RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01779
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20060523

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve 01, Auxiliary Machinery Officer, medically separated for “conversion disorder” with a disability rating of 10%.  

CI CONTENTION:  “Released from the Navy due to conversion disorder.  However, aside from one time severance pay, neither the Navy nor the VA has deemed this to be disability.  If it’s not a disability why did I have to leave the service?”  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 review of disability ratings assigned 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 or non-compensable.  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 determination 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 after separation.  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 – 20060206	VARD - 20080315	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Conversion Disorder	9424	10%	Conversion Disorder	9424	0%	20071024	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Conversion Disorder.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s conversion disorder began in July 2000 when she lost consciousness with no preceding symptoms or events.  Following a 30-minute loss of consciousness (LOC) she awoke to experience bilateral lower extremity paralysis and numbness that lasted one week.  Her symptoms continued to wax and wane for several months.  She had a second LOC episode aboard ship in March 2005 which was preceded by nausea.  She reported no sensation below the mid-thigh level of either leg, but this resolved after several days.  Medical evaluation including labs, spinal MRI, brain MRI and echocardiogram failed to elicit an underlying cause.  Psychiatric evaluation concluded the CI’s symptoms were consistent with conversion disorder, with sensory symptom or deficit.  

The 16 December 2005 MEB NARSUM examination, 6 months prior to separation, noted no current complaints.  Physical examination showed no findings.  An MRI of the brain revealed the presence of a Chiari I malformation; however, this was not felt to be related to her clinical symptoms.  Mental status examination revealed a well-developed and well-nourished individual who appeared appropriately groomed in the uniform of the day.  There were no observable speech or psychomotor abnormalities.  Her mood was neutral with a full, congruent affect.  Her thought process was linear, logical and goal-directed.  There were no perceptual disturbances, delusions or overt paranoia.  Her reality sense and testing were intact.  The patient was alert and oriented to person, place and time.  Concentration, recent past and remote memory, immediate retention, and recall were grossly intact.  Insight and judgement were intact.  She denied suicidal or homicidal ideation.  Her Global Assessment of Functioning (GAF) score was 56 which is consistent with moderate symptoms, or moderate difficulty in one of the following: social, occupational, or school functioning.  

The 21 December 2005 non-medical assessment, 6 months prior to separation, noted the CI excelled at handling primary duties.  Assigned tasks were completed efficiently and met the high standards expected.  Despite medical appointments that kept her out of the office, she had been able to meet the demands placed upon her.  However, her ability to work was hindered by the numbness in her hands and/or legs that rendered her incapable of typing duties.  This had not resulted in any long term physical or mental incapacitation.  The numbness usually occurred every 2-3 days and lasted approximately 30-45 minutes.  This tendency had minimally impaired her ability to perform office duties.  She continued to engage in daily physical fitness training.  She was able to walk and run long distances and maneuver stairwells with no pain or physical hindrances.  She had no other known medical problems.  Her disposition and mood were normal.  

At the 24 October 2007 VA Compensation and Pension (C&P) evaluation, 17 months after separation, the CI reported her last episode of paralysis or numbness was in February 2007.  Mental status examination showed the CI was punctual for her appointment.  She was casually dressed and neatly groomed and presented an attractive appearance.  She was psychomotor appropriate without any difficulty in ambulation.  Her mood was neutral with a congruent pleasant affect.  She did not smiled infrequently.  She was cooperative and conversant and there was no thought disorder.  Her associations were logical, linear, and progressive.  She was not delusional, hallucinated, disorganized, or paranoid.  She was not suicidal or homicidal.  There were no cognitive difficulties despite her subjective complaints of poor memory.  Her participation in the clinical interview suggested her memory was intact.  She smiled at times when describing what would ordinarily be stressful or unpleasant recollections.  She had a GAF score of 70-71, consistent with mild symptoms in one area, or difficulty in one of the following: social, occupational, or school functioning, but the person is generally functioning pretty well and has some meaningful interpersonal relationships.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the conversion disorder 10%, coded 9424 (conversion disorder).  The VA rated the conversion disorder 0%, also coded 9424, citing in partial to full remission and no symptoms that were severe enough to either interfere with occupational and social functioning or to require continuous medication.  The panel agreed the CI’s symptoms were consistent with a rating of 10%, coded 9424, based on 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.  She did not have symptoms of depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, recent events) to justify a 30% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the conversion disorder.  

BOARD FINDINGS:  In the matter of the conversion disorder and IAW VASRD §4.130, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends there be no modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150622, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN

		
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	     				  Acting