RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00541
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Electrical Systems Journeyman, medically separated for “psychotic disorder, not otherwise specified [NOS]” with a disability rating of 0%.  

CI CONTENTION:  The CI contends that his rating should be increased because his condition has not changed and it effects all aspects of his life. The applicant’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 confined to 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 - 20071227	VARD - 20080519	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Psychotic Disorder	9210	0%	Psychotic Disorder	9210	NSC	20080320	
Adjustment Disorder	Cat III	Adjustment Disorder	9499-9440	NSC		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  --%	

ANALYSIS SUMMARY:  

Psychotic Disorder.  The narrative summary (NARSUM) was conducted on 26 September 2007, 3 months before separation.  The CI was first seen in mental health (MH) on 19 March 2007 on command referral because of alcohol-related misconduct.  The NARSUM examiner, who was also his treating psychologist, noted that the CI reported an incident in November 2006, opined to be psychotic in nature.  The CI reported he consumed alcohol after a stressful day at work.  He noticed he had become very angry and left his dorm room to sit in the hall.  He was approached by a friend and began to feel fearful, thinking his friend was a threat.  He ran out of the dorm and was stopped by Security Forces, and became combative.  He then entered the patrol car without permission and attempted to obtain a weapon and was subdued after the patrol drew their weapons.  This incident was not reported to mental health.  The CI then had a second incident in March 2007 where he reportedly experienced hallucinations and delusions.  He described an unusual visual experience of seeing himself “a few feet away;” his “evil self.”  He drank heavily in the bar and after the hallucination, he asked his friend to leave the bar with him as he was fearful.  The CI could not recall all of the details; however, noted that the police had confronted him and he was taken to the local civilian hospital where he was released after a short period of time.  He returned to the hospital and was charged with trespassing and put in jail.  Approximately 6 hours after the onset of his symptoms, he began to “feel normal” and had no further experience with hallucinations or delusions.  He was not evaluated by a mental health professional at that time.  The record demonstrated that the CI had three visits with psychology in March 2007 without a diagnosis.  He underwent neurologic evaluation at the end of April 2007.  At the evaluation, the CI reported he thought someone put something in his drink which caused the hallucinations.  He noted that he had not used any drugs and that at times he experienced some dizziness.  The EEG was normal.  Of note, the CI had two episodes, both occurred after consuming alcohol.  The NARSUM documented that the CI had abstained from alcohol since the March 2007 incident and had no further incident of psychosis.  He was not evaluated by psychiatrist and he was not prescribed any psychotropic medication.  The examiner noted his psychotic symptoms occurred in the evening while the CI was off duty and had no direct impact on duty performance.  The mental status examination (MSE) was completely normal.  It was noted that there had not been a change in the CI’s participation in activities and that he enjoyed spending time with friends and working out.  The psychologist assessed psychotic disorder NOS and assessed a Global Assessment of Functioning (GAF) score of 90.  

The VA Compensation and Pension (C&P) mental examination was accomplished 1 month after separation.  The examiner noted his symptoms occurred only twice and both episodes lasted less than 6 hours; however, during each incident he had placed himself and others in danger due to his combativeness.  The CI was scheduled to begin a new job as an electrician at the end of March.  He had remained in the relationship with his girlfriend, and was living with his parents.  He noted that following the psychotic episodes he avoided alcohol.  The examiner noted that in review of the November 2006 hospital record, the CI reportedly had disclosed he had drank two beers and had eaten eight hallucinogenic mushrooms.  He also reported possible marijuana use.  The CI noted he had more problems with trust following the two incidents; however, he continued to enjoy family and friends.  The MSE was normal, and the diagnosis of psychotic disorder NOS.

The Board directed its attention to the rating recommendation based on the evidence just described.  The PEB rated the condition of psychotic disorder NOS, associated with alcohol induced hallucinations at 0%, coded analogously 9210 (Psychotic disorder, not otherwise specified (atypical psychosis).  The VA did not service-connect a mental health condition.  The VARD cited the C&P examination that noted since the CI’s first incident was related to the ingestion of hallucinogenic mushrooms, and the second to alcohol intoxication; therefore, the CI “Need to avoid all substances.”  A 0% disability rating under VASRD §4.130 (mental disorders) is granted when “A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.”  The record clearly demonstrates that the condition was substance-induced and that in the absent of substance use, symptoms were absent.  The CI took no medication and none was prescribed or deemed required.  The commander’s statement noted the CI had performed “admirably” and if he continued to perform in the same manner, the recommendation would be to retain him; however, the commander had hesitation given the bizarre nature of the 2006 incident. It was noted that he was able to perform all primary in-garrison military duties without limitations, restrictions, or work-a-rounds and that he had not missed any days from work.

All Board members agreed the 0% evaluation was not exceeded at the time of separation.  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 psychosis NOS condition.  
   
Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that adjustment disorder was not unfitting.  Adjustment disorder is not a physical disability and therefore, not ratable IAW DoDI 1332.38.  

BOARD FINDINGS:  In the matter of the psychotic disorder NOS condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder condition, the Board unanimously recommends no change from the PEB determination as not unfitting.   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 20150602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MR

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00541.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings