Search Decisions

Decision Text

AF | PDBR | CY2012 | PD2012 01074
Original file (PD2012 01074.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD1201074
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20130423
SEPARATION DATE: 20020820


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty A1C/E-3 (1C032/Operations Resource Management Apprentice) medically separated for schizophrenia. The CI was first documented with anxiety in August 2000, shortly after she arrived at her first duty station after initial training. In May of 2002, she was voluntarily hospitalized for 15 days for her psychiatric condition. A Medical Evaluation Board (MEB) was initiated while she was still in the hospital; she was discharged and continued outpatient treatment while awaiting the outcome of her MEB. The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty. The schizophrenia condition, characterized as schizophrenia, paranoid type with axis ii personality disorder, was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AFI 48-123. No other conditions were submitted by the MEB. The PEB adjudicated schizophrenia, paranoia type as unfitting. Personality disorder not otherwise specified, with paranoid traits was determined to have existed prior to service and determined to be a Category III condition (Air Force Category III ratings are for conditions that are not separately unfit, compensable or ratable). The schizophrenia condition was rated at 30% with 20% subtracted for the contributory/aggravating factors resulting in a final rating of 10% utilizing both DoD instructions and the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION : “ ACCORDING TO THE PHYSICAL DISABILITY BOARD OF REVIEW, I WASN'T GIVEN PROPER RATING BEFORE DISCHARGED FROM THE AIRFORCE AND FOR THIS REASON, I AM NOW ELIGIBLE TO RECIEVE RETROACTIVE PAY FROM THE WOUNDED WARRIOR'S ACT IN ADDITION TO THE 100% DISABILITY COMPENSATION THAT I ALREADY RECEIVE. ” [ sic ]


SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting schizophrenia condition is addressed below, and no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 Board for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20020620
 VA - (One Year Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Schizophrenia, Paranoid Type 9203 10% Schizophrenia, Paranoid Type 9299-9203 50%* 20030103
No Additional MEB/PEB Entries
 Other x 1 20031007
Combined: 10%
 Combined: 60%
* Derived from VA Rating Decision (VA RD ) dated 200 30820 ( not the original VARD but effective date of 20030313 which is within the one year of separation). Original VARD dated 20030313 rated the Sch izo phrenia at 30% effective 20020821.
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.

Schizophrenia, Paranoid Type Condition. The CI was initially seen in mental health in January 2001; she reported difficulty getting along with other people at work and in her dormitory. The CI felt that people were talking about her. She was referred for psychological testing; however, the testing results were not in evidence. A hospital discharge summary sheet, dated 21 June 2001, was in the service treatment record (STR). The summary sheet listed the initial assessment/diagnosis as schizophreniform disorder and paranoid personality traits. The course and progress of the CI was “pleasant, attended & participated in all groups. Completed psych testing.” The summary indicated that the CI was on “no” medications at the time of discharge. The STR indicated that the CI was followed by mental health and initially diagnosed with an anxiety disorder, not otherwise specified (NOS). She was given several “rule out” diagnoses (delusional disorder, posttraumatic stress disorder, and paranoid personality disorder/traits) at the start of her treatment. The CI was followed by an outpatient psychiatrist who documented “hx of paranoid personality”on a progress note dated 07 May 2002. The CI was hospitalized following this visit which recommended that the CI be evaluated by a psychologist and considered for “repeat MEB.” (It was noted that the provider’s progress notes that followed indicated no diagnosis on Axis II.) The CI was hospitalized on 16 May 2002 and the MEB was initiated during the admission. The MEB narrative summary (NARSUM) and discharge summary, dated 28 May 2002 noted that the chief complaint on admission was “I have listening device implanted by military in my mouth, have camera in my room and people are following me.” The NARSUM summarized the course of the CI’s condition, her presentation on admission, and her hospital course. The CI reported that when she first had symptoms, she was seen by her primary care doctor, but that her symptoms had progressively worsened. She said she underwent psychological testing in June 2001 and was told that she “possibly had a personality disorder, paranoid type” but she was diagnosed with an adjustment disorder at that time. She was then followed in outpatient mental health until this admission. The NARSUM reported that the CI continued to have “bizarre delusions” and “strange and hyper-religious beliefs” on admission. She thought that the transmitter in her teeth was “broadcasting” her thoughts to others on a “website.” The CI denied command hallucinations and she denied suicidal ideation or homicidal ideation. The CI also complained of frequent headaches, chest pains, and shortness of breath. She denied any history of mania and denied having panic attacks. The CI reported having no friends and feeling like her relationship with her family had become “strained” due to the website and the CI’s “beliefs.” During this hospital admission, the CI was started on Zyprexa (antipsychotic medication) and it was gradually increased. The CI was also evaluated by neurology to rule out the possibility of any seizure disorder. She had a head CT scan and sleep deprived electroencephalogram performed; both were normal. The CI responded to her treatment and was discharged to outpatient services, pending MEB/PEB. The final diagnosis given on Axis I was “schizophrenia, paranoid type, with psychotic features manifested by impaired reality testing i.e. paranoid delusions, ideas of reference, bizarre thoughts and behaviors, themes of persecution, some auditory hallucinations, causing psychosocial and occupational impairment.” The social and industrial impairment was “considerable” and the military impairment “marked.” The NARSUM listed “personality disorder, nos, with paranoid personality traits” as an Axis II diagnosis. The social and industrial impairment related to the Axis II diagnosis was “mild” and military impairment “minimal.” The examiner noted “this individual is highly vulnerable to recurrent psychotic episodes, which can cause sudden incapacitation…” The Board noted that the final two mental health visits in evidence while on active duty diagnosed the CI with schizophrenia, paranoid type, without an Axis II diagnosis. The VA rating decision summarized the VA Compensation and Pension examination performed on 3 January 2003, less than 4 months after separation. The CI was living with her sister, at that time, and her sister was helping the CI “pay her insurance.” The CI reported that she worked as a security guard for about 2 weeks, following her separation from the military. She then moved from Texas to Georgia and was living with a friend. The CI reported that she was working at Pizza Hut, but she was not taking her medication and she expressed feeling “fearful” about going to work. She reported that the pressure from work made her weak. She was also having difficulty sleeping. The CI reported the continued belief that a listening device was implanted in her by the military dentist. She said that the device made her aware that people were talking about her. She also reported hearing voices the week before. The CI also reported that she had been attending church. The CI was noted to have “some rambling or loose associations.” Her diagnosis was schizophrenia, paranoid type, but without an Axis II diagnosis.

The Board directs attention to its rating recommendation based on the above evidence. The PEB coded the schizophrenia, paranoid type condition 9203 and assigned a 30% disability rating but then subtracted 20% citing “less contributory/aggravating factors” for a total of 10%. The VA also coded the condition 9203 and assigned a 30% disability rating. The VA increased the rating, initially 50% and then 70%, effective 12 March 2003 due to a decline in the CI’s condition that was noted in VA treatment records. The rating was increased to 100% effective
20 September 2006 at a later review. The Board determined that this case did not meet the requirements for application of a retroactive TDRL rating IAW VASRD §4.129. The psychiatric condition was not adjudged to be a result of a “highly stressful event” (as per §4.129). The Board considered next the PEB’s deduction of 20% due to aggravating factors. The Board members agreed that the record did not show disability from a mental condition at accession and, therefore, that the rating should solely reflect the disability from the unfitting schizophrenia condition. Review of the evidence showed that the CI was seen one time 4 months after accession for dehydration and noted anxiety, but there is no record of another visit for a mental health condition until January 2001, 9 months after accession. The Board did note that the CI was disqualified from personnel reliability program status shortly after accession, but found no mental health explanation for this determination in the records in evidence. On her accession history and physical, she was issued a S1 profile. Her psychiatric examination, item 42 on the SF 88, was noted as normal and no mental health history was documented on the SF 93. The action officer opined that the early diagnosis of a personality disorder could well have been an indication of early manifestations of the unfitting schizophrenic condition. The Board agreed that the schizophrenia condition, at the time of separation, indeed met the rating criteria for a 30% disability rating, as decided by both the PEB and VA. The Board members agreed that there was a paucity of evidence to substantiate a diagnosis of a personality disorder. The Board agreed that the rating should solely reflect the disability from the unfitting schizophrenia condition. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the schizophrenia, paranoid type condition.


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. As discussed above, probable PEB reliance on DoDI 1332.39 for rating schizophrenia condition was operant in this case and the condition was adjudicated independently of that instruction by the Board. In the matter of the schizophrenia, paranoid type condition, the Board unanimously recommends a disability rating of 30%, coded 9203 IAW VASRD §4.130. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

UNFITTING CONDITION VASRD CODE RATING
Schizophrenia, Paranoid Type Condition 9203 30%
COMBINED 30%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120619, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





         XXXXXXXXXXXXXXXXXXXX, DAF
         Director of Operations
         Physical Disability Board of Review

 SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews MD 20762

Dear XXXXXXXXXXXXXXXXXXXX :
         Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2012-01074.
         After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Administration Schedule for Rating Disabilities. Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.
         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly. The office responsible for making the correction will inform you when your records have been changed.
         As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP). Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election. If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

                                                               Sincerely,



XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

cc:
SAF/MRBR
DFAS-IN

Similar Decisions

  • AF | PDBR | CY2012 | PD2012 01973

    Original file (PD2012 01973.rtf) Auto-classification: Denied

    The FPEB’s DA Form 199 cited “symptoms are controlled by continuous medication” as a 10% criterion of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD); and “rated as mild social and industrial impairment” referencing AR 635-40 (derived in turn from Department of Defense Instruction [DoDI] 1332.39).The GERD condition was determined to be not unfitting by the IPEB, but not specifically adjudicated by the FPEB (assumed to be an erroneous omission and a de facto adjudication as not...

  • AF | PDBR | CY2013 | PD-2013-01338

    Original file (PD-2013-01338.rtf) Auto-classification: Denied

    On admission the CI reported worsening depression and anxiety symptoms, auditory hallucinations of people calling her name and anger episodes involving hurting herself, though she denied SI or homicidal ideation (HI). 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...

  • AF | PDBR | CY2012 | PD2012-00579

    Original file (PD2012-00579.pdf) Auto-classification: Denied

    At the MEB examination on 24 June 2003, 10 months prior to separation, the examiner noted a history of psychotic disorder without further elaboration. The PEB coded the condition 9210 for a non specified psychotic disorder and rated it at 10% for mild impairment treated with medication. The Board noted that the CI was responding well to medications at the time of discharge from the hospital, 9 months prior to separation.

  • AF | PDBR | CY2012 | PD2012 01496

    Original file (PD2012 01496.rtf) Auto-classification: Denied

    Although she continued to endorse symptoms of PTSD, her GAF was 60 which correlated with moderate symptoms or moderate difficulty in social, occupational, or school functioning.The documents did not cite evidence which would confirm that either reliability or productivity on the job was suffering because of psychiatric symptoms, and both speculation and liberal reliance on reasonable doubt would be required to draw that conclusion.Her level of disability at that time was most consistent with...

  • AF | PDBR | CY2012 | PD2012 01782

    Original file (PD2012 01782.rtf) Auto-classification: Denied

    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 Board for Correction of Military Records. The diagnosis was the same as at the MEB exam with the C&P examiner noting “GAF of 45- “indicating major symptoms of depression along with evidence of impairment of reality with visual hallucinations and problems with sleep and concentration, which would interfere with her ability...

  • AF | PDBR | CY2011 | pd2011-00255

    Original file (pd2011-00255.doc) Auto-classification: Denied

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: BRANCH OF SERVICE: NAVY CASE NUMBER: PD1100255 SEPARATION DATE: 20030321 BOARD DATE: 20120130 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty FC3/E-4 (1119, Aegis Radar System Technician), medically separated for major depression, recurrent with psychotic features. As discussed above, any impairment due to this condition was considered in...

  • AF | PDBR | CY2014 | PD-2014-03325

    Original file (PD-2014-03325.rtf) Auto-classification: Denied

    The MEB forwarded the following Axis I conditions to the Physical Evaluation Board (PEB) IAW AFI 48-123 and 44-113:“maj depressive disorder/recurrent/moderate; anxiety disorder NOS; alcohol dep.” The MEB also forwarded “borderline personality traits” as an Axis II condition.No other conditions were submitted by the MEB.The PEB adjudicated the referred Axis I conditions, less the alcohol dependence condition, as a single unfitting condition (for rating purposes), “major depressive disorder...

  • AF | PDBR | CY2009 | PD2009-00210

    Original file (PD2009-00210.docx) Auto-classification: Denied

    The CI was thus medically separated with a combined disability rating of 10%. The NARSUM did not formally identify any other medical conditions at separation. In the matters of the chronic adjustment disorder/borderline personality disorder and the hearing loss conditions, the Board unanimously recommends no recharacterization of the PEB adjudications as not unfitting.

  • AF | PDBR | CY2010 | PD2010-00529

    Original file (PD2010-00529.docx) Auto-classification: Approved

    In the seven months since the previous C&P exam, the CI had been hospitalized once for command hallucinations and suicidal ideation. Subsequent VA records indicate the CI was hospitalized at least four more times in 2006-2008 with hallucinations and suicidal ideation, with GAFs ranging from 20 to 58. The Board determined, therefore, that none of the stated conditions were subject to Service disability rating.

  • AF | PDBR | CY2013 | PD-2013-01950

    Original file (PD-2013-01950.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. He indicated he had been hospitalized for suicidal ideations and gestures to include a deliberate overdose. The plan was for the CI to follow his self-care plan, be released to his First Sergeant, be separated that...