RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03986
BRANCH OF SERVICE:  NAVY  	                        SEPARATION DATE:  20011024

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Storekeeper, medically separated for “schizophreniform disorder” with a disability rating of 10%.  

CI CONTENTION:  “Please 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 - 20010906	VARD - 20020307  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizophreniform Disorder	9299-9204	10%	Paranoid Schizophrenia (Competent)	9203	100%	20010924	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  100%	

ANALYSIS SUMMARY:  

Schizophreniform Disorder.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s schizophreniform condition began in 2000 during boot camp.  He appeared to Mental Health (MH) in October 2000 with a report of perceptual disturbances that included visual and auditory hallucinations, delusions, ideas of reference (everything involves you) and psycho sensorial hallucinations.  He had difficulty knowing what was real and what was not real.  He worried he appeared to others like an “idiot” and admitted to social withdrawal.  In first grade he experienced seeing things shrink in size but this went away.  He had tunnel vision in second grade, which a doctor said was self-induced.  There was no psychiatric evaluation and treatment. He consulted with the chaplain initially and was assessed by a psychiatrist when last home on leave.  January 2001 NARSUM mental status exam (MSE) showed visual illusions, hallucinations, ideas of reference, subdued and guarded affect, and spontaneous self-destructive thoughts with an urge to act on them that waxed and waned.  Sometimes he would laugh as if responding to internal stimuli.  Judgment and insight were not impaired.  

He was started on antipsychotic medication and followed twice monthly.  There was a little lessening of hallucinations and there was less trouble identifying reality but he thought this was due to decrease in environmental stress.  By the end of January the medicine was discontinued and he chose to not take another medication.  He was last seen 28 February 2001 and described continuing hallucinations of various types with no cognitive deficits and could be direct.  He was not bothered by the symptoms so chose to take no medication.  A diagnosis of schizophreniform disorder was rendered with a Global Assessment of Functioning (GAF) score of 40 (impairment in reality testing or major impairment in several areas.)  He was referred to the Medical Board.

At the VA Compensation and Pension (C&P) examination dated 24 September 2001, performed a month before separation, the CI reported he had inpatient psychiatric treatment from 20 August, 2001-present.  He reported mood lability, a lack of interest, suspicious quality to social interaction, intrusive thoughts and periods of anxiety.  Several times a day he could not tell what was real and had déjà vu situations.  Sleep was normal and he had no problem with anger.  He was taking an antipsychotic medication and an antidepressant medication, which had improved his anxiety and but not eliminated the hallucinations.  He denied substance abuse.  MSE showed auditory and visual hallucinations, ideas of reference and a delusional quality to his description of some of his hallucinations.  He denied suicidal or homicidal problems and memory was intact.  He was clean and neatly dressed.  

The examiner opined he had a moderate to severe level of psychosocial impairment due to problems with his thinking process and perceptions.  He was guarded and suspicious in interactions with others.  He had a severe level of occupational impairment due to the daily problems with differentiating reality of his perceptions and thoughts, making it hard for him to work independently.  A diagnosis of schizophrenia was rendered with a GAF score of 33 (impaired reality testing or major impairment in several areas.)  A MH addendum, dated June 2002, noted the CI’s mother called and was distressed that he was not taking his medication.  Her 3-year-old granddaughter, his niece, stated that he was kissing her.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 9299-9204 code (schizophrenia, undifferentiated type).  The VA assigned a 100% rating using the 9203 code (schizophrenia, paranoid type) based on the VA C&P examination a month before separation, citing total social and occupational impairment.  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 PEB assigned a 10% rating but the Board must consider whether the §4.130 criteria for a higher rating is reasonably satisfied by the evidence at separation.  The Board also noted that because total psychiatric impairment (regardless of co-existing MH diagnoses) is subsumed under a single rating, the presence of multiple MH diagnoses is irrelevant to rating.  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,” criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity,” while criteria for a 70% rating requires “occupational and social impairment with deficiencies in most areas.”  Both the NARSUM and the C&P exams noted he was severely impaired and had impaired reality testing and had major impairment in several areas.  The VA exam was a month prior to separation and therefore and had the highest probative value and showed a GAF score of 33, a decrease from the NARSUM GAF score of 40.  The Psychiatric addendum noted he was not taking his medication and had begun to molest his niece. The CI continued to have impaired reality testing and major impairment in social and occupational functioning, therefore meeting criteria for a 50% disability rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 50% for the schizophreniform condition.  

BOARD FINDINGS:  In the matter of the schizophreniform condition, the Board unanimously recommends a disability rating of 50%, coded 9204 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, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Schizophreniform Disorder	9204	50%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140829, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND 
 DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:   (a) DoDI 6040.44
       (b) PDBR ltr dtd 24 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX    
       (c) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
       (d) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
       (e) PDBR ltr dtd 27 Jun 16 ICO XXXXXXXXXXXXXXXXXXXX
       (f) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX
       (g) PDBR ltr dtd 29 Aug 16 ICO XXXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (g) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a.  Placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 10 percent) effective date of discharge.

     b.  Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     c.  Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     d.  Placement on the Permanent Disability Retired List with a 50 percent disability rating (increased from 10 percent) effective date of discharge.

     e.  Entitlement to disability separation pay with a 20 percent disability rating (increased from 0 percent) effective date of discharge.

     f.  Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.