RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05060
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070913

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Parachute Rigger, medically separated for “conversion disorder” with a disability rating of 10%.  

CI CONTENTION:  In addition to the conversion disorder, 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 - 20070731	VARD - 20080919	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Conversion Disorder	9424	10%	Conversion Disorder 	9424	50%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  100%	

ANALYSIS SUMMARY:  

Conversion Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s conversion disorder began in May 2006 after an infectious illness, Rocky Mountain spotted fever (RMSF), with neurological complications.  The CI experienced a seizure and was hospitalized for 4 days and then discharged.  On the first day he experienced pain while running and the next morning he had difficulty awakening and was unable to move his extremities.  He had positive titers for RMSF and typhus and was diagnosed with fever due to rickettsial disease.  A brain CT scan at the time was normal.  During follow-up the CI reported pain throughout the spine and bilateral foot drop.  He improved somewhat in physical therapy but continued to have an abnormal gait.  He was given braces for the foot drop.  The CI underwent neurological testing and evaluation by two neurologists and no cause of his symptoms was identified.  The second neurologist indicated that “his symptoms are not organic in nature and likely represent a somatoform disorder.” 

At an undated MEB NARSUM examination, the CI reported, “I can’t walk normal.  My gait function is not normal.”  He reported bilateral foot drop and bilateral numbness from the knees down.  The physical examination showed an altered gait, with bilateral braces that caused him to walk with knees bent and at a slow pace.  Examination of the head, ears, eyes, nose, throat, heart, lungs and abdomen was normal.  There was muscle spasm of the lower thoracic muscles, left greater than right, and decreased spine ROM due to pain.  Lower extremity strength was normal with bilateral foot drop noted.  Neurological examination showed intact cranial nerves.  There was decreased sensation below the knees bilaterally.  The CI reported a tingling sensation to touch but was unable to distinguish two point discrimination.  Brain MRI in August 2006 was normal.  Cervical and thoracic MRIs showed degenerative disc disease and arthritis with some mild encroachment of the neuroforamina and mild spinal stenosis at some levels.  The MEB NARSUM examiner noted that the neurology opinions indicated “no obvious sequelae related to RMSF episode.”  

The 17 April 2007 MEB NARSUM mental health (MH) examination, 5 months prior to separation, noted complaints of inability to lift due to back pain; gait problems which limit being active; and braces for foot drop.  The CI denied significant stress, but noted his illness caused stress in his relationship with his girlfriend, who was anxious for him to come home.  He described his mood as calm, although the psychiatrist noted that at his MH evaluation 4 months earlier he reported he was depressed with insomnia and decreased appetite.  The mental status examination noted an abnormal gait.  The CI showed no distress over his symptoms and expressed no anxiety about the future.  The examiner stated the CI discussed his future in a way that neglected his limitations.  His mood was normal (euthymic) without suicidal or homicidal ideations.  His affect was “bright.”  His thought processes and content were normal.  He was not preoccupied with health concerns and there was no obsessive thought or compulsive behavior.  The Axis I diagnosis was conversion disorder with motor deficits manifested by gait abnormality which cannot fully be explained by a general medical condition.  The global assessment of functioning assignment was 60, which is in the moderate range of impairment.  Regarding his current functional status, the psychiatrist stated the “current symptoms cause impairment in his functioning in the military environment as well as his social environment.  

The commander’s statement dated 17 July 2007, 2 months prior to separation, indicated the CI worked 9-hour work days and could perform an ordinary routine as long as it did not require heavy lifting or prolonged walking.  He could not “perform without an unreasonable number and duration of rest periods.”  He was able to communicate with others and his interactions with others were civil.  He was able work with reasonable concentration.  He could make simple work decisions.  The commander stated the CI did have psychological difficulties that impacted his medical problems.  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 conversion disorder 10%, coded 9424 (conversion disorder), citing conversion disorder manifested by impaired ambulation with abnormal gait and bilateral foot drop that cannot be explained by a general medical condition and are not thought to be intentionally produced.  The VA rated the conversion disorder 50%, coded 9424, based on the STR, citing disturbances of motivation and mood and difficulty in establishing and maintaining effective work and social relationships.  

The panel agreed a 30% rating was supported for “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal).  Although the CI’s MH condition caused daily limitations in his work performance which could be considered reflective of “reduced reliability and productivity” supportive of a 50% rating, he was able to satisfactorily work 9-hour days with his limitations, communicate with and interact with others, display focus and concentration and make work decisions.  His speech and thought were normal and his mood was not adversely affected.  The panel judged this evidence did not support a level of disability reflected by the 50% rating specified as “occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective 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 30% for the conversion disorder, coded 9424.  

BOARD FINDINGS:  In the matter of the conversion disorder, the panel recommends a disability rating of 30%, coded 9424 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	
Conversion Disorder	9424	30%	

AR20190007042, XXXXXXXXXXXXXXXXXX 

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.  Inquiries 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.