RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03440
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050314

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

CI CONTENTION:  Review the rating for the mental health condition.  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 - 20041207	VARD - 20120224	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizoaffective Disorder	9211	10%	Bipolar Disorder	9432	100%	20111110	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  100% 	

ANALYSIS SUMMARY:  

Schizoaffective Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s mental health (MH) condition was initially recognized in late 2003 when she was admitted to the psychiatric inpatient unit for 1 week after a situation occurred with her boyfriend.  She was diagnosed with borderline personality disorder.  In March 2004, the CI was admitted to inpatient psychiatry when she began banging her head against the wall and threatening to hang herself with her restraints.  No acute stressor was identified and she received the diagnosis of schizoaffective disorder.

During the 29 March 2004 MEB MH examination, 12 months prior to separation, the CI reported a history of unstable and intense interpersonal relationships and a history of self-mutilating behavior.  During hospitalization, she was prescribed psychotropic medication for her symptoms of mood instability and psychosis.  The CI’s symptoms included aggression, depressed mood, sleep difficulty and disorganized behavior.  She initially refused to take medication and her mother was enlisted to encourage the CI to comply with treatment.  This intervention was helpful as the CI begin to take her medication.   Her behavior and affect improved dramatically and the diagnosis was changed from borderline personality disorder to schizoaffective disorder.  The CI was stabilized on medication and was considered competent to participate in discharge planning.  At the time of discharge, she was not suicidal, homicidal or psychotic.  The CI was transferred to medical hold.

The 23 August 2004 addendum to the MEB examination, 7 months prior to separation, noted the CI had remained in medical hold and continued to receive psychotropic medication.  It was opined that the CI’s mood and behavior had improved significantly, but that she continued with moderate negative symptoms in the form of apathy, amotivation and concrete thinking.  Her mental status was not addressed.

The STR was silent going forward until January 2005, 2 months prior to separation, when the CI presented to sick call requesting refills of her medication.  There was no indication that the CI had not remained stable in the 7 months prior to separation.  Medication refills indicated that she had continued with mood stabilizing, antipsychotic and sleep medication.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MH condition 10%, coded 9211 (schizoaffective disorder), citing partial remission.  There were no STRs in the 12 months after separation for panel consideration.  The 10% rating under §4.130 is assigned when there is evidence of 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.  

The higher rating of 30% requires evidence of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, due to symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss.  The record documented that the CI was stable at the time of the psychiatric addendum and prior to separation.  According to the addendum, her condition had significantly improved and she had only residue symptoms of her condition.  The mood and behavior symptoms had improved significantly.  The STR demonstrated 1 hospitalization 12 months prior to separation with no additional hospitalizations or visits to the emergency room for psychiatric symptoms.  Suicidal ideation was absent in the 12 months prior to separation, and her mood and behavior symptoms were controlled with medication.  There were no documented hallucinations or impairment in perception.  Although there was some impairment in abstract thinking and motivation, there was no reported cognitive impairment, and judgment was not impaired.  Additionally, there was no report of panic attacks or mild memory problems.  Although there was evidence of chronic sleep impairment, this appeared to have been responsive to medication.  After due deliberation, considering all of 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 schizoaffective disorder.  

BOARD FINDINGS:  In the matter of the schizoaffective disorder and IAW VASRD §4.71a, 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 20170511, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180008988, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
Enclosure