RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00481
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050728

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Cryptologic Communications Interceptor/Locator, medically separated for “schizoaffective disorder, bipolar type…” with a disability rating of 10%.

CI CONTENTION:  The CI requested a review of all conditions.  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 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 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 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 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 - 20050505	VARD - 20060524	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizoaffective Disorder…	9211	10%	Schizoaffective Disorder	9211	10%	20060224	
Personality Disorder, Not Otherwise Specified (NOS), with Schizotypal Features	Not Unfitting					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Schizoaffective Disorder.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first manifested mental health (MH) symptoms 2 years prior to service entry, but these were resolved at enlistment.  He developed some depression and anxiety in the midst of linguistic training a few years after enlistment.  This evolved into a cyclic mood disturbance that was initially diagnosed as bipolar affective disorder and eventually as schizoaffective disorder.  In September 2004 the CI was evaluated in the emergency department for suspected suicidal ideation, although a psychiatric consultant documented that this had been “misinterpreted” and he was not admitted.  Medications were adjusted, the MH condition was stabilized, and earlier symptoms of paranoid delusions and auditory hallucinations cleared.   The CI’s performance evaluation from this period (at the peak of psychiatric acuity) was still very favorable and documented that he was attending college with excellent grades.  There was no STR evidence for recurrent suicidal ideation or other crisis, nor was there evidence of additional psychotic or other acute symptoms, psychiatric hospitalization, disciplinary or legal issues, or alcohol/substance abuse.  The CI remained fearful of weapon access, however, and was not deployable; thus, an MEB was initiated.  

The 9 December 2004 psychiatric NARSUM examination, nearly 9 months before separation, documented an improving course, and stated, “At this time he has had much clearing of his mental state.”  The CI was prescribed three psychoactive medications (risperidone, Topamax, and Paxil) and was still undergoing outpatient therapy.  The mental status examination (MSE) was notable for a “somewhat depressed” mood, “bland” affect, and residual paranoid ideations.  There was no suicidal ideation, delusional or hallucinatory symptoms, objective cognitive impairment, or other abnormality.  The Axis I diagnosis of “schizoaffective disorder, bipolar type” was forwarded for PEB adjudication, and the examiner made an Axis II diagnosis of personality disorder (schizotypal features, prodromal) that was also forwarded on the MEB submission.  The DoDI 1332.39-derived assessment of social and industrial impairment was “severe” and the Global Assessment of Functioning (GAF) assignment was 55 (moderate range of impairment).

There were several MH clinical notes from the period between the NARSUM and separation documenting continued improvement with clearing of all (or at least most) symptoms, and a normal MSE except for sporadic mood disturbance.  The commander’s performance statement, 5 months before separation, documented the CI had “improved dramatically ... [and] ... his medications have worked remarkably well... [but] ... his condition and profile are not compatible with serving in the U.S. Army.”  The final MH clinical note, 2 months before separation, stated the CI was “doing well on risperidone” and had obtained civilian employment as a software engineer.  

A 24 February 2006 VA psychiatric Compensation and Pension (C&P) examination, 6 months after separation, documented continued treatment with risperidone (no other medications mentioned) and monthly psychotherapy visits.  The examiner did not elaborate the nature of active MH symptoms, but the only noted functional impact was “the need to constantly focus on each task.”  The CI had been successfully employed since separation with good work relationships; and, the examiner documented that there had “not been any major social function changes.”  A detailed MSE was normal, and specifically noted the absence of paranoia or delusions, “no problem with concentration,” and no other cognitive impairment.  The Axis I diagnosis was unchanged and there was no Axis II entry.  The assigned GAF was 80 (no more than slight impairment).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under the 9211 code specific to schizoaffective disorder cited the “mild” criterion of DoDI 1332.39 (E2.A1.5).  The VA’s rating under the same code, based on the C&P evidence, quoted the 10% criteria of VASRD §4.130, “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 panel first considered whether the PEB adjudication of the associated personality disorder was appropriate.  Although difficult to separate the impairment from the personality disorder itself from the overall psychiatric impairment for either fitness assessment or rating, this was rendered moot by the fact that all MH impairment was effectively subsumed in a single §4.130 rating for the unfitting condition; and, because personality disorders are not service compensable IAW DoDI 1332.38 (E5.1.3.9.2).  Members thus agreed that the PEB adjudication was appropriate and that the personality disorder was not separately ratable.  The panel next considered whether the provisions of VASRD §4.129 for any “mental disorder that develops in service as a result of a highly stressful event” were applicable to this case (as mandated by DoD).  Members agreed that, although there were contributory stressors from military service, schizoaffective disorder is inherently an organic mental illness not caused by any service-connected event consistent with the meaning and purpose of §4.129; thus, its application was not appropriate for this case.  

The panel then turned to deliberation of a fair rating recommendation under criteria of §4.130 at the time of separation.  Members first agreed that the intact functioning evidenced at separation would not support the §4.130 criteria for a 50% rating (“occupational and social impairment with reduced reliability and productivity”).  Deliberations thus settled on recommendations for a 10% rating as quoted above vs. a 30% rating (“occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks”).  

The performance evaluation during treatment, the STR evidence proximate to separation, the commander, and the post-separation VA psychiatrist all described “symptoms controlled by continuous medication” and intact (if not superior) occupational functioning.  The clinical course of schizoaffective disorder is subject to fluctuations, as manifested in this case; but, as elaborated in the scope of review, the panel’s recommendation is applicable to ratable disability at separation, and compensation for changes in disability after separation is the role of the VA.  Members agreed that the disability in evidence at separation was convincingly better aligned with the §4.130 criteria for a 10% rating than with those for 30%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication of schizoaffective disorder.

Contended PEB Condition:  Personality Disorder, NOS, with Schizotypal Features.  This condition is addressed above.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

PANEL FINDINGS:  In the matter of the schizoaffective disorder and IAW VASRD §4.130, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  In the matter of the contended personality disorder, the panel unanimously recommends no change from the PEB determination as not unfitting and not ratable.  The panel, 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 20150601, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170004791, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure