RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01125
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20041023

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Fire Support Specialist, medically separated for schizophrenia, paranoid type, with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20040923	VARD -  2000516	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizophrenia, Paranoid Type…	9203	10%	Paranoid Schizophrenia with Tremors	9203	70%	20041207	

ANALYSIS SUMMARY:  

Schizophrenia, Paranoid Type.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health condition began in in September 2003 when he requested treatment for 5 months of psychotic symptoms including paranoia.  During the 8 December 2003 MEB examination, 10 months prior to separation, the CI reported a recent history of depressed mood ("feeling down"), anhedonia, poor concentration and energy, low self-worth, decreased appetite with a ten pound weight loss, decreased sleep, and passive suicidal ideation, wishing that "somebody would kill me."  He had never experienced similar symptoms previously, despite a past history of using cocaine, ecstasy, and marijuana at the age of 16-17.  He had responded well with psychotropic medication, although he continued to experience mild tremors from his medication.

Mental status examination (MSE) was unremarkable with the exception of depressed mood and flat affect.  The examiner noted the absence of psychosis or suicidal or homicidal thinking.  Insight and judgement were thought to be returning to normal.  

The 13 September 2004 psych addendum examination, 1 month prior to separation, noted the MEB process was interrupted when the SM went AWOL until March 2004.  He experienced increased psychotic symptoms in December 2003, including paranoid delusions, and bolted away from unit safety watch into the woods in the middle of a snowstorm, wearing no winter clothes.  He ran away because he feared that others would harm him, reflecting disorganized behavior.  He was admitted to the hospital and discharged on medication after 4 months of treatment.  At the time of discharge, his condition had improved.  At the time of the addendum, the CI had remained on psychotropic medication and his depression was assessed as mild, and the examiner stated, he had “lingering mild to moderate paranoia.”

At the 7 December 2004 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI complained of hearing voices telling him to hurt himself.  He stated that he felt like everyone was “out to get me.”  He reported that he was no longer taking medication because he had no money or health insurance.  The CI was not employed.  He had not been hospitalized since leaving the military, and there was no evidence of treatment in the emergency room.  The CI’s medical status examiner (MSE) noted that he was “somewhat fragile.”  He was a fairly accurate historian though did not remember much.  His affect was flat, and he did describe being depressed to the extent that it affected his ability to function independently.  He described impaired impulse control and unprovoked irritability and very poor motivation.  His communication was reasonable.  He denied panic attacks, and he did describe auditory hallucinations on a regular basis telling him to run away and telling him also to hurt himself.  His thought processes were abnormal.  His judgment was poor and he had impaired abstract thinking.  He denied suicidal or homicidal ideation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the mental health condition 10%, coded 9203 (schizophrenia, paranoid type), citing symptoms requiring the use of anti-depressant and anti-psychotic medications.  The VA rated the mental health condition 70%, coded 9203, based on the C&P examination 2 months after separation citing occupational and social impairment, with deficiencies in most areas.

The 10% rating under§ 4.130 is assigned when there is evidence of “ 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 70% rating is assigned when there is evidence of “Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.”  The record documented that the CI was not stable at the time of the psychiatric addendum.  According to the examiner he had continued to have “mild-moderate paranoia.”  The panel noted that at the time of the C&P examination, the CI’s condition had worsened and he was no longer taking medication.  The STR demonstrated that his condition was chronic and his response to medication was partial.  Panel members agreed, his condition exceeded the 10% disability level, but was not reflective of the 70% level since suicidal ideation was not present, and although he reported command hallucinations to harm self, his judgment was not impaired to where he acted on the commands.  The CI had no hospitalizations, or ER visits for mental health concerns.  Although the C&P examiner opined that the CI depression affected his ability to function independently, there was no objective evidence to support that his depression was severe enough to support that claim.  The only symptoms recorded was irritability, and history of suicidal thoughts without attempts.  His reported impaired impulse control and unprovoked irritability had not resulted in aggressive behaviors, or self-harm behaviors or a legal history.  Therefore, panel members concluded, the 70% level was not approached.  The panel then considered the 50% level of impairment and panel members agreed at the time of separation, evidence supported his condition met the description for “Occupational and social impairment with reduce reliability and productivity.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 50% for the schizophrenia, paranoid type condition, coded 9203  

BOARD FINDINGS:  In the matter of the mental health condition, the panel unanimously recommends a disability rating of 50%, coded 9203 IAW VASRD §4.130.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends 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	PERMANENT RATING	
Schizophrenia, Paranoid Type…	9203	50%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160921, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170018701, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to recharacterize your separation as a disability retirement with the combined disability rating of 50% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The recharacterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure