RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  pd-2016-00270
BRANCH OF SERVICE:  navy 	SEPARATION DATE:  20091224

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Navy, active duty E5, Transmission System Technician, medically separated for “psychotic disorder, NOS” with a disability rating of 10%.  

CI CONTENTION: “Continued hospitalizations and an increased bipolar condition.”  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(s) 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 - 20091028	VARD - 20140228	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Psychotic Disorder, NOS	9210	10%	Bipolar Disorder	9432	70%	20140218	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Psychotic Disorder, NOS.  According to the service treatment record STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), symptom onset for this condition began in January 2009 after the CI watched the Discovery Channel about volcanos and tsunamis and started thinking what would he do if this disaster should hit his duty station (Hawaii).  Prior to this, he had requested a transfer from his duty station.  

Since symptom onset, the CI had thoughts about the volcano erupting and generating a tsunami.  He tried to calm his thoughts by reading the bible and praying, which helped a little; however, he did not feel safe and worried all the time.  He was afraid to leave his house.  He had symptoms of general nervousness, shortness of breath, racing thoughts and avoidant behaviors.  His symptoms worsened and he sought help from the police and was transported to the emergency room (ER) for evaluation.  On 21 January he was admitted to psychiatry where he remained until his discharge on 26 January.  Brain magnetic imaging (MRI) showed no evidence of intercranial pathology.  During inpatient treatment, the CI was prescribed antipsychotic medication that stabilized his symptoms.  He was discharged with the diagnosis of brief psychotic disorder and medications were continued for 1 month to allow for assurance that symptoms would not recur.  In March 2009, medications were discontinued and his condition was considered resolved.  In May 2009, his symptoms recurred and he spent 1 day on an inpatient psychiatry unit.

During the 30 June 2009 NARSUM, the CI complained of anxiety.  He endorsed several psychosocial stressors including difficult work schedule that consisted of 12 hours of rotating shifts (day, night, days off, then repeat), moving from California to Hawaii, and loss of support system after a friend was discharged from the Service.  He also noted there had been significant family issues, and that he had learned some things about the family that was disturbing to him.  

At the time of the NARSUM the CI was taking psychotropic medications.  It was noted that in May 2009, the CI contacted his Senior Chief and expressed paranoid thoughts.  He had symptoms suggestive of mania and psychosis.  He had also continued to express passive thoughts of death which he reportedly stated were influenced by his Bible reading and watching the news.  He was admitted for the 2nd time to psychiatry overnight as noted above.  The CI reportedly attributed his paranoia to lack of sleep and high stress level.  He was discharged with an antipsychotic medication and his diagnosis was changed to psychotic disorder NOS.

The NARSUM mental status examination (MSE) was unremarkable.  The examiner noted the absence of psychotic thoughts, and that his judgment was not impaired.  The examiner opined that the CI was unable to successfully perform his military duties in the presence of stress, which increased his symptoms.  The examiner assessed the diagnosis of psychotic disorder NOS and assigned a Global Assessment of Functioning (GAF) score of 61-70 for “some mild symptoms.”  Ongoing therapy and medication would likely be required.

STR going forward was silent regarding MH status.  However, the record reflected another psychiatric admission 22 months after separation.  The hospital record noted that at the time of admission, the CI was a full-time student, living with his girlfriend.  On the day of admission, the CI had presented to the police department to “turn himself in” and had expressed several bizarre, paranoid thoughts.  The CI’s girlfriend reportedly stated she thought her pregnancy created stress and that he had been behaving differently for the last few weeks, and had not been sleeping at all for the last 4 days.  It was noted that the CI had been off of his medications for about 7 months.

The VA Compensation and Pension (C&P) mental examination was accomplished 5 years after separation.

The panel directed attention to its recommendations based on the above evidence; and, first considered whether the provisions of VASRD §4.129 for any “mental disorder that develops in service as a result of a highly stressful event,” and panel members agreed they were not applicable to this case.  

The PEB rated the condition of psychotic disorder NOS, coded 9210 at 10%.  The VA rating decision was too remote from separation for panel’s consideration.

The panel considered the 30% rating which requires evidence that his condition caused “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks chronic sleep impairment, mild memory loss.  The panel noted that at the time of the NARSUM, the CI was taking an antipsychotic medication and a mood stabilizer; he denied symptoms suggestive of depression or PTSD, and he denied suicidal and homicidal ideations and hallucinations.  His MSE was normal.  The panel noted a pattern of instability in the absence of medication with rapid return to stability in the presence of medication.  Although the STR was silent in the 6 months prior to separation, the 2 year post separation hospitalization indicated there had been stability with medication in the months or perhaps up to 14 months after separation.  The CI had stopped his medications about 7 months prior to his 2011 hospitalization.  At the time of admission, he had been under stress and due to the absence of medication, he deteriorated.  Therefore, panel members concluded, the evidence demonstrated that in the 6 months prior to separation, and more than 1 year after separation, the CI’s condition was stable with medication.  

All panel members agreed, based on the evidence in the record, the 30% rating criteria was not approached.  The record demonstrated that his condition was best reflected in the 10% disability rating for symptoms controlled by continuous medication.  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 for the psychotic disorder NOS condition.

BOARD FINDINGS:  In the matter of the psychotic disorder NOS condition and IAW VASRD, the panel 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 that 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 20160429, w/atchs
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:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

		
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