RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2015-00132
BRANCH OF SERVICE: Army		SEPARATION DATE:  20080527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Power Generator Equipment Repairer, medically separated for “schizoaffective disorder with depressive disorder” with a disability rating of 10%.  

CI CONTENTION:  The CI contends for a higher rating for his mental health condition.  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 - 20080211	VARD - 20080709	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizoaffective Disorder with Depressive Disorder	9211	10%	Schizoaffective Disorder, Depressive Type	9211	70%	20080327	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDTIIONS:  80%	

Schizoaffective Disorder with Depressive Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health condition began in 2005 and he was treated with an anti-depression medication.  He was admitted to Landstuhl Medical Center in 8 June 2007 after an attempted sexual assault on his wife and arrest.  He had been having persecutory ideations for two weeks.  His wife indicated that he had been having these ideations for the past year with each episode usually lasting only a few weeks but the most recent episode lasting over 2 weeks.  He was treated with anti-psychotic medication and transferred to Walter Reed inpatient psychiatric ward.  After it was discontinued for 4 days, the CI decompensated.  The anti-psychosis medication was restarted and he returned to baseline, with a guarded attitude, and minimizing symptoms but not feeling the overwhelming persecutory ideations.  After being in outpatient status for 2 days, he was readmitted 23 June 2007 due to cardiac side effects of the medication, which was stopped. A new anti-psychosis medication greatly decreased the persecutory ideations and he was discharged to intensive outpatient care.  The MEB forwarded schizoaffective disorder for PEB adjudication.  

The MEB NARSUM examination on 4 January 2008, 5 months prior to separation, noted complaints of stress due to his cardiac surgery and his daughter’s future surgery for cleft palate.  He was stable and coping well without worsening of his psychotic symptoms.  His medication was helping.  Diagnoses of schizoaffective and major depressive disorder were rendered with a Global Assessment of Functioning (GAF) of 55 (moderate symptoms, impairment.)  The medications helped him to relax, focus and concentrate, think more clearly but only minimized his delusional thinking.  

At the 27 March 2008 VA Compensation and Pension (C&P) evaluation, performed 2 months before separation, the CI reported he was not doing so well.  He continued to have a milder degree of delusional thoughts, though less intense as previously.  They caused interpersonal difficulties and challenged others and made accusations against others, often losing friends.  The delusions led to marital conflict and unwarranted anger with his kids.  He was receiving weekly individual therapy and medication management that included anti-depression and an anti-psychosis medications.  His delusional beliefs resulted in confrontations and conflicts with others as well as the sexual abuse of his wife. He attended outpatient treatment 3 days per week and was involved in various sporting activities.  He was working as a generator mechanic but could not meet work demands due to his inability to get along with others due to delusional thoughts/persecutory ideations and verbal confrontations.  Panic attacks were present weekly but he was able to function with them.  MSE showed delusions and hallucinations, memory loss and impairment, presence of obsessive or ritualistic behaviors, panic attacks, depression and anxiety and impaired impulse control.  A diagnosis of schizo affective disorder, depressive type was rendered with a GAF score of 45 (severe symptoms, impairment.)

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the schizoaffective disorder condition 10%, coded 9211 (schizoaffective disorder), citing the possibility of working if not subjected to significant stress and if compliant with his psychotropic medications.  The VA rated the schizoaffective disorder condition 70% coded 9211 based on the VA C&P examination 2 months before separation, citing deficiencies in most areas.  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 then considered if there was evidence for a §4.130 rating higher than the 10% assigned by the PEB.  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.”  Members noted the CI continued to have delusional thoughts that resulted in confrontations and conflicts with others, including co-workers, his wife and his children.  These thoughts persisted despite receiving two psychotropic medications, outpatient treatment 3 days a week, and weekly medication management.  There were no further psychiatric inpatient hospitalizations or visits to the emergency room for psychiatric issues.  Members agreed the CI met criteria for a 30% disability.  

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 schizoaffective condition.  

BOARD FINDINGS:  In the matter of the schizoaffective condition, the Board unanimously recommends a disability rating of 30%, coded 9211 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	RATING	
Schizoaffective Disorder	9211	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150209, 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 XXXXXXXXXXXXXXXXXXXXX, AR20160018483 (PD201500132)

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.

BY ORDER OF THE SECRETARY OF THE ARMY:

			       
						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA