RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04202
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080325

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, M1 Armor Crewman, medically separated for “undifferentiated somatoform disorder” with a disability rating of 10%.   

CI CONTENTION:  In addition to the mental health (MH) disorder and GERD, the CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 – 20080417	VARD - 20080619	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Undifferentiated Somatoform Disorder	9423	10%	Undifferentiated Somatoform Disorder 	7399-9423	10%	STR	
GERD	Not Unfitting	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Undifferentiated Somatoform Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was referred to MH in August 2006 following a diagnosis of psychogenic vomiting.  The CI had an extensive history involving gastrointestinal procedures and surgery.  The CI developed the inability to tolerate minimal amounts of solid food, which progressed to frequent vomiting.  A detailed medical workup was not able to determine the cause of the chronic vomiting.  Eventually the condition was thought to have a psychological overlay and the CI was diagnosed with undifferentiated somatoform disorder (mysterious physical symptoms that cannot be explained or have no physiological origin).     

The 30 May 2007 psychology examination, 10 months prior to separation, detailed a historical background (prior to Service entry) of emotional distress and physical abuse that centered about the CI’s stomach (being hit in the stomach) which induced vomiting.  Additionally, the CI endorsed an increase in personal stress secondary to his father’s suicide death.  “While [the CI] denied problems with vomiting prior to [his initial surgery], he reported being plagued by stomach problems during those months.  [The CI] recalled a childhood marked by excessive physical abuse from his father, and was frequently beaten in the stomach on most of these occasions.”  Additionally, the examiner documented the following summary.  “Coupled with the stress from his surgery, his father's suicide several months prior and his failure to address or resolve these emotions (and those of his childhood), his psychological distress was likely to have been converted into the physical symptoms for which he continues to experience.  The nature of his diagnosis suggests that his vomiting of food, restricted eating habits and associated physical problems may serve a purpose for him.  For example, by focusing on the physical pain in his stomach and his dietary habits, he remains detached from the emotional feelings that are associated with the death of his father and the severe physical abuse he experienced as a child.”  

The 28 August 2007 psychiatric MEB NARSUM examination, 7 months prior to separation, noted an inability to participate in activities without getting ill secondary to dehydration and poor nutritional status.  The mental status examination was detailed and normal.  The examiner noted, “The Soldier's vomiting and weight loss problems have been stable for approximately two years.” The CI’s medications consisted of Bentyl and Prevacid; both GI drugs that were prescribed on a daily basis.  There was no VA examination proximate to separation in evidence.

Panel members first considered if VASRD §4.129 was applicable in this case.  Members agreed the “highly stressful event” connected with service was not satisfied.  The panel next directed attention to its rating recommendation based on the above evidence and noted that disability associated with any MH disorder, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 (general rating formula for MH disorders).   

The PEB rated the MH disorder 10%, coded 9423 (undifferentiated somatoform disorder), citing requirement of continuous medication.  The VA also rated the MH disorder with gastroparesis (a condition whereby the stomach cannot empty itself of food in a normal manner) 10%, analogously coded 7399-9423, based on the STR, citing 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.  
 
Panel members agreed that the PEB’s use of VASRD code 9423 was appropriate in defining the CI’s MH disorder that produced physical symptoms.  The panel next considered if a rating higher than the 10% adjudicated by the PEB proximate to separation was justified.  In this case, the lack of significant symptoms, such as sleep disturbance, anxiety, suspiciousness, paranoia or panic attacks, does not support the higher 30% impairment.  The panel also noted the NARSUM examiner indicated the disorder had been “stable for approximately 2 years.”  Therefore, after due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends no change in the PEB’s adjudication for the MH disorder.

Contended PEB Condition:  GERD.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled or judged to fail retention standards.  The commander’s statement included a reference that the CI’s medication caused a significant degree of drowsiness which made him susceptible to heat injuries and would further impair his physical capabilities.  Despite the commander’s comment regarding the relationship of medication and drowsiness, panel members agreed that there was no performance-based evidence from the record that the GERD condition separately and significantly interfered with satisfactory duty performance at or near separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB’s fitness determination for the contended condition, so no additional disability rating is recommended. 

BOARD FINDINGS:  In the matter of the MH disorder and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  In the matter of the contended GERD condition, the panel recommends no change from the PEB’s determination as not unfitting.  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:

AR20190006863, XXXXXXXXXXXXXXXXXX

Dear  XXXXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 40% 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 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.