RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00288
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20080425

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Information Systems Technician, medically separated for “obsessive compulsive disorder rule out Tourette’s syndrome” with a disability rating of 10%.  

CI CONTENTION:  He was admitted to a mental health facility during his Medical Evaluation Board (MEB) period, suffering from anxiety, and his medication was not effective. He was placed on an anti-psychotic medication and suffered a breakdown, then was told that his rating was reduced from 30% to 10% while he was hospitalized.  He had a stellar career prior to that point.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20080204	VARD - 20081007	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Obsessive Compulsive Disorder…	9404	10%	Obsessive Compulsive Disorder	9404	10%	20080611	
Obsessive Compulsive Personality Disorder	Cat IV					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Obsessive Compulsive Disorder (OCD).  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s initial mental health evaluation was in February 2007 after he made verbal and written statements including suicidal ideation.  He was diagnosed with OCD and dysthymic disorder (depressive neurosis), and treated with medication and group therapy.  The 15 November 2007 MEB NARSUM examination, 5 months prior to separation, noted the CI was being treated for anxiety and OCD and denied suicidal and homicidal ideations.  The mental status examination (MSE) showed an anxious mood and congruent affect. There was no indication of thought disturbance of content; however, thought process was “somewhat disorganized.” Insight, judgement, and impulse control were adequate.  

On 24 January 2008, the CI received inpatient psychiatric treatment for worsening OCD symptoms and disorganized thinking.  During the admission, he reported discontinuance of the psychiatric medications.  He had a good relationship with his dad and siblings, and was in an 18-month live-in relationship with intent to marry.  The 29 January 2008 discharge MSE showed a euthymic mood and congruent affect.  Thought process was linear, logical and goal-directed with good insight and judgement and fair impulse control.  The discharge diagnosis was “OCD with rule out Tourette’s disorder.” 

At the 11 June 2008 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported repetitive compulsions (coughing, sneezing, and picking of skin inside the mouth), but denied suicidal and homicidal ideations.  He had family support, was in a relationship, and enjoyed leisurely pursuits to include golf, web design, and writing.  The MSE showed a slightly anxious mood and appropriate affect.  Judgement, insight and impulse control were intact.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the OCD condition 30%, coded 9404 (obsessive compulsive disorder), determining that it existed prior to service and was permanently service aggravated.  A 20% deduction was applied for noncompliance resulting in a 10% rating.  The VA rated the OCD condition 10%, coded 9404, based on the C&P examination 2 months after separation, citing occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress.  The panel noted that the 20% deduction was not compliant with VASRD guidelines and determined that the PEB adjudicated 30% rating is the minimum baseline for the rating recommendation.  The next higher 50% rating requires "occupational and social impairment with reduced reliability and productivity."  According to the commander's statement, the CI was unable to perform his duties due to multiple weekly appointments and OCD symptoms.  Social impairment was not evident in that his family and dating relationships were intact.  The panel concluded that the evidence did not support "reduced reliability and productivity" for the 50% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the OCD condition, coded 9404.  

BOARD FINDINGS:  In the matter of the OCD condition, the panel unanimously recommends a disability rating of 30%, coded 9404 IAW VASRD §4.130.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends 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	
Obsessive Compulsive Disorder Rule Out Tourette’s Syndrome	9404	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150429, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs)
		     COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	 (b) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX 
	 (c) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (d) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (e) PDBR ltr dtd 10 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (f) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (g) PDBR ltr dtd 23 Jan 18 ICO XXXXXXXXXXXXXXXXXX    
	 (h) PDBR ltr dtd 10 Jan 18 ICO XXXXXXXXXXXXXXXXXX
	 (i) PDBR ltr dtd 10 Jan 18 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (i) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge. 

     b. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.

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

     d. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.      

     e. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.
 
     f. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge. 

     g. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 40 percent rating (increased from 20 percent) effective date of discharge.

     e. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 0 percent) effective date of discharge.
    
2.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.

                              	XXXXXXXXXXXXXXXXXX
                              	Acting