RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX  	CASE:  PD-2017-01886
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060512

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Ground Radar Systems Apprentice, medically separated for “psychotic disorder, not otherwise specified [NOS]” with a disability rating of 10%.  

CI CONTENTION:  He received a 100% disability rating from the VA.  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 - 20060221	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Psychotic Disorder, NOS, Social and Industrial Adaptability Impairment, Mild to Definite	9210	10%	The CI did not consent to VA record release	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA 	

ANALYSIS SUMMARY:  

Psychotic Disorder, NOS.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s psychotic disorder began in 1995 or 1996 at the age of 15 when he began experiencing hallucinations.  He was prescribed an antipsychotic medication, which he took for an unknown period of time.  Prior to entering the Air Force, he had a mental health (MH) evaluation in August 2002, which revealed no diagnosis on Axis I or Axis II.  He entered the Air Force in May 2003 without a waiver.  On 22 May 2003, the CI had a visit for clearance to proceed with basic training.  At that visit, he acknowledged previously taking an antipsychotic medication and the history of hallucinations.  The physician assistant (PA) recorded that the previous medical documentation was not available because the treating physician had retired.  At the conclusion of the visit, the PA recommended counseling with the chaplain due to “emotional hurt experienced as adolescent.”  During technical school in October 2003, the CI was referred to the life skills clinic after making a comment that was perceived as being a threat to a military training leader.  After initial evaluation, he was enrolled in a weekly stress management group therapy.  His next interaction with the MH clinic was in October 2004, 6 months after arriving at a new assignment.  He was referred by his first sergeant for being “odd” and making concerning comments to other airmen.  After a lengthy evaluation and treatment including multiple neuropsychiatric tests, psychotherapy, medication, and counseling for well over a year, paranoid and delusional thinking continued.  

On 6 September 2005, 9 months prior to separation, the CI was referred to a civilian psychiatrist for a second opinion.  During that evaluation, he confirmed multiple statements to the psychiatrist including, “…if you knew who I was, you would want to kill me,” which he said was an attempt to get one of his workmates who had accused him of sexual harassment to “shut up;” and “they give him hidden messages as to what they are classifying,” which did not make any sense to the provider.  

During a 1 December 2005 psychotherapy session, 5 months before separation, the CI questioned the validity of the various neuropsychiatric tests he took asking, “how do I know those tests and computers were not rigged?”  He also asked the psychologist if his equations were in the chart, when the psychologist said no, he responded, “she (the previous therapist) probably took them … just let her know they are not the real equations … do you think I would give her the real ones?”  He also stated, “all I know is that one of these days I’m going to prove my ideas to build a car that can run for 6 months without needing to refuel.  I will make my statement when I won’t let anyone who’s affiliated with DoD have access to my car… people will be lining up to get out of the Air Force so they can buy my car … you can send your snipers and sharpshooters to steel my idea, but I’ll have my property guarded so that if anyone steps one foot on it they will die.”  

The 7 December 2005 MEB NARSUM examination, 5 months prior to separation, noted findings of continued delusional beliefs.  Mental status examination showed increased psychomotor activity and angry mood with congruent but labile affect.  He became tearful when discussing his diagnosis.  He was alert and oriented to all spheres of cognition with poor insight and judgment.  Thoughts were coherent, logical and goal-directed with significant delusional content noted.  He did not exhibit suicidal or homicidal ideation or auditory or visual hallucinations.  The CI did not consent to the release of his VA treatment records.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the psychotic disorder 30%, coded 9210 (psychotic disorder, NOS), citing the condition prevented the CI from reasonably performing duties commensurate with the office, grade, rank or rating and was not compatible with the rigors of military service.  The PEB then deducted 20% and opined that the personality disorder NOS significantly affected the severity of the psychotic disorder, and further stated it believed if it were not for the non-ratable and non-compensable condition, his social and industrial adaptability impairment rating would best be described as none-to-mild in accordance with the VASRD.  The PEB also stated a case could be made for the presence of the MH condition prior to enlistment.  

Upon deliberation, members agreed there was occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to symptoms of suspiciousness, paranoia, delusional thought content and hallucinations to justify a 30% rating, but no more, under the General Rating Formula for Mental Disorders.  Although the CI was diagnosed with a personality disorder with cluster A traits, which would account for odd behavior, it would not contribute to the suspiciousness, paranoia, delusional thought content or hallucinations and therefore, no deduction is justified.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the psychotic disorder condition, coded 9210.  

BOARD FINDINGS:  In the matter of the psychotic disorder condition, not otherwise specified, the panel recommends a disability rating of 30%, coded 9210 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 the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Psychotic Disorder, NOS	9210	30%	

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

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01886.

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 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.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.