RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04581
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061229

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Power Generator Equipment Repairer, medically separated for “schizophrenia, undifferentiated type” with a disability rating of 0%.    

CI CONTENTION:  The military did not diagnose post traumatic stress disorder and his condition has worsened and prevents him from working and caring for his family.  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 - 20060611	VARD - 20070118	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizophrenia…	9205	0%	Paranoid Schizophrenia	9203	30%	20061102	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Schizophrenia.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s first episode of schizophrenia began in January 2006 under the stress of deployment, marital problems, and drug use.  He was reportedly functioning sufficiently for military service until July 2005, when a pending divorce coincided with an increased frequency and intensity of hearing voices which commanded him to harm himself or others.  He was started on medication and his paranoia and disorganized thoughts improved with the treatment.  The CI was hospitalized in Germany for a week in February 2006, and then transferred to Walter Reed Army Medical Center on 6 March 2006 for inpatient care.  Upon release, he was inconsistent with his outpatient program attendance. 

The 6 March 2006 MEB NARSUM psychiatric examination, 10 months prior to separation, noted reports of intermittent, derogatory auditory hallucinations calling for him to end his life.  Mental status examination showed he was cooperative during the interview but with minimal eye contact, and mildly slowed speech and body movements.  Mood was "tired" with a blunted affect, and thought processes were remarkable for mild poverty of speech, but for the most part were linear, logical and goal directed.  The CI admitted to recurring auditory hallucinations that were persecutory in nature, but denied their presence at the time of the interview.  His cognition was intact with no suicidal ideation or homicidal ideation.  Judgment and insight were fair, and estimated intelligence was average.  The examiner noted that based upon psychological testing, the CI met criteria for “schizophrenia, undifferentiated type,” manifested by auditory hallucinations, persecutory delusions, disorganized behavior, and affective flattening, with significant social and occupational dysfunction.  He also met criteria for schizotypal personality disorder, with symptoms including: chronic hallucinations from age 7 that did not previously cause significant distress, chronic suspiciousness and paranoia, constricted affect, few friends, and odd beliefs with a blurring of fantasy and reality.  The examiner concluded that the CI would only be able to maintain employment under supervisors with an understanding of his psychiatric condition and limitations, and provided structure and routine.  He would function best in jobs with repetitive and simple tasks, but have difficulty with a changing work pace or environment with safety hazards.

At the 2 November 2006 VA Compensation and Pension (C&P) mental health examination, 2 months before separation, the CI reported not doing particularly well and was having hallucinations and hearing a voice telling him that others had bad intentions toward him.  He experienced both moderate and severe panic attacks, usually lasting until the stimulus was removed, followed by mild bouts of depression and anxiety.  The examiner documented that the CI had severe short term memory loss, but retained good long term memory.  He also obsessively locked car doors and windows, checking them over and over again, and got up in the middle of the night to investigate and check the house.  He had trouble sleeping due to intrusive thoughts.  The examiner concluded that CI had chronic severe symptoms of paranoid schizophrenia with intermittent bouts of mild depression and severe anxiety.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the schizophrenia 0%, coded 9205 (schizophrenia, residual type; other and unspecified types), citing cannabis and alcohol dependence, and that the condition existed prior to service (EPTS) but was permanently aggravated by military service; a deduction was not indicated.  The VA rated the schizophrenia 30%, coded 9203 (schizophrenia, paranoid type), based on the C&P examination, citing that the CI was unemployable and experienced intermittent periods of inability to perform occupational tasks due to mild depressed mood, anxiety and panic attacks.  Members agreed that the CI met a minimum 30% rating based on the presence of depressed mood, anxiety, panic attacks, chronic sleep impairment, and mild memory loss as noted on the NARSUM and C&P evaluations prior to separation.  A 50% rating is assigned when there is evidence of occupational and social impairment with reduced reliability and productivity, and the panel noted evidence of 4 of the 9 criteria (flattened affect, impaired short-term memory, mood disturbances, and difficulty in understanding complex commands) were met.  However, he did not demonstrate abnormal speech, more than weekly panic attacks, impaired judgment, impaired abstract thinking, or difficulty in establishing and maintaining effective work and social relationships.  Thus, members adjudged that the CI’s condition more closely met the 30% rating criteria.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the schizophrenia, undifferentiated type, coded 9205.   
BOARD FINDINGS:  In the matter of the schizophrenia, the panel recommends a disability rating of 30%, coded 9205 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	9205	30%	

The following documentary evidence was considered:

AR20190005370, 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 30% 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 ), XXXX XXXXXXX XXXX, XXXXX XXX XXXXXXX, XX XXXXX.
A copy of this decision has also been provided to the Department of Veterans Affairs.