RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200898 SEPARATION DATE: 20021018 

BOARD DATE: 20130326 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty Soldier, SPC/E-4(77F, Fuel Handler), medically 
separated for conversion disorder with mixed presentation complicated by hypochondriasis. 
The CI presented with multiple physical complaints with no clear physical etiology after 
evaluation. The CI could not meet the physical requirements of his Military Occupational 
Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent S3/L3 profile 
and referred for a Medical Evaluation Board (MEB). The MEB submitted two Axis I conditions as 
medically unacceptable IAW AR 40-501: conversion disorder w/mixed presentation and 
hypochondriasis w/poor insight. An Axis II condition, histrionic personality disorder, was 
forwarded as medically acceptable. The Physical Evaluation Board (PEB) adjudicated the 
conversion disorder with mixed presentation complicated by hypochondriasis as unfitting and 
rated it 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). 
The PEB adjudicated the Axis II condition as not unfitting. The CI made no appeals and was 
medically separated with a 10% disability rating. 

 

 

CI CONTENTION: The CI states: “Several medical surgeries and one that left me unable to have 
kids. See VA file and CID reports from platoon incidents of trying to have me killed in 3rd 
Infantry Div. PTSD, bylateral nerve damage & etc. I was supposedly given a surgery that I had 
to fix a varicose dill. The first was a 121 Med Eval Korea. It went fine. The second was at Fort 
Benning GA. and now I can’t have kids. Also PTSD from Platoon Expin 3rd ID Also severe 
depression and bipolar disorder Bilateral partial nerve damage due to incident and a PA put on 
a bulky Jones which made (can’t read word) worse and much more. I was told I was getting a 
varcoccill surgery to stop leaking around my groin. Come to find out that dumb ass Dr. did a 
vasectomy asshole. Now my wife is begging for a child and I can’t give her one. I really got 
jacked all the way around.” [sic] 

 

 

SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44 Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings 
for unfitting conditions will be reviewed in all cases. Any conditions or contention not 
requested in this application, or otherwise outside the Board’s defined scope of review, remain 
eligible for future consideration by the Army Board for Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service PEB – Dated 20020927 

VA (6 Mos. Post-Separation) – All Effective Date 20021019 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Conversion Disorder… 

9425-9424 

10% 

Conversion Disorder and 

9425-9424 

30%* 

STRs 

Histrionic Personality… 

Not Unfitting 

Histrionic Personality…** 

9499-9435 

NSC 

STRs 

.No Additional MEB/PEB Entries. 

0% X 2 / Not Service-Connected x 9 

20030422 

Combined: 10% 

Combined: 30%* 



*The 20040316 VARD increased condition to 100% based on VA hospital admittance in January 2004, retroactive to separation. 


ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit 
and vital fighting force. While the DES considers all of the member's medical conditions, 
compensation can only be offered for those medical conditions that cut short a member’s 
career, and then only to the degree of severity present at the time of final disposition. The DES 
has neither the role nor the authority to compensate members for anticipated future severity 
or potential complications of conditions resulting in medical separation nor for conditions 
determined to be service-connected by the Department of Veteran Affairs (DVA) but not 
determined to be unfitting by the PEB. However the DVA, operating under a different set of 
laws (Title 38, United States Code), is empowered to compensate all service-connected 
conditions and to periodically re-evaluate said conditions for the purpose of adjusting the 
Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is 
confined to the review of medical records and all evidence at hand to assess the fairness of PEB 
rating determinations, compared to VASRD standards, based on severity at the time of 
separation. 

 

Conversion Disorder with Mixed Presentation Complicated by Hypochondriasis. The CI had two 
enlistments in the US Army: 14 August 1991 to 10 March 1994 and the last on 27 August 1999 
to 18 October 2002. On his first enlistment, the CI received formal treatment for alcohol abuse 
and had non-judicial punishment for alcohol offenses twice. He was involved in three recorded 
altercations (fights). Per the mental health narrative summary (NARSUM), he apparently 
worked as a restaurant manager following discharge until his re-enlistment in 1999. It was 
noted that on a history form, completed by the CI on 3 August 2000 for Special Forces training, 
he failed to disclose multiple medical conditions that were documented in the service 
treatment records (STRs). The Board noted that the CI failed to show for his VA evaluation and 
that the VA rating decision (VARD) was based on his STRs. Some time that same year, 2000, he 
presented with a year history of lower extremity pain. The neurological evaluation noted 
ongoing tobacco and alcohol abuse. He was thought to have a possible peripheral neuropathy. 
However, electrodiagnostic studies were negative for either a neuropathy or myopathy of the 
lower extremities. Magnetic resonance imaging (MRI) of the spine was also noted as normal, 
but this report is not in evidence. He also complained of blue feet after exercise and was 
thought to possibly have Buergers Disease, thromboangiitis obliterans, a vascular disease 
strongly associated with tobacco abuse. He continued to use tobacco despite consideration of 
this diagnosis and recommendations that he stop. On 1 February 2001, he was issued a L3 
profile for Buergers Disease. An arterial duplex scan was normal. A rheumatologic examination 
on 26 June 2001 excluded the diagnosis of Buergers Disease. The Board found no further 
clinical entries for either condition after this appointment until a 2002 MEB evaluation. The 
rheumatologist did note that the CI had been successful in reducing his tobacco abuse. 
However, it was determined that he did not meet retention standards for his MOS and he was 
referred to a MOS Medical Retention Board (MMRB) for Buergers Disease. The commander 
noted in his letter dated 24 July 2001 had the CI had “stellar” duty performance both in 
Garrison and in the field, but that he could not deploy due to his condition. Incidentally, in 
August of 2001, the CI presented with a left varicocele which was treated with laparoscopic 
varicocelectomy in October 2001. Subsequently, he complained of incomplete voiding and 
erectile dysfunction (ED). On 10 October 2001, the MMRB deferred the decision due to 
comment by the rheumatologist that Buergers Disease was not likely. Despite this, the MMRB 
determined on 9 January 2002 that he could not meet worldwide requirements due to Buergers 
Disease and recommended an MEB. On 5 June 2002, the CI was again seen in the neurology 
clinic. The CI stated that in October 2000, he developed pain, cramping, and discoloration of 
the lower extremities after running or prolonged standing. Muscle and nerve biopsies in 
November 2001 were normal. Repeat electrodiagnostic studies of the lower extremities in 
April 2002 were also normal. A CT of the head and MRIs of the cervical and lumbar spine were 
normal. He had quite tobacco and was taking Neurontin for pain. On examination he was 
noted to have significant tremors of the R>L upper extremities which had not been present 
when the CI was observed in the waiting room. His strength was 5/5 (normal), but with poor 


effort and give-away weakness (a sign of non-organic weakness). Tone and bulk of the muscles 
were normal. He could not voluntarily dorsiflex his ankles, but could walk on his toes. 
Sensation was diminished over the left foot and lower extremity. He had a resting, postural and 
kinetic tremor of the R>L upper extremity which abated with distraction. The CI was thought to 
meet retention standards from a neurological standpoint and that he most likely had a 
somatoform disorder. Psychiatric referral was recommended. The NARSUM was dictated on 
18 July 2002 and based on an examination dated 24 June 2002 and review of the available 
medical records. The CI complained of constant worrying about possible medical illness. The CI 
complained of “complete numbness” of his left leg, tremor of his right arm, and hair loss with a 
bald spot on his scalp. The CI reported that his legs had not been working for 2 years and that 
he was misdiagnosed several times. The NARSUM noted that the onset of the CI’s complaints 
coincided with his separation from his wife; however, the CI blamed the breakup of his 
marriage on ED that he felt was secondary to a surgical repair of a hydrocele. The CI 
complained of constant worry and chronic insomnia with difficulty falling asleep due to his 
worry about his physical issues. He denied episodes of panic or anxiety attacks. He reported a 
decreased appetite. He denied depressed mood and feelings of worthlessness, but reported 
feelings of humiliation and low self-worth due to his separation from his spouse. He strongly 
expressed a desire to receive compensation for service-connected disability. He denied any 
perceptual changes or symptoms of psychosis. He had significant interpersonal relational 
problems and had not spoken with his family for 2 years following a physical fight with one of 
his brothers. At the examination, 24 June 2002 the CI presented on time and he walked 
independently, but slowly. He displayed a “dramatic” limp of his left lower extremity and 
tremor of the right upper extremity. The examiner noted the tremor fluctuated in amplitude 
and frequency under different circumstances. It decreased with distraction and increased 
when he was drawing attention to it. In a follow-up visit, he presented with a similar slow, 
limping gait. After the evaluation, he left the room angrily with no limp or tremor. “As I 
watched him walk down the hall, he began an exaggerated limp, but walked very quickly.” He 
was alert and oriented. He appeared angry. Speech was normal. He was very talkative, but it 
was difficult to engage him on topics other than his perceived disabilities “caused by the Army.” 
“He demonstrated significant thoughts of entitlement.” The examiner reported that the CI’s 
thought processes were logical and linear. There were no thoughts of harming himself or 
others and no delusions or hallucination. Memory and cognition were intact. The CI’s insight 
was said to be poor; however, the examiner reported that the CI had good judgment and the 
capacity to discern right from wrong. He was thought to have a conversion disorder with mixed 
presentation as well as hypochondriasis with poor insight. The predisposition for both was 
moderate. Military impairment for both was marked, but social and industrial adaptability 
impairment mild. He was also noted to have a histrionic personality disorder. The 
Commander’s letter was written on 24 July 2002. It noted that that the CI had been severely 
curtailed in activities due to his profile for the past year. The Board observed that the profile 
had been for Buergers Disease, a diagnosis later discounted. On 30 July 2002, the CI was 
granted an extension of his expected termination of service (ETS), scheduled for 26 August 
2002, to allow completion of his MEB. A permanent S3 profile was issued on 22 July 2002. The 
urology report addendum to the NARSUM was dictated 19 August 2002. It evaluated the CI’s 
complaints of left scrotal pain, voiding issues, and erectile dysfunction. The examiner noted 
“obvious” lower and upper extremity spasms described as uncontrollable and unpredictable. 
The examiner reported that the CI was able to ambulate with some difficulty and displayed 
seeming weakness in upper and lower extremities. There were no abnormal findings noted in 
the actual urological examination. The urologist noted that the CI complained of some 
frequency and incomplete emptying sensation; however, from a functional standpoint, his 
voiding was normal and he emptied to completion. The kidneys were normal on ultrasound 
study. The CI’s ED symptoms were relieved with Viagra. The scrotal pain was unrelated to 
neurological dysfunction and had no defined etiology. The urologist opined that the CI should 
be referred to MEB for his neurological symptoms. The MEB was dated 10 September 2002 and 
determined that the conversion disorder with mixed presentation and hypochondriasis with 


 

 

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 condition and IAW VASRD §4.130, the 
Board unanimously recommends no change in the PEB adjudication. There were no other 
conditions within the Board’s scope of review for consideration. 

 

 

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 with Hypochondriasis Condition 

9425-9424 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120612, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
xxxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130008803 (PD201200898) 

 

 

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 xxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)