RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04451
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070514

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

CI CONTENTION:  “Because I am 100% disabled and unemployable.”  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 - 20070201	VARD – 20070524	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Conversion Disorder	9424	10%	Conversion Disorder with Pseudo-Seizures	9424	0%	20070326	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Conversion Disorder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s conversion disorder began in July 2005 while deployed to Afghanistan.  The CI was medically evacuated and pseudo-seizures were confirmed by video electroencephalogram in July 2006.  At the 3 November 2006 neuropsychology evaluation, following extensive testing, the examiner concluded that the CI had no neuropsychological impairment.  There was no indication of intentionally feigning neurological impairment or malingering.  The CI did not acknowledge depression during the interview, but psychological testing revealed clinically significant psychopathology.  Intellectually, the CI was functioning at a low average level and he appeared to have limited insight into his psychological functioning.  Psychological testing also indicated significant male stereotypical thinking, characterized by an unwillingness to admit weakness, discuss personal problems and a need to portray a strong, positive image.  His own self-perception appeared to be grounded in his need to be strong, tough and capable of managing his distress.  As a result, he had poor insight into the nature and extent of his psychological distress.  Consequently, it appeared that his distress was manifested in physical symptoms, which did not reflect weakness to the CI and gave him a concrete focus upon which to focus complaints and efforts at treatment.  Thus, in the absence of a medical cause for his reported seizures, it appeared that he was suffering from a conversion disorder.  

The 28 December 2006 MEB NARSUM examination, 5 months prior to separation, noted no specific complaints.  Physical examination showed a normal physical examination.  Formal neuropsychological testing by the Womack Department of Behavioral Science and Neuropsychology revealed the CI had a conversion disorder with pseudo-seizures.  They concluded that he was unfit to deploy but could reasonably perform the primary functions of his MOS, although not more than 4 hours per work day.  They found no evidence of malingering or other underlying psychopathology.  

At the 26 March 2007 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported no recurrence of seizure-like activities for the previous two months and was not currently under treatment for the condition.  Mental status examination showed the CI was a reliable historian, oriented to person, place and time.  He understood the nature of the examination.  There was no abnormality of behavior.  His mood and affect were appropriate without crying, pressured speech or grandiosity.  His communication and speech were within normal limits.  He sustained concentration and did not describe panic attacks, suspiciousness, delusions, hallucinations, obsessional rituals, abnormality of thought process, impaired judgment or difficulty with abstract thinking.  He did not report memory problems or suicidal or homicidal thoughts.  The examiner noted that the CI was able to manage his own benefits.  The CI reported no difficulties in performing the activities of daily living and was able to establish and maintain effective work and social relationships.  He was able to understand commands and represented no danger to self or others.  The examiner concluded the CI had attention deficit/hyperactivity disorder by history and was in remission for conversion disorder with a history of pseudo-seizures and a global assessment of functioning of 76.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the conversion disorder 10%, coded 9424 (conversion disorder), citing mild impact on his industrial and social capabilities.  The VA rated the conversion disorder 0%, coded 9424, based on the C&P examination 2 months before separation, citing minimal functional impact so as to interfere with occupational and social functioning or to require continuous medications.  

The panel agreed that a 10% rating was justified for the CI’s manifested symptoms of occupational and social impairment due to mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods of significant stress.  There was no evidence of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks to justify the next higher 30%.  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 conversion disorder.  

BOARD FINDINGS:  In the matter of the conversion disorder and IAW VASRD §4.130, 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 20170425, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20180006652, 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