RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02550 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20050328

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Fire Controlman, medically separated for “schizophrenia, paranoid type” with a disability rating of 10%. Post-traumatic stress disorder [PTSD] was determined to have existed prior to service (EPTS) and was not rated.

CI CONTENTION: Mental health conditions have worsened. 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 - 20041207	VARD - 20050502	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizophrenia, Paranoid Type	9203	10%	Psychotic Disorder, NOS	9210	30%	20050209	
PTSD	EPTS					
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Schizophrenia, Paranoid Type. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s psychotic condition began in October 2008 with complaints of auditory hallucinations. The CI was participating in a combat control air scenario simulation while onboard the ship when he heard a command auditory hallucination. He was diagnosed with psychotic disorder not otherwise specified (NOS) and placed on limited duty. He continued to report auditory hallucinations on a regular basis. He heard a single voice making critical comments about his life, and derogatory comments about him. His condition was treated with anti-psychotic medication and did not require psychiatric hospitalization or urgent care.

During the 13 May 2004 psychiatry examination, 10 months prior to separation, the CI noted he was less anxious, and was tolerating new medication well. He stated he was doing well at work, and in his relationships with his family members. The mental status examination (MSE) recorded

a good mood that was euthymic and calm. His speech was normal and thought process was goal- directed and logical. Judgment was intact. The diagnoses documented were psychotic disorder NOS and personality disorder NOS. The examiner noted the CI was fit for full duty and could return to his parent command.

The 18 October 2004 MEB NARSUM examination, 5 months prior to separation, noted complaints of auditory hallucinations that were critical of him. He had difficulty concentrating and sometimes had trouble distinguishing reality and hallucinations during testing. He did not have voices telling him to hurt himself or anyone else. The CI’s symptoms had improved significantly with medication. There was no report of chronic insomnia, panic attacks, suicidal or homicidal thoughts or attempts, or problems with memory. The MSE noted pleasant mood with pleasant affect. His insight and judgment were intact, as were memory and cognition. The diagnosis of schizophrenia, paranoid type, was recorded for the first time.

At the 9 February 2005 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported a recent increase in the frequency of hearing voices to about four or five times monthly. He had problems falling asleep but was able to sleep well. There were no other symptoms reported. The CI noted that he had discontinued his antipsychotic medication one month prior because he no longer had access to the prescribing doctor. The CI was studying at the local community college. The MSE noted mild suspiciousness towards the examiner, anxious affect and mood, good abstracting ability, and good memory functioning and fund of knowledge. However, the examiner opined that insight and judgment were poor. There was no evidence presented for poor judgment. The CI noted that he was unaware of the causes for his psychotic symptoms. The examiner noted the only symptoms referable to psychosis were the reported visual hallucinations and the “probable” auditory hallucinations.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the schizophrenia, paranoid type condition 10%, coded 9203. The PEB also determined the condition of PTSD was pre-existing. The PTSD was not noted on limited duty forms, implicated in the non-medical assessment (NMA), and was not diagnosed until after the CI was in the MEB process. The NARSUM examiner assessed the diagnosis based on the CI’s report of childhood sexual abuse and attendant symptoms. The STR demonstrated this condition was not diagnosed prior to the MEB NARSUM. The CI had denied a history of sexual abuse during the February 2004 psychiatry examination, 8 months prior to the NARSUM, but did report a childhood history of physical and verbal abuse. No trauma symptoms were recorded. The STR and the CI’s self-reported history is consistent with the determination that PTSD was pre-existing and not permanently service aggravated. However, any impairing symptoms from this condition were considered under the primary mental health impairment, since VASRD 4.130 (schedule of ratings–mental disorders) rating is based on impairment and not diagnosis. The VA rated the claimed schizophrenia, paranoid type condition 30%, coded 9210 (psychotic disorder, NOS), based on the C&P examination and citing the rating was also based on the level of symptomatology reported.

The panel first addressed if the provisions of VASRD of §4.129 (mental disorders due to traumatic stress) were applicable. The panel determined that the schizoaffective disorder was not due to a “highly stressful event” and §4.129 is not applicable in this case. The panel next proceeded with the rating recommendation based on the evidence at the time of separation. The STR showed the CI had no chronic sleep impairment, no significant impairment in concentration or memory, and no panic attacks. Antipsychotic medications had been beneficial. There was no evidence of impairment in thinking or judgment and no report of violence, disinhibiting behaviors, or psychotic episodes after the initial episode aboard ship. There was no report of active suicidal or homicidal ideation, no treatment requiring emergency care, and no psychiatric hospitalizations. The NMA indicated the CI was capable of performing his assigned duties, but his condition prevented him from performing his in-rate duties as a shipboard fire controlman due to his profile

restrictions. There was no mention of psychotic symptoms being present while on duty. The C&P examination noted he had not continued his medication. Despite no medication, he remained stable with few incidences of reported auditory hallucinations. Evidence of psychotic experiences was not present during any of the examinations or MH visits. He was able to continue his college education with no apparent difficulty.

Therefore, panel members agreed, a 10% rating and no higher was justified for “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.” 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 schizophrenia condition.

BOARD FINDINGS:  In the matter of the schizophrenia, paranoid type condition and IAW  VASRD
§4.130, the panel recommends no change in the PEB adjudication. In the matter of the contended post-traumatic stress disorder, the panel agrees it cannot recommend it for additional disability rating. 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 20170424, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY  REFER  TO:
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY  BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 28 Oct 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate  action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.