RECORD OF PROCEEDINGS
                     PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  .
BRANCH OF SERVICE:  Army
CASE NUMBER:  PD1001298                                  SEPARATION DATE:
20050325
BOARD DATE:  20120201


SUMMARY OF CASE:  Data extracted  from  the  available  evidence  of  record
reflects that this covered individual  (CI)  was  a  Reserve  SFC/E-7  (42L,
Personnel) medically separated for conversion disorder.   She  was  treated,
but did not respond adequately to fully perform her military duties or  meet
physical fitness  standards.   She  underwent  a  Medical  Evaluation  Board
(MEB).  Conversion disorder was forwarded to the Physical  Evaluation  Board
(PEB) as medically unacceptable IAW  AR  40-501.   Three  other  conditions,
identified in the rating chart below, were listed on the  DA  Form  3947  as
medically acceptable.  The PEB found the conversion disorder  unfitting  and
rated it 10%.  The CI made no appeals, and was thus  separated  with  a  10%
disability rating IAW applicable Army and DoD regulations.


CI CONTENTION:  The CI states, “I am rated at 100% combined through  the  VA
with a rating of 30% for conversion disorder (the diagnosis  from  the  Army
for my medical discharge).  Some of the  symptoms  have  continued  to  hold
steady but most of them have worsened with time.  There  are  days  that  my
left side does not want to function for me at all and I struggle to  get  up
and about.  On those days my cane is  not  enough  and  I  need  to  use  my
wheelchair (which is not easy when I  can  only  use  one  arm  and  leg  to
maneuver the chair with).  I am in pain all the time, some  days  very  much
worse than others.  I know that the board is  only  supposed  to  take  into
consideration the symptoms as they were when I was  discharged  but  I  also
know that the symptoms that I was medically discharged with  are  what  have
gotten worse.  I believe the fact that my symptoms have either  held  steady
or gotten worse with time should be taken into consideration.   I  was  told
that the Army would only rate me on the conversion disorder  and  leave  all
of the other symptoms out of the equation because it would all go away if  I
could find the source of my conversion  disorder  (because  they  could  not
find any other source for the symptoms).  None of that changes what  I  have
to go through on a daily basis with my physical limitations and pain –  that
should be what is looked at not the fact that the  doctors  have  difficulty
finding the source of my symptoms, whether from conversion disorder or  not.
 The VA has rated the symptoms that they have found –  not  just  what  they
can find the source of.”

















RATING COMPARISON:

|Army PEB – dated 20050304     |VA (9 mo. After Separation) – All       |
|                              |Effective 20050326                      |
|Condition         |Code        |Rating                                  |
|↓No Additional MEB/PEB        |Hemiparesis, Left Leg         |8520     |
|Entries↓                      |                              |         |
|Combined:  10%                |Combined:  90%                          |


ANALYSIS SUMMARY:
The Board acknowledges the sentiment  expressed  by  the  CI  regarding  the
significant impairment with which her condition  continues  to  burden  her.
The Board is subject to the same laws for disability entitlements  as  those
under which the Disability Evaluation System (DES) operates.   The  DES  has
neither the role  nor  the  authority  to  compensate  Service  members  for
anticipated  future  severity  or  potential  complications  of   conditions
resulting in medical separation.  That role  and  authority  is  granted  by
Congress  to  the  Department  of  Veterans’  Affairs  (DVA).   The  Board’s
authority resides in evaluating the fairness of DES  fitness  decisions  and
rating determinations at the time of separation  from  Service.   The  Board
also  acknowledges  the  CI’s  contention  for  Service  ratings  for  other
symptoms and conditions.  While the DES considers all of  the  CI's  medical
conditions, compensation can only be offered for those conditions  that  cut
short a Service member’s career, and then only to  the  degree  of  severity
present at the time of  separation.   The  DVA,  however,  is  empowered  to
compensate Service connected  conditions  and  to  periodically  re-evaluate
said conditions for the purpose of  adjusting  the  CI’s  disability  rating
should the degree of impairment vary over time.

Mental Condition.  In March 2004, the CI  began  having  left  visual  field
symptoms.  A work-up for multiple  sclerosis  was  negative.   Visual  field
testing was normal, and her left visual field symptoms were felt to be “non-
organic.”  Three months later, after a minor surgical procedure, the CI  had
some episodes which involved shaking of the  head  and  extremities.   These
unusual  spells  were  initially  thought  to  be  seizures,  so   she   was
transferred to a larger hospital for care.  On arrival she was  unresponsive
and had five more episodes, each lasting about a minute.  She was  intubated
and started on intravenous anti-seizure medication.  The next day  she  woke
up, but had difficulty opening her  eyes.   She  also  exhibited  left-sided
numbness and weakness.  A full neurological evaluation was  done,  including
magnetic resonance imaging (MRI), continuous  electroencephalography  (EEG),
and extensive laboratory testing.  No organic etiology for her symptoms  was
found.  She was diagnosed  with  non-epileptiform  spells  (pseudoseizures).
She  was  then  seen  by  psychiatry,  and  was  diagnosed  with  conversion
disorder.  At discharge, she needed a cane due to  her  left  leg  weakness.
The left leg weakness improved with physical  therapy  (PT).   In  September
2004, she passed out during a PT session.   When  she  came  to,  she  noted
onset of headache and stuttering.  She said that her  stuttering  was  worse
during a  headache.   A  speech  evaluation  concluded:  “a  highly  unusual
presentation” of speech deficit, due to exam inconsistencies.   The  CI  was
treated with biofeedback, and  was  also  given  vitamin  B-12  and  folate.
Psychological testing supported the diagnosis of conversion  disorder.   Her
PT  and  psychotherapy  were  continued.   Eventually,  due   to   lack   of
improvement, an MEB was initiated.

At her December 2004  MEB  mental  health  (MH)  exam,  16  weeks  prior  to
separation, she reported that her  numbness,  weakness  and  headaches  were
better.  She said that  two  weeks  after  starting  the  vitamin  B-12  and
folate, her stuttering and “spells”  had  completely  resolved.   On  mental
status exam (MSE), her mood was euthymic.  The CI’s symptoms  were  felt  to
be ego-syntonic, meaning that she did not appear to be disturbed at  all  by
her symptoms.  Affect was restricted and  her  insight  was  poor.   Thought
processes were linear,  logical  and  goal-directed.   Thought  content  was
devoid of delusions, hallucinations, or  suicidal  ideation.   Judgment  was
intact.  Impulse control  was  unimpaired.    On  mini  mental  status  exam
(MMSE) she scored a perfect 30  out  of  30,  with  excellent  abstractions.
When walking, she used a cane and dragged her left foot.  The examiner  felt
that the CI was unable to  perform  in  stressful  or  physically  demanding
environments.  However, she should be able to work full-time at  a  civilian
job with low stress  and  moderate  structure.   The  Global  Assessment  of
F.unctioning (GAF) score was 65. In a written  statement  dated  21  January
2005, her commander reported that her duty performance was superior for  all
assigned tasks, within her physical limitations.  At a MH evaluation  on  22
March 2005, just three days prior to separation, the MSE was normal and  the
GAF score was 67.  Diagnosis was adjustment disorder,  rule  out  conversion
disorder.  A six-month follow-up was  recommended.   At  her  June  2005  VA
Compensation and Pension (C&P) exam,  14  weeks  after  separation,  the  CI
reported left leg weakness.  She was wearing an  ankle  brace.   She  denied
being anxious or depressed,  and  she  had  no  difficulty  controlling  her
temper.  She worked around the house, was still married,  had  friends,  and
was  taking  college  courses  online.   She  was  not  on  any  psychiatric
medications or receiving any treatment.   Her  MSE  was  normal.   Judgment,
insight and intellectual capacity were adequate.

The Board carefully reviewed all  evidentiary  information  available.   The
Board debated the applicability of the VA Schedule for  Rating  Disabilities
(VASRD) §4.129 in this case.  The CI’s psychiatric symptoms did  not  result
from a highly stressful event, and clearly did not meet the implicit  intent
of VASRD §4.129.  The Board unanimously agreed that  VASRD  §4.129  did  not
apply in this case.  The Board then directed its  attention  to  its  rating
recommendations, based on the evidence.  As noted above, the Army PEB  rated
the CI’s mental condition at  10%.   In  December  2004,  the  examiner  had
opined that the CI should be able to work full-time at a civilian  job  with
low stress and moderate structure.  Six weeks later,  her  commander  stated
that duty performance was  superior  for  all  assigned  tasks,  within  her
physical limitations.  At separation, her MSE was normal and her  GAF  score
was 67.  Then, 14 weeks later, she was seen again for a MH evaluation.   She
denied being anxious or depressed, and she  had  no  difficulty  controlling
her temper.  She worked around the house, was married, had friends, and  was
taking  college  courses.   At  that  point,  she  was  not  requiring   any
psychiatric medications  or  treatment.   Her  MSE  was  normal.   Judgment,
insight and intellectual capacity were all felt to be adequate.   After  due
deliberation, all Board members agreed that based on the evidence,  10%  was
an appropriate rating recommendation.  The Board determined  that  the  CI’s
symptoms would decrease her efficiency and ability to perform certain  tasks
only during periods of significant stress.  Considering  all  the  evidence,
and  mindful  of  VASRD  §4.3  (Reasonable  doubt),  the  Board  unanimously
recommends a permanent rating of 10% for the mental  condition.   IAW  VASRD
§4.130, it is appropriately coded 9424 and meets  the  criteria  for  a  10%
rating.

Weakness of Left Lower Extremity (LLE).  As noted above,  the  LLE  weakness
started after the pseudoseizure  incident.   Electromyography  (EMG),  nerve
conduction velocity (NCV) and MRI  were  all  normal.   In  September  2004,
physical therapy (PT) reported that the LLE weakness was  characteristic  of
psychogenic  weakness  due  to  inconsistencies  during  testing.   A   full
neurology evaluation was done in November 2004.  Ankle  dorsiflexion  was  0
out of 5, but this was due to lack of effort.  When walking, the CI  dragged
her left foot but since she did not try to lift  it,  this  was  not  “true”
foot drop.  The neurologist found no evidence of neurological  disease,  and
agreed that the symptoms were psychogenic.  At her PT  evaluation  in  March
2005, just prior to separation, the CI reported persistent LLE weakness  and
difficulty ambulating.  She used a cane,  but  still  had  trouble  walking.
However, if she slowed down and concentrated, she was able to lift her  foot
off the floor.  On LLE strength testing it was noted that her  hip  flexion,
leg extension and leg flexion were all four out of five.  The CI  was  given
an ankle brace and although there was no observable improvement of gait,  it
made the CI feel better.  At her VA neurology evaluation in June  2005,  the
examiner affirmed that the LLE symptoms were  non-organic  in  nature.   The
Board examined all the evidence.  It was clear that  the  LLE  weakness  was
part of her mental condition symptom complex, and not  due  to  neurological
disease.  After deliberation, the Board determined that due  to  overlap  of
symptoms, the LLE weakness is subsumed by the conversion disorder  diagnosis
and  does  not  represent  a  separately   unfitting,   separately   ratable
condition.

Other PEB  Conditions.   Eustachian  tube  dysfunction,  endometriosis,  and
hypoglycemia were all adjudicated by the PEB as “not  unfitting.”   None  of
these conditions were profiled, implicated in the commander’s statement,  or
noted as failing retention standards.   All  were  reviewed  by  the  action
officer and considered by the Board.   There  was  no  indication  from  the
record  that  any  of  these  conditions   significantly   interfered   with
satisfactory  performance  of  required  military  duties.    All   evidence
considered, there is not reasonable  doubt  in  the  CI’s  favor  supporting
reversal of the PEB fitness adjudication for any of the stated conditions.

Remaining Conditions.  Upper  extremity  weakness,  cervical  spine  strain,
lumbosacral strain, left visual field defect, hysterectomy, bronchitis,  car
sickness, chest pain, and several other conditions were also  noted  in  the
DES file.  These conditions were all reviewed  by  the  action  officer  and
considered by the Board.  It was determined that none  could  be  argued  as
separately  unfitting  and  subject  to  separation  rating.   Additionally,
certain other conditions were noted in the VA Rating Decision but  were  not
documented in the DES file.  The  Board  does  not  have  the  authority  to
render fitness or rating recommendations for any conditions  not  considered
by the DES.  The Board, therefore, has no reasonable basis for  recommending
any additional unfitting conditions for separation rating.


BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military  Department
regulations or guidelines relied upon by the PEB will not be  considered  by
the Board to the extent they were inconsistent with the VASRD in  effect  at
the time of the adjudication.  The Board did not surmise from the record  or
PEB ruling in this  case  that  any  prerogatives  outside  the  VASRD  were
exercised.  In the matter of the conversion disorder, the Board  unanimously
recommends no change in the PEB adjudication.  In  the  matter  of  the  LLE
weakness, Eustachian tube dysfunction,  endometriosis,  hypoglycemia,  upper
extremity   weakness,   cervical   spine   strain,    lumbosacral    strain,
hysterectomy, left visual field  defect,  bronchitis,  car  sickness,  chest
pain  or  any  other  conditions  eligible  for  consideration;  the   Board
unanimously agrees that it  cannot  recommend  any  findings  of  unfit  for
additional rating at separation.


RECOMMENDATION:  The Board, therefore, recommends that there be no
recharacterization of the CI’s disability and separation determination, as
follows:

|UNFITTING CONDITION                               |VASRD CODE  |RATING  |
|Conversion Disorder                               |9424        |10%     |
|COMBINED    |10%     |


____________________________________________________________________________
__

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20101213, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans' Affairs Treatment Record





President
                                                      Physical    Disability
Board of Review


SFMR-RB


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB /), 2900 Crystal Drive, Suite 300, Arlington, VA  22202

SUBJECT:  Department of Defense Physical Disability Board of Review
Recommendation for


I have reviewed the enclosed Department of Defense Physical Disability
Board of Review (DoD PDBR) recommendation and record of proceedings
pertaining to the subject individual.  Under the authority of Title 10,
United States Code, section 1554a,   I accept the Board’s recommendation
and hereby deny the individual’s application.
This decision is final.  The individual concerned, counsel (if any), and
any Members of Congress who have shown interest in this application have
been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:




Encl
                                       Deputy Assistant Secretary
                                           (Army Review Boards)

CF:
(  ) DoD PDBR
(  ) DVA