RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00370
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030911

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve 03, Registered Nurse, medically separated for “psychotic disorder” with a disability rating of 0%.

CI CONTENTION:  “I was going thru an adjustment from reserve officer to active duty officer.  There was no support for my transition from civilian to AD officer.”  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 - 20030618	VARD - 20011210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Psychotic Disorder	9210	0%	Situational Depression Disorder	9434	NSC	20010315	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS: N/A	

Psychotic Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s psychotic disorder condition began 29 March 2003 after driving from Texas to Washington DC after activation from Inactive Ready Reserve status as a registered nurse.  Bizarre behavior was noted over the next few days and in April 2003, while in processing, the CI exhibited “bizarre behaviors” resulting in a command-directed referral for emergency mental health evaluation.  The Emergency Room evaluation determined the CI to have impaired reality testing, to include delusions and vague paranoid ideations.  The CI was admitted to the Inpatient Psychiatry Services.  Despite treatment, the mental condition did not meet the requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “psychotic disorder not otherwise specified” for PEB adjudication.  
The CI reported he had a similar episode in 1999 while on active duty at the William Beaumont Medical Center and was admitted to inpatient psychiatry service.  He was having significant marital and economic stressors and had been informed of retirement due to failure to promote to 0-4.  He described a depressed mood and paranoid thought processes at that time.  He reported he took an anti-depression medication for 1-2 weeks and in agreement with his doctor, stopped the medication.  There was “no record” of admission to this medical center for “any reason.”  At the 15 March 2001 VA Compensation and Pension (C&P) evaluation, performed 29 months before the 2003 separation, the CI reported he had problems with depression in 2000 and took medication for three days.  He was not currently taking any medication.  He was stable and not suicidal.  Service-connection for situational depression disorder was denied.  

The VARD, dated December 2001, noted the CI had an admission for depressive disorder and narcissistic personality features.  The depression was due to situational, family related problems and career choices.  Since then he had been gainfully employed as a nurse in three separate nursing jobs since his discharge from the military.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated May 2003, 4 months prior to separation, the CI reported he did not know why “they are saying I have psychosis.”  He denied psychiatric symptoms, slept well and took no medications for psychosis.  

The MEB NARSUM examination on 16 April 2003, 5 months prior to separation, noted complaints of “dehydration and low blood sugar.”  Mental status examination (MSE), conducted during the hospital admission, noted the CI appeared anxious, with mild psychomotor retardation, blunted affect, circumstantial and occasionally loose in nature, and thought content that was significant for delusional thoughts.  Insight was limited.  As he acclimatized to the inpatient environment, he stopped having delusions without psychotropic medications.  The CI was discharged psychiatrically stable and without medication, however, it was determined that he had a propensity to have delusions in response to stress or unfamiliar surroundings.  Psychological testing 2 weeks after discharge, showed no evidence of active psychosis.  He was able to function at an acceptable level while in a familiar and structured environment and was able to cope without medications to date, including his personal life.  A diagnosis of psychotic disorder NOS was rendered with a Global Assessment of Functioning (GAF) score of 75 (mild symptoms, impairment.)

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the psychotic condition 0%, coded 9210 (psychotic disorder), citing psychiatric stability without use of medication.  The VA found the situational depressive disorder condition non-service connected, coded 9434 (major depressive disorder), based on the VA C&P examination 29 months before separation, citing no evidence of permanent residual or chronic disability.  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 0% rating assigned by the PEB.  The §4.130 criteria for a 0% rating is mental condition formally diagnosed but symptoms not severe enough to interfere with occupational/social functioning or to require continuous medication, 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.”   The 2003 NARSUM and the 2001 C&P exam noted the CI was able to achieve psychiatric stability with either very short medication (3 days) or without medication.  Psychiatric symptoms appeared in 1999 and in 2003, and responded quickly to therapeutic intervention and occurred only during severe stressors.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the psychotic disorder NOS condition.  

BOARD FINDINGS:  In the matter of the psychosis disorder condition and IAW VASRD §4.130, the Board recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150530, 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

19 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018702  (PD201500370)

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, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA