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

From: To:

Director, Secretary of the Navy Council of Review Boards PD-2017-02730

IN REPLY REFER TO

1850
CORB:003
19 Feb 20

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

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

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (bl) to the Department of the Navy for appropriate
·	action.

2.	On 12 February 2020, the Assistant Secretary of the Navy took action in your case by accepting the correct recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Physical Evaluation Board from 10 to 50 percent with assignment to the Permanent Disability Retired List.

3.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the Navy Personnel Command, for correction of your records as stated above.	You will be notified once those changes are complete.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXX	CASE: PD-2017-02730
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060425

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Private Mess Operations, medically separated for “schizophrenia, paranoid type” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made.  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 - 20060117	VARD - 20060912	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizophrenia, Paranoid Type	9203	10%	
Schizoaffective Disorder	
9211	
50%	
20060322	
Schizoid Traits	Cat II					
Dysthymia, Single Episode						
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	
	
ANALYSIS SUMMARY:

Schizophrenia, Paranoid Type. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was initially evaluated for mental health concerns in August 2005 after having difficulty relating to co-workers. The CI was reported to have pushed a female co-worker, lacked motivation, was disinterested and socially withdrawn, demonstrated avolition (severe lack of initiative); and had mild dysphoria (feeling uneasy, unhappy, or unwell). She reported being lonely and felt that others did not like her. She admitted intentionally purging and feeling depressed for greater than 2 years. She agreed to start anti-depression medication and reported improved mood and social interaction. However, subsequent mental health sessions revealed paranoid traits. The CI was approximately 18 weeks pregnant, out of psychiatric medication for 3 weeks, and had admitted suicidal thoughts. She endorsed hearing male and female voices for over a month. She denied a previous psychiatric history and her entrance examinations did not note past psychiatric illness.

The 23 December 2005 MEB NARSUM examination, 4 months prior to separation, noted her mood had improved for 10 days due to pregnancy. Her antipsychotic and anti-depression medications were suspended until other doctors could be consulted for her baby’s protection. During the mental status examination (MSE) the CI looked visibly pregnant. Her mood was mildly frustrated with congruent affect. She admitted to having passive thoughts about death and was able to contract for safety. Her insight was limited and judgment was poor and impulsive. The  CI was diagnosed with Axis I schizophrenia, paranoid type, with severe military and civilian impairment, dysthymia with moderate military and civilian impairment, and Axis II schizoid traits. A Global Assessment of Functioning (GAF) score of 43 (serious symptoms, impairment) was assessed.

At the 22 March 2006 VA Compensation and Pension (C&P) mental health examination, one month before separation, the CI reported both depressive symptoms (e.g. suicidal impulses, isolation, crying spells) and psychotic symptoms, (.e.g. paranoia, auditory hallucinations whose content she could not recall). The CI reported functioning normally during her military duties but her superiors felt she was not doing her work properly; therefore, she was given fewer and fewer assignments. She had grown withdrawn and felt people did not like her and did not talk to her. She did not sustain relationships with friends and her family relationship was not close. She  worked 3 hours per week in the optical clinic repairing and cleaning glasses, which was going “okay.” She lived in quarters and had a roommate, but had no social interactions beyond her psychiatric therapies. Medications included an anti-depressant and a sleep aide. The MSE showed the CI as calm with well-organized thoughts. No psychotic content was addressed. The examiner noted a history of significant mental decompensation and rendered a diagnosis of schizoaffective disorder with a GAF score of 52 (moderate symptoms, impairment).

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the schizophrenia 10%, coded 9203 (schizophrenia, paranoid type). The PEB listed schizoid traits and dysthymia, single episode as related diagnoses (Category II) contributing to the Category I disability in this case. The panel noted that these Category II mental health diagnoses are subsumed under a single rating for the Category I condition IAW VASRD §4.130 general rating formula for mental health conditions. The VA rated the schizophrenia 50%, coded 9211 (schizoaffective disorder), based on the C&P examination, citing occupational and social impairment with reduced reliability and productivity. The panel considered the provisions of VASRD §4.129 (mental disorders due to traumatic stress), and agreed there was no evidence of a traumatic event or stressor that caused the unfitting mental health condition; and therefore VASRD §4.129 was not applicable.

The panel agreed that the CI had psychosis and depressive symptoms that negatively affected her work performance and relationships which resulted in social isolation. Even after inpatient treatment and ongoing psychiatric therapy, the CI continued to display serious depression and psychosis symptoms, as documented by the NARSUM and the C&P examinations. Both examinations noted the CI’s pregnancy and moderate to severe symptoms/impairment. The C&P examination, most proximal to discharge, noted the CI was only able to work 3 hours per week, had a poor work performance, was socially isolated, and had poor work and social relationships. 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 schizophrenia, coded 9203.

BOARD FINDINGS: In the matter of the schizophrenia condition, the panel 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 the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Schizophrenia, Paranoid Type	9203	50%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170405, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record