RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-02412
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070604

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

CI CONTENTION:  The CI makes no contentions.  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 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 - 20070418	VARD - 20080723	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Psychotic Disorder, NOS	9210	10%	Post-Traumatic Stress Disorder (PTSD), Schizoaffective Disorder	
9211-9411	
100%	
STR	
Anxiety Disorder, NOS	Not Unfitting					
Depression, NOS	Not Unfitting					
Right Shoulder Pain	Not Unfitting	Right Shoulder Subluxation	5203	Deferred	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 100%	

ANALYSIS SUMMARY:

Psychotic Disorder, NOS. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s mental health (MH) condition began during his second deployment to Iraq from November 2005 to August 2006. He reported that his first deployment, from July 2004 to January 2005, was very demanding and stressful due to combat exposures, but he denied experiencing any significant psychiatric symptoms and stated the he initially felt more secure during the second deployment. In January 2006, he developed sleep problems in association with conflicts during combat with his chain of command, and at about this time, he also learned of his wife’s pregnancy. The CI reported that many stressors, including missions twice daily, life- threatening, vulnerable combat situations, and a July 2006 IED explosion and firefight, led to a breakdown. He developed suicidal thoughts and believed his unit would put him in jail with Iraqis who would kill him. He also reported being increasingly sad with decreased sleep as well as paranoia that returned after his wife left him.

The 8 January 2007 commander’s statement, which provided a chronology of significant events, documented that the CI completed over 175 combat patrols, was involved in a firefight and survived three IED attacks and numerous other shootings. The statement noted that in February 2006, he developed sleep difficulties and experienced insecurities as a result of numerous combat patrols in Iraq, and he began “to withdraw from his platoon and tried to work through issues on his own.” In July 2006, his symptoms began to intensify and although the unit MH provider diagnosed normal combat related stress, his motivation declined and he became apathetic. He experienced sleep deprivation, anxiety and psychosis, difficulty concentrating, and “trouble distinguishing between what was real and what was imaginary.” The CI was medically evacuated in August 2006 and began treatment with MH and other providers. Diagnoses of psychosis, PTSD, anxiety and depression were rendered.

During the 16 January 2007 MEB psychiatric examination, 6 months prior to separation, the mental status examination showed a slightly sad affect, and occasional appearance of suspicion. The CI stated he was not thinking “clearly,” but denied suicidal or homicidal ideation. The examiner noted significant sleep deprivation and ongoing conflicts with his chain of command as the source for psychotic symptoms. Although these symtpoms had improved, they were “re- exacerbated in association with the stress of his wife recently leaving.” Noting significant mood and anxiety disorders, the examiner rendered diagnoses of psychotic disorder NOS, anxiety disorder NOS, depression disorder NOS and cognitive disorder NOS with a Global Assessment of Functioning (GAF) score of 48 (severe symptoms, impairment.) At the 14 March 2007 MEB neuropsychological consultation, 4 months before separation, the CI denied any delusions and had a full scale IQ of 121 (above average). The examiner rendered diagnoses of psychotic disorder, NOS and cognitive disorder NOS, “as reflected in impaired memory and concentration,” with a GAF score of 55 (moderate symptoms, impairment). Impairment for social and industrial adaptability was recorded as “severe.”

The 20 March 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of psychiatric problems treated with anti-depression and anti-psychosis medication. The CI reported memory and concentration difficulties, indecision and impulsivity, and was performing staff work and other administrative duties. Diagnoses of psychotic disorder and cognitive disorder were rendered and noted to fail retention standards while additional diagnoses of anxiety disorder and depression did not fail retention standards. The examiner documented that social and industrial impairment from the psychotic disorder was considerable and impairment from cognitive disorder for social and industrial adaptability was severe. The January 2008 neuropsychology consult noted the CI stopped taking his medications after separation and was hospitalized in December 2007 for suicidal ideation. Several psychiatric re-admissions occurred in December 2007 and early 2008 due to suicide ideation and/or attempts. There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the MH condition 10%, coded 9210 (psychotic disorder, NOS), citing mild industrial impairment. The PEB subsumed the cognitive disorder under psychotic disorder NOS, citing an inability to rate due to overlap of symptoms and medication side effects. The VA rated the MH condition 100%, dual coded 9211-9411 (schizoaffective disorder-posttraumatic stress disorder (also claimed as cognitive disorder, depression and anxiety disorder), based on the STR, citing evidence of total occupational and social impairment. The panel first agreed that the provisions of VASRD §4.129 (mental disorders due to traumatic stress) were not applicable in this case. Neuropsychological and psychiatric NARSUM examinations prior to separation noted the presence of psychosis and severe cognitive impairments that included a loss of memory and concentration, and the CI remained in treatment that included regular psychotherapy and psychotropic medications. A review of the STR after separation revealed an unstable and deteriorating mental condition that resulted in multiple psychiatric hospitalizations between January-June   2008.       The   CI   was   not   able   to   work   in   a   civilian   environment      and

neuropsychological functioning was noted to be in the moderate to severe range. Thus, panel members concluded the CI’s condition most closely met criteria for a 50% disability rating. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 50% for the psychotic disorder, coded 9210.

BOARD FINDINGS: In the matter of the psychotic disorder, the panel recommends a disability rating of 50%, 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	50%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170224, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

PD-2017-02412

AR20200000289, XXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a permanent 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 re-characterization of your separation as a permanent 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.

Enclosure

PD-2017-02412