RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05621
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20030709

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Automated Logistics Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “schizophrenia” with a disability rating of 10%.  

CI CONTENTION:  “Totally and permanently disabled due to service-connected disability.”  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 - 20030522	VARD - 20030623	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Schizophrenia	9205	10%	Psychotic Disorder	9210	70%	20030602	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70% 	

ANALYSIS SUMMARY:  

Schizophrenia.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s schizophrenia began with multiple auditory hallucinations in December 2000.  The 14 January 2001 MEB NARSUM examination, conducted concurrent with discharge from inpatient psychiatry, showed the CI admitted to the ICU where he underwent extensive evaluations before his transfer to a civilian mental health (MH) facility on 29 December 2000.  He was started on psychotropic medications for symptoms of intermittent hallucinations, paranoid delusions and agitation.  The CI was subsequently transferred in stable condition, to a military psychiatry inpatient service for further work-up and evaluation.  He had no recent history of alcohol or substance use, but had used cannabis in the past.  During the 7 to 14 January 2001 hospitalization, the CI reported that he believed his symptoms resulted from sleep deprivation due to noise in the barracks at Fort Campbell.  His hospital course was uneventful and he was maintained on psychotropic medication.  The examiner commented that there were likely additional stresses, and that the origin of the psychotic episode was unclear.  The mental status examination (MSE) was unremarkable.  The examiner opined that the condition was stable and well controlled “in the regimented environment of the inpatient psychiatry ward.”  The diagnosis of schizophreniform disorder was documented with a Global Assessment of Functioning (GAF) score of 60 (cusp of moderate-mild).  The CI was separated and placed on TDRL on 30 March 2001 with a 30% disability rating.  

On 8 January 2002, the CI was admitted to inpatient psychiatry secondary to auditory hallucinations, bizarre aggressive behaviors and threatening to hurt his aunt.  The CI spent 3 weeks on the inpatient unit.  He responded well to medication, and at the time of discharge he no longer heard voices, and his judgement was noted as improved.  It was noted that he had not been compliant with medication.  The MSE was unremarkable.  The CI was placed on monthly antipsychotic medication.
  
At the TDRL evaluation on 20 February 2002, 15 months prior to TDRL removal, the CI reported two subsequent psychotic episodes since TDRL placement.  He reported a history of auditory and visual hallucinations.  It was noted that he was not compliant with oral medications and that his aunt refused to let him live with her unless he was receiving monthly injections, which was initiated and administered less than a month before the TDRL evaluation.  The MSE was unremarkable with the exception of poor judgement.

At the TDRL evaluation on 25 April 2003, less than 3 month prior to permanent separation, the CI stated, “I’m doing fine as long as I take that medication, (referring to the monthly injections).  If I don’t I start hearing voices again.”  The CI had worked for only 2 months since placement on TDRL but was seeking employment.  He quit the job he held for two months in 2002 because he was required to use a computer.  The MSE was unremarkable.  The examiner indicated that his judgement was good and that he was stable on medication for “a little over 1 year.”  The examiner also noted the CI had considerable social and industrial impairment, “has extreme job instability, marginal social adjustment and can easily lapse back into delusions.”

At the 2 June 2003 VA Compensation and Pension (C&P) evaluation, 1 month before separation, the CI reported “I really have no complaints.”  He reported hearing voices that made negative comments, but command hallucinations were not reported.  He had no visual hallucinations since the first hospitalization.  The CI indicated that sleep and appetite were good and he had no history of suicidal or homicidal ideation.  The MSE noted that he was initially tense, but adjusted as the evaluation continued.  There were some extra-pyramidal symptoms described and reference was made to him having some processing difficulty.  However, it was noted that he displayed no delusional thinking, and his perception was not impaired.  He demonstrated some difficulty with abstract thinking.  The examiner alluded to the possibility of impaired judgment.

The panel directed attention to its rating recommendation based on the above evidence.  The CI was removed from the TDRL with a rating of 10%, coded 9205 (schizophrenia), citing “stable when on antipsychotic medication, no recurrences of symptoms since his first periodic TDRL examination, has job instability and marginal social adjustment.”  The VA rated the schizophrenia 70%, coded 9210 (psychotic disorder), based on the C&P examination 1 month before separation, citing occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood.  

The record documented the CI was stable at the time of TDRL removal (3 months prior to separation), but the stability was noted to be tenuous.  The TDRL examiner stated that the CI was stable on medication for “a little over 1 year,” but had considerable social and industrial impairment, “has extreme job instability, marginal social adjustment and can easily lapse back into delusions.”  The C&P examiner, 1 month before separation, noted the CI had problems with processing information.  In assessing the CI’s judgment, the examiner asked him what he would do “if he were walking down the street, saw flames and smoke coming from the first floor window,” he responded “try to get out of the building.”  While such a response does not necessarily translate into impaired judgment, it does demonstrate some impairment in the processing of information, which could be compromising in an employment situation.  

Panel members agreed, his condition exceeded the 10% disability level, but was not reflective of the 70% VA rating since suicidal ideation, obsessional rituals, panic attacks, disorientation or command hallucinations were not present.  There was no legal history of violence recorded.  Therefore, panel members concluded, the 70% level was not justified.  However, panel members agreed that at the time of TDRL removal, the evidence supported a rating of 50% for occupational and social impairment with reduced reliability and productivity due to difficulty in understanding complex commands, impaired abstract thinking and difficulty in establishing and maintaining effective work and social relationships.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 50% for the schizophrenia at the time of TDRL removal.

BOARD FINDINGS:  In the matter of the schizophrenia disorder, the panel majority recommends a disability rating of 50%, coded 9205 IAW VASRD §4.130.  The single voter for dissent recommends modification to 30%, but elected not to submit a minority opinion.  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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Schizophrenia	9205	50%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170724, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007479, 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 50% 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), XXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure