required social and occupational impairment with evidence of deficiencies in most areas.  The Board agreed that the §4.130 criteria for a rating higher than 50% were not met near the time of separation.

The Board then considered the rating at the time of TDRL removal.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.” The TDRL reevaluation examiner noted the CI was brought to mental health by his mother who stated he could not care for himself and a history of arrest for unusual behavior.  Medications did bring some stability and he was able to take classes and have a girlfriend although the mental status examination showed impaired speech and blunted affect.  Examiner noted little change in his condition since the first MEB NARSUM examiner.  The more proximal C&P examiner noted two more arrests with incarceration.  He was not taking his medication.  By history and by mental status examination, there was evidence of psychosis though less pronounced than previously.  He was able to perform chores, live with an ex-girlfriend, travel with a credit card and do mundane chores.  He remained unemployed.  Board members therefore concluded that the 50% rating most accurately depicted the condition at the time of removal from TDRL.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 50% at the time of TDRL placement, and a 50% permanent rating thereafter for the schizophrenia condition.

BOARD FINDINGS:  In the matter of the schizophrenia condition, the Board unanimously recommends a disability rating of 50%, coded 9205 IAW VASRD and then a permanent separation rating of 50% IAW VASRD §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	9205	50%	50%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140818, 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 
AR20160017228 (PD201403793)

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 50% 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 50% 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.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure
CF: 
(  ) DoD PDBR
(  ) DVA