RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX 	CASE:  PD-2015-00905
BRANCH OF SERVICE:  Air Force 	
DATE PLACED ON TDRL:  20000713	
DATE REMOVED FROM TDRL:  20020203 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Command and Control Craftsman, medically separated from the Temporary Disability Retired List (TDRL) for “schizophrenia, paranoid type, in partial remission” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  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.  

RATING COMPARISON:  

SERVICE PEB – 20000427/20011126	VARD - 20041112	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Schizophreniform Disorder	9210	30%	---	Paranoid Schizophrenia	9203	NA	100%*	
Schizophrenia, Paranoid Type, in Partial Remission	9203	---	10%					
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	
*Original VARD 20040916 rated 0% pending an exam to determine current disability. Rated 100% effective 20031230, based on 20041015 exam.

ANALYSIS SUMMARY:  

Schizophreniform Disorder/Schizophrenia, Paranoid Type.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s psychiatric disorder condition began in January 2000 when he was hospitalized with paranoid delusions, ideas of reference, confusion and somatic delusions.  Symptoms improved after 10 days of inpatient treatment that included antipsychotic medication.  

According to the 24 March 2000 MEB NARSUM examination, 4 months prior to TDRL placement, the CI did not like the psychotropic medications and declined to take them.  He endorsed “job-related stressors.”  Although he had received a few letters of counseling or reprimand during his career, the timing of these was not provided.  He was divorced and had two children who he saw on weekends.  A mental status examination (MSE) showed good grooming and normal orientation, but psychomotor retardation was present.  Speech was decreased but not circumstantial or stereotyped.  Mood was “ok” and affect was euthymic but restricted.  Insight and judgment were considered to be fair, and he denied current thoughts of harm, delusions or hallucinations.  Cognition was intact.  The examiner rendered an Axis I diagnosis of schizophreniform disorder (provisional) based on a pattern of continued delusions and negative symptoms.  A Global Assessment of Functioning (GAF) score of 30-40 was assigned, connoting major or serious impairment in functioning.  The examiner opined that the degree of impairment for civilian social and industrial adaptability was “severe.”

The 18 October 2001 TDRL NARSUM examination, 15 months after TDRL placement and 3 months before TDRL removal, noted that since placement on TDRL the CI lived with his mother and had finalized his divorce.  His ex-wife had custody of their children.  He was laid off, along with a group of colleagues, in February 2001 after being a production worker for early 6 months.  He was having no work-related performance issues prior to the business-related layoff; he subsequently collected unemployment for a time, found some temporary employment, but was currently unemployed.  Since being on TDRL, he took no psychotropic medications, received no psychiatric treatment, and was not psychiatrically hospitalized.  He denied any delusions, hallucinations, thoughts of harm, or problems with sleep, appetite, interests, energy or concentration.  MSE was normal except for a blunted affect and slowed speech.  There was evidence of possible thought blocking.  Judgment was fair and insight was poor.  A diagnosis of schizophrenia, paranoid type (single episode in partial remission) was rendered.  The CI was considered to have “severe impairment for civilian social and industrial adaptability” and an assigned GAF was 50 (serious symptoms or impairment).  He was deemed to be mentally competent and capable of self-care.

The CI presented to a civilian provider in December 2003 (22 months after removal from TDRL) with a complaint of hearing voices on the radio and television for the past year.  He reported having about five jobs since leaving the military in 2000, but he could not tolerate the stress of the “mind reading and monitoring” he experienced in the workplace, and therefore quit each job.  The examiner rendered a diagnosis of paranoid schizophrenia, and suggested follow-up and medication which the CI apparently declined. 

The Board directed attention to the permanent rating recommendation after removal from TDRL based on the above evidence.  The PEB assigned a permanent 10% rating under the 9203 code, indicating that the history of employment with no need for treatment was consistent with mild impairment.  The VA assigned a 100% rating based on an examination almost 3 years after removal from TDRL, which was not probative to the Board’s deliberations.  

The 30% rating is characterized by “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, while the 50% rating specifies “occupational and social impairment with reduced reliability and productivity.”  Although the December 2003 evaluation (22 months after removal from TDRL) noted recurrence of some auditory hallucinations during the previous year, Board members carefully deliberated the October 2001 evaluation at the end of TDRL, since it provided the only evidence that was actually obtained proximal to the time of TDRL removal.  This evaluation reported a period of employment after entry on TDRL that suggested intact occupational functioning, with employment termination that did not result from impairment or performance issues.  However, the examiner did not provide details regarding subsequent temporary employment or the reasons for the unemployed status concurrent with the time of that evaluation.  Likewise, there was no description of social functioning beyond the statement that the CI was living with his mother and that he had gone through a divorce.  The Board noted that despite the reported absence of the prior psychiatric symptoms in the context of no treatment, and the conclusion that the condition was in partial remission, the examiner still opined that impairment was “severe.”  In debating this apparent inconsistency the Board considered that the December 2003 evaluation, 22 months after removal from TDRL, reported an inability to maintain employment (due to psychiatric symptoms) since being out of the military, and that psychotic symptoms likely re-appeared sometime within a year after removal from TDRL.  It was concluded that this evidence could not be reconciled with the 10% rating description (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); and that the “intermittent periods of inability to perform occupational tasks” stipulation of the next higher 30% rating best captured the CI’s functioning at the time of removal from TDRL.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the schizophrenia condition, coded 9203.

BOARD FINDINGS:  In the matter of the schizophrenia, paranoid type, condition, the Board unanimously recommends a disability rating of 30%, coded 9203 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; 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	RATING	
		TDRL	PERMANENT	
Schizophrenia, Paranoid Type	9203	30%	30%	

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

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00905.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect permanent disability retirement, rather than separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
1. Record of Proceedings
2. Directive 

cc: SAF/MRBR