RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX.	CASE:  PD-2021-00070
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, M1 Armor Crewman, medically separated for “conversion disorder” with a disability rating of 0%.   

CI CONTENTION:  “Veteran was rendered unfit due to being diagnosed with conversion disorder, with mixed presentation and also PTSD, considered chronic.  Veteran is now rated at 100% for PTSD.”  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 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 - 20060123	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Conversion Disorder	9424	0%	No VA Examination Proximate to Separation in Evidence	
Post Traumatic Stress Disorder (PTSD)	“Not Supported”		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Conversion Disorder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s mental health condition began in April 2005 after developing acute generalized weakness, chest pain, dizziness, and having multiple episodes of reported loss of consciousness for which no etiology could be discerned after an extensive work up.  

The 13 July 2005 MEB NARSUM examination, written 8 months prior to separation, but performed while the CI was in an inpatient unit during May 2005, 10 months prior to separation, noted complaints of global weakness, and episodes of dizziness and lost consciousness.   His condition had improved with treatment.  The CI was stable throughout his hospital course, had no adverse events and was discharged on 30 May 2005 with medication.  At the time of discharge, the mental status examination (MSE) was unremarkable.  His mood was “good,” and affect was mood congruent.  There was no evidence of psychosis or of a thought disorder.  He did not have a history of suicidal or homicidal ideation, and his judgment was intact.  Although he reported traumatic symptoms, psychological tests noted his testing profile “did not suggest evidence of PTSD [post traumatic stress syndrome].”

After the 30 May 2005 hospitalization discharge noted above (MEB NARSUM), the CI was seen in the behavior health clinic on 1 June 2005 and his MSE was unremarkable.  Mood was normal, and he was prescribed antianxiety/antidepressant medication.  He reported he was looking forward to being home for the birth of his baby.  He had a good relationship with his wife of one year.  Treatment records were absent going forward; however, the psychiatric consultation recorded the following:  The CI started group therapy on 5 June 2005 and attended 9 group meetings prior to the 9 January 2006 consultation examination (synopsis below).  At the 5 June visit, the CI reported feeling normal, sleep was normal, as was concentration and appetite.  The CI reportedly stated he did not think he had a conversion disorder but possibly had fainting due to chemicals he was exposed to during his 6 month tour in Iraq in 2004.  At the 15 August 2005 clinic visit, the CI reported he was doing better.  His affect and mood were normal.  The CI also had a normal MSE on 18 August 2005, and on 7 November 2005.  His last clinic visit (non-scheduled, walk-in), 16 November 2005 noted the CI complained of “PTSD” symptoms that had not been reported during the previous several months.  He cancelled his following two scheduled follow-up appointments, and had no other follow up visits.

The 9 January 2006 MEB consultation examination, 2 months prior to separation, noted the PEB returned the case because the CI’s condition had possibly improved and there was no recent psychiatric evaluation within the past 6 months.  At the time of the examination, the CI was in medical hold.  He reported he had been doing pretty well, and had been off medication since the summer of 2005.  He also reported he was feeling distressed living away from his wife.  The CI noted he also had nightmares.  The MSE noted he was pleasant and cooperative.  His speech was normal and his affect was full and appropriate.  His mood was normal and there was no evidence of a formal thought disorder, psychosis or delusions.  He stated the he worried about heavy metal exposure due to working with exploded ordnance.  He was cognitively intact and judgment was intact.  The examiner indicated that his condition of conversion disorder was in remission, and the diagnosis of PTSD was believed to be “erroneous and premature.”  It was noted the CI reported some combat stress symptoms, “but this does not appear consistent with a diagnosis of posttraumatic stress disorder.”  His condition was assessed as not having any impact on duty.

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 condition 0%, coded 9424 (conversion disorder), citing “By current evaluation is in remission.”  The panel members first agreed that the provisions of VASRD§ 4.129 for a “mental disorder that develops in service as a result of a highly stressful event” were not applicable.  

The panel next proceeded with the rating recommendation.  The panel considered the absence of emergency room treatment, or hospitalization, and the apparent stability of symptoms during the 9 months prior to separation (noting there was no VA examinations proximate to separation).  At the time of the NARSUM, the CI was in an inpatient unit and was taking anxiety and sleep medication.  He was in a stable marriage, and his symptoms were notably improved with medication.  His mood was documented as good, and he had a normal MSE.  Post inpatient treatment, the CI attended group treatment and individual clinic appointments.  His examinations were normal, and he reported doing well.  The psychiatric consultation examination, most proximate to separation, recorded a normal MSE, and absence of conversion symptoms.  His impairment for social and vocational adaptability was “extremely mild,” and his condition was assessed to have no impact on duty performance.  The CI noted he no longer took psychotropic medication, and he last took medication in the summer of 2005.  There was no evidence medication was required for symptoms controlled in the months prior to separation, since his condition did not show deterioration after medication discontinuation.  The psychiatric consult noted that removal of the threat of deployment was very helpful in the remission of his symptoms, and there were no current significant impact on duty performance; however, it was suggested that his symptoms would likely recur if he were to deploy again.  Panel members agreed, the condition appeared to have reached a state of remission, and he was without conversion symptoms in the 9 months prior to separation.  There were no complaints of psychosis, clinically significant physical, or mental symptoms in the 9 months prior to separation.  There was no evidence of chronic insomnia leading to impairment, problems with memory, panic attacks, or signs of impairing psychosis, or visits to healthcare with complaint of fainting, weakness or dizziness at the time of separation.  There was no report of domestic violence or aggression.  A non-compensable rating is assigned when “A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.”  After careful deliberations, panel members concluded, a higher than 0% rating was not justified at the time of separation.

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 adjudication for the conversion disorder condition.  

Contended PEB Condition: PTSD.  The panel’s main charge is to assess the fairness of the PEB’s determination that the PTSD condition was not unfitting.  The PTSD condition was profiled, and was not implicated in the commander’s statement, but did fail retention standards.  A review of the record showed PTSD diagnosed during inpatient hospitalization, 10 months before separation.  During multiple visits to mental health clinics, there was no evidence of a diagnosed PTSD.  In fact, while the CI was diagnosed with PTSD during hospitalization, psychological testing at the time revealed no evidence of PTSD diagnosis.  The psychiatric consultation examination, 2 months before separation, acknowledged the PTSD diagnosis recorded in the NARSUM, but opined the diagnosis was “erroneous and premature.”  A 1 November 2005 statement from the battalion operations officer noted the CI “was exposed to indirect fire was near the compound [in Iraq], but [it was] never life threatening to any soldier by its proximity. The [CI] was exposed to direct fire due to daily convoys but the direct fire never hit any of the vehicles or personnel while the [CI’s] platoon was on mission. The operations officer statement further elaborated the CI “never treated any fellow soldier for injuries or any foreign national. The [CI] never witnessed any soldier or foreign national die or get injured due to combat.  The [CI] was never involved in the clean up of any-dead body while in Iraq. The [CI] was never involved in any hostile attacks or raids while in Iraq.”  The CI was prescribed medication for nightmares related to Iraq, and the record showed improvement in anxiety symptoms and in sleep symptoms with medication.  At the time of separation, there was no evidence that the CI had any clinically significant symptoms from any mental health condition.  Additionally, there was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for a PTSD condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the conversion disorder condition and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  In the matter of the contended PTSD condition, the panel recommends no change from the PEB determination as not unfitting (not supported).  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 20210528, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20210017324, XXXXXXXXXXXXXXXX. 

Dear XXXXXXXXXXXX:

	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,