RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxx 	CASE:  PD-2017-05608
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090701

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

CI CONTENTION:  Review all conditions.  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 – 20090506	VARD - 20100217	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Conversion Disorder	9424	10%	Conversion Disorder	9424	NSC	20090827	
Peripheral Neuropathy	Not Unfitting 	Dysesthesias and Foot Drop, Right Lower Extremity	8520	10%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Conversion Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the physical symptoms of the CI’s condition began as decreased sensation and weakness in the right leg in early 2007.  Within one week from onset, he endorsed worsening weakness and numbness, which caused difficulty in all physical activity, as well as walking.  Despite an extensive multi-system radiologic evaluation, as well as specialty neurologic consultation, no abnormal physical anomalies were discovered.       

A VA Compensation and Pension (C&P) examination, performed on 4 August 2008, 11 months prior to separation, recorded the CI’s symptoms as right leg and foot weakness and numbness with loss of motor function occurring on a daily basis.  Aggravating factors include lifting, and prolonged standing or sitting. The physical examination (PE) was normal except for a mild decrease in right ankle strength and dorsiflexion.  Gait was noted to be normal despite the use of a brace on the right foot, and the diagnosis was “right mild lateral plantar neuropathy.”   

Neuropsychological testing conducted on 10 December 2008, 7 months before separation, revealed a personal profile indicative of a “conversion pattern” (a profile produced by individuals who have the tendency to express psychological conflicts in the form of physical symptoms for which it may be difficult or impossible to determine underlying medical causes.)  The CI was diagnosed with an Axis I condition of “conversion disorder.”  

The 24 February 2009 MEB NARSUM examination, 4 months prior to separation, noted complaints of right leg numbness.  For PE findings, the examiner stated “see DD Form 2808;” however, the Form 2808 (signed 8 August 2008) specified “see VA dictation” for PE findings.  Additionally, the examiner documented (under consultations section) that neuropsychological testing showed “conversion 5 type pattern which is indicative of somatization tendencies.  Individuals with this type of profile are likely to develop physical symptoms in response to psychological stressors, and these people are likely to report any of a number of physical problems, particularly during times of stress.  Axis I diagnosis reported as conversion disorder.” 
A primary care clinical evaluation conducted on 13 March 2009, nearly 3 weeks after the NARSUM, revealed normal and full range of motion of both hips, knees and ankles, as well as a normal gait/stance, and peripheral muscle strength, tone and sensation.  The diagnosis was recorded as “conversion disorder:  stable.”  

At the 3 September 2009 VA C&P general examination, 2 months after separation, the CI reported "loss of feeling in my right leg, and pain in my lower back.”  The PE revealed normal right lower extremity motor function, and altered sensation described as “no feeling in the entire right lower extremity.”  The diagnosis was listed as “dysesthesia [altered sensation] right lower extremity,” and the provider noted minimal effect on usual occupation and daily activities.  On 7 November 2009, the CI had an initial PE conducted by the VA to establish his primary healthcare.  That examination, 4 months after separation, revealed no abnormalities of the extremities except for scaling of the feet, which was diagnosed as dermatitis. 

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 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.  The VA determined the conversion disorder was not service connected (NSC) based on the STR, citing no current diagnosis of conversion disorder or any type of psychiatric disorder.    

Panel members first unanimously agreed that VASRD §4.129 was inapplicable in this case due to the absence of a highly stressful causative event.  Members then considered if there was evidence for a §4.130 rating higher than 10% at the time of separation.  A rating of 30% requires “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.”  Although the CI’s subjective symptoms appeared to wax and wane during a time period from 11 months prior to separation to 4 months after separation, so did his PE findings of minimal weakness and movement of his right ankle to normal parameters of both lower extremities.  Overwhelmingly, normal versus abnormal physical findings were ascertained.  Such normal findings at the 3-month pre-separation examination, coupled with the provider’s comment of the CI’s usual occupation and daily activities being  “minimally affected” at 2 months post-separation, did not support a rating greater than the PEB’s 10%.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB’s adjudication for the conversion disorder.

Contended PEB Condition: Peripheral Neuropathy.  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 implicated in the commander’s statement and profiled L3 in June 2008, however, the MEB listed the condition as medically acceptable.  Citing the same rationale as previously stated (normal PE findings and maintenance abilities for occupational work and daily activities), panel members found no performance-based evidence that the contended condition significantly interfered with satisfactory duty performance.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the conversion disorder and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  In the matter of the contended peripheral neuropathy, the panel recommends no change from the PEB 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.  

XXXXXXXXXXXXXXXXX, 

Dear XXXXXXXXX:

	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.