RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00299
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061222

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Translator Aide, medically separated for “schizophreniform disorder,” with a disability rating of 0%.

CI CONTENTION:  The CI contends that his condition did not exist prior to entry in the Service and requests that the Board review the rating.  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. 

In addition, the Secretary of Defense Mental Health Review Terms of Reference directed a comprehensive review of Service members with certain mental health (MH) conditions referred to a disability evaluation process between 11 September 2001 and 30 April 2012 that were changed or eliminated during that process.  The MH condition was reviewed regarding diagnosis change, fitness determination and rating in accordance with VASRD §4.129 and §4.130.

RATING COMPARISON:  

SERVICE PEB - 20061128	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizophreniform Disorder	9299-9204	0%	CI filed VA Claim nearly 7 years Post-Separation	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Schizophreniform Disorder.  According to service treatment records and the Medical Evaluation Board (MEB) MH narrative summary (NARSUM), the CI’s psychotic condition began in March 2006 when he presented to the clinic endorsing symptoms that were consistent with psychosis.  The CI noted persecutory delusions involving his chain of command, feeling as though someone in the command was “trying to execute him.”  He reported problems with sleeping and thinking.  There were voices in his head trying to talk him into suicide.  He was admitted to inpatient psychiatry where he spent more than a month.  He was treated with antipsychotic medication and his symptoms slowly improved; however, he was discharged to a step-down program (partial hospitalization) for continued treatment.  He participated in the partial hospitalization program for approximately 4 weeks.  Despite his good response to treatment, the CI was referred to the MEB based on the nature of both his job and illness.

The MEB NARSUM examination on 10 July 2006, 5 months prior to separation, noted the CI self-referred to MH in October 2005 secondary to anxiety and depressive symptoms associated with occupational stress.  He failed to follow up for treatment, and in March 2006, he presented with symptoms of psychosis.  After his discharge from a partial hospitalization program, his condition stabilized with medication.  It was noted that the CI was no longer delusional, nor was he responding to voices.  There were no recorded depressive or anxious symptoms.  The examiner noted that there had been a conversation between the treating team and the command, and his unit had concerns regarding the CI’s ability to serve as an interpreter under high stress in a deployed setting.

The mental status examination documented flat affect, monotone speech, and that the CI was concerned about his future.  There was no evidence of psychosis, suicidal or homicidal ideation, cognitive impairment, or impairment in thinking or judgment.  The examiner noted that the CI’s symptoms were in partial remission, his condition was chronic, and that he would need continued social support and medication in the civilian sector.

The CI did not file a VA claim for nearly 7 years after separation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition of schizophreniform disorder at 0%, coded analogously 9299-9205, with the notation that additional information indicated that the CI’s condition was in complete remission.  The VA, nearly 7 years after separation, determined that the MH condition was not service connected, citing “there was no continuity of symptoms from service to the present.”

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 10% requires demonstration of “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, or; symptoms controlled by continuous medication.”  

The Board noted the NARSUM indicated that the CI’s condition was in partial remission.  However, it was noted he had responded well to medication and that medications were required to control his symptoms.  The PEB noted his condition was in full remission at the time of adjudication; however, it was not stated that his condition would remain stable in the absence of treatment.  All Board members agreed that given the course and nature of his illness, the CI’s condition reflected the 10% disability level for symptoms controlled by continuous medication.

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the schizophreniform condition, coded 9299-9205.  

BOARD FINDINGS:  In the matter of the schizophreniform disorder condition, the Board recommends a disability rating of 10%, coded 9299-9205, 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 the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Schizophreniform Disorder	9299-9205	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150509, 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

03 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170000949 (PD20100299)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

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.   

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:

CF: 
(  ) DoD PDBR
(  ) DVA