JAN 1 5 2019

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS Ref: (a) DoDI 6040. 44

listed

In accordance with reference (a), I have reviewed the cases 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:

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-00033
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20091102

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Hospital Corpsman, medically separated for “somatoform disorder” with a disability rating of 10%.  

CI CONTENTION:  “My mental condition was rated only 10%.  I am now rated at 100%.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20090804	VARD - 20090724	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Somatoform Disorder	9210	10%	Psychotic Disorder	9210	10%	20090330	
Anxiety Disorder	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Somatoform Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s mental health (MH) disorder began in October 2008 when he complained that people around him purposely made noises to disturb his sleep and also believed his chain of command was trying to harm him.  The CI had other symptoms suggestive of a psychotic process.

The 12 January 2009 MEB NARSUM examination, 10 months prior to separation, noted the CI was being admitted to inpatient psychiatry.  The mental status examination (MSE) noted normal behavior and motor activity.  He had a frustrated mood and was somewhat worried, but his thought process was not impaired. Physical examination was unremarkable.  The examiner referred to a psychological evaluation conducted in October 2008 that recorded a provisional diagnosis of somatization disorder with rule out of factitious disorder.  

On 22 January 2009, the CI was discharged from the inpatient unit.  The MSE at discharge noted good mood and judgement, full-ranged affect and no evidence of a thought disorder.  There were no hallucinations, illusions, preoccupations or suicidal or homicidal ideation.  The examiner noted the CI engaged well during group therapy and displayed adequate socialization during hospitalization.  The CI was seen as visibly improved and was prescribed antipsychotic medication.  The examiner acknowledged somatic symptoms; however, opined that those symptoms had not been as predominant as the psychotic symptoms.  

At the 30 March 2009 VA Compensation and Pension (C&P) examination, 7 months before separation, the CI reported his delusional thoughts and auditory hallucinations had pretty much subsided with medication.  His sleep was no longer a problem.  The MSE was unremarkable.  He was diagnosed with psychotic disorder with a Global Assessment of Functioning (GAF) score of 65 (mild symptoms and/or impairment).  

The 19 June 2009 psychiatry outpatient encounter, 5 months before separation, recorded a diagnosis of somatoform disorder and indicated the CI’s antipsychotic medication had been discontinued.  He was now prescribed medication to treat anxiety.  The CI noted he was doing well and no longer experienced loud banging noises at night or shock sensations in his chest.  Although he had occasional tactile sensations, they did not bother him and most of the time he had no symptoms at all.  The CI indicated that he believed he had improved because of medication and his spiritual practice.  He noted that he was sleeping well, exercising and had plans to sign up for a few college courses.  He was attending church on Sundays and bible school on Wednesdays.  He denied feelings of paranoia.  The MSE was unremarkable.  The examiner opined that the CI was doing well and functioning in all spheres.  The examiner also noted that there was no evidence of psychotic symptoms or a mood disorder.  A GAF of 70 was recorded.  The examiner implied the CI’s diagnosis was most consistent with somatic manifestations of emotional distress, but clarification of the diagnosis was the primary treatment goal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MH disorder 10%, coded 9210 (psychotic disorder, not otherwise specified).  The PEB indicated the anxiety disorder contributed to the CI’s unfitting somatoform disorder, but separate ratings for the somatoform and anxiety disorders would constitute pyramiding IAW VASRD §4.14.  The VA rated the MH disorder 10%, also coded 9210, based on the C&P examination, citing occupational and social impairment due to mild or transient symptoms or symptoms controlled by continuous medication.  Regardless of the diagnosis, the VASRD §4.130 rating is based on symptoms independent of diagnosis, therefore, all MH symptoms are considered in the rating.  Panel members agreed that the provisions of VASRD §4.129, for a “mental disorder that develops in service as a result of a highly stressful event,” were not applicable in this case.

The panel proceeded with its rating recommendation under VARSD §4.130 based on the evidence.  The NARSUM noted the CI’s condition had improved significantly at the time of discharge from the inpatient ward; however, the CI continued to have some symptoms of psychosis.  At the time of the VA mental examination, the CI’s condition had stabilized and he no longer reported problems with sleep.  There was an indication that his psychosis had partially if not fully remitted.  The last MH encounter (5 months before separation) indicated the CI no longer required antipsychotic medication and was being primarily treated for anxiety symptoms.  It was noted that the CI was doing well and psychotic symptoms were absent.  The STR demonstrated no hospitalizations or significant psychosocial impairment in the 10 months preceding separation and no report of memory or concentration problems, panic attacks or chronic sleep impairment.   

Panel members concluded the evidence demonstrated the CI’s condition was stable at the time of separation, and that the disability was most reflective of the 10% level for “Occupational or 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.” After due deliberation, considering all 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 MH disorder.   

BOARD FINDINGS:  In the matter of the MH disorder and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20161212, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record