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AF | PDBR | CY2012 | PD2012 01192

Original file (PD2012 01192.rtf) Auto-classification: Approved

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX CASE: PD1201192
BRANCH OF SERVICE: Army BOARD DATE: 20131115

SEPARATION DATE: 20020627

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (71L/Administrative Specialist) medically separated for a major depression with psychotic features. While on leave in March 2002 the CI was hospitalized at the Veterans Administration Hospital. She was diagnosed with psychosis not otherwise specified (NOS) and medicated with psychotropic drugs. Upon arrival at her new duty station she was immediately referred to the mental health (MH) clinic. The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty. She was issued a permanent S3 profile and referred for a Medical Evaluation Board (MEB). The MH condition, characterized as “major depression with psychotic features” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also submitted AXIS II condition, dependent personality trait and Axis III condition, condyloma. The PEB adjudicated “major depression with psychotic features” as unfitting, rated 10%, citing criteria of AR 635-40, and stated that the Axis II and Axis III conditions were not unfitting. The CI made no appeals and was medically separated.

CI CONTENTION: “I am not able to hold a job due to my condition. I have been trying to work steady for 10 yrs now and I can’t.” A second application dated 08/10/2013 stated “I am sick to the point where I can’t sleep, my mind race, I’m hearing voices and seeing ghost and I can no longer work.”

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 MH 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. The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate 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, operating under a different set of laws.

RATING COMPARISON :

Service IPEB – Dated 20020521	VA - (28 Mos. Post-Separation)
Condition	Code	Rating	Condition	Code	Rating	Exam
Major Depression w/Psychotic Features	9434	10%	Psychotic Disorder NOS Claimed as Depression w/Psychosis	9210	10%	20041108
Axis II: Dependent Personality Trait	Not unfitting	Other x 0	20041108
Axis III: Condyloma	Not unfitting
No Additional MEB/PEB Entries
Combined: 10%	Combined: 10%

Derived from VA Rating Decision (VA RD ) dated 20041217 ( most proximate to date of separation [ DOS ] ).

ANALYSIS SUMMARY:

Major Depression with Psychotic Features. The narrative summary (NARSUM) was written while the patient was an inpatient at Fort Benning, GA (source in-patient records were sought, but not available). She had recently arrived in CONUS after having completed a tour in Korea. During that tour, she had encountered several stressors including a pregnancy and a subsequent abortion which she later regretted. Her mother later reported that when she returned from Korea, the CI appeared depressed, tearful and had trouble sleeping. While on leave visiting family in Miami in March 2002, her behavior deteriorated to the point where she was talking incoherently and behaving strangely. She was admitted to the VA hospital in Miami where she remained for 6 days. She was diagnosed with psychosis NOS and started on Olanzapine. Following discharge, she returned to Ft. Benning where she stated that she was not sure she would not harm herself and was subsequently re-hospitalized there. Mental status at the time of the MEB exam on 19 April 2002 revealed that the CI was alert, oriented to all spheres and cooperative. Affect was reactive and congruent to mood. Psychomotor activity was normal. There was no evidence of psychosis or suicidal ideation (SI). During her hospitalization at Ft. Benning, the CI was reported to have been cooperative and to have maintained appropriate behavioral control although she had difficulty accepting that she could not be very quickly reunited with her family. At discharge, she was taking the antipsychotic medication prescribed during her initial hospitalization in Miami (Olanzapine) as well as an antidepressant prescribed during her hospitalization at Ft. Benning (Venlafaxine). Diagnosis was Axis I: major depression with psychotic features. No Global Assessment of Functioning (GAF) was recorded but impairment for military duty was considered to be “marked,” and impairment for social and industrial adaptability was considered “definite.” The commander’s statement indicated “fragile mental condition … was obvious that she would have to be monitored day and night while with her unit.”

At the VA Compensation and Pension (C&P) exam performed in November 2004 the CI reported that in the interval since her discharge from the Army, she had been living with her mother and attending college as a full-time student. She reported that 24 months after separation, she had been hospitalized again because of bizarre behavior, difficulty sleeping and because she was isolating herself. She was started on a different antipsychotic medication at that time but she had not been taking any medication for the 2 months prior to the C&P exam. She reported occasional difficulty controlling her thoughts, but denied problems with sleep, appetite, concentration, socializing or academic pursuits. Mental status exam revealed no evidence of a current thought, mood or cognitive disorder. Judgment was considered to be good and insight was judged to be fair. Diagnosis was Axis I: psychotic disorder not otherwise specified, and GAF was 75 (“…no more than slight impairment in social, occupational, or school functioning”). VA treatment notes indicated symptom worsening in 2005 with a GAF decreasing to 55.

The MEB listed Axis II dependent personality traits with the Axis I condition, and the PEB specified the Axis II condition was “not unfitting, not rated.” Dependent personality traits is not a compensable condition IAW DoDI 1332.38, E5; however, any MH overlap is considered in rating the Axis I disorder.

The Board directs attention to its rating recommendation based on the above evidence. The PEB, while citing the CI’s recent hospitalizations and the fact that she had required antipsychotic and antidepressant medication, also noted that the NARSUM had indicated that her condition had improved and that there was no longer any manifestation of acute psychosis or SI. The NARSUM psychiatrist stated the “degree of psychiatric impairment for social and industrial adaptability: Definite” (30% rating language from AR 635-40 B–107 or DoDI 1332.39). The PEB characterized the condition as major depression with psychotic features with “mild” social and industrial impairment. The PEB coded the condition 9434 and awarded a disability rating of 10% citing AR 635-40 B–107.

The VA’s evaluation and rating decision took place more than 2 years after separation and was therefore quite remote. Nevertheless, it characterized the condition as psychotic disorder NOS, coded at 9210 and rated it similarly at 10%. The Board considered the fact that the CI’s condition, while serious enough to require two hospitalizations, was reported in the NARSUM as having improved to the point where there was no longer any evidence of acute psychosis or SI. At that point, social and occupational functioning was limited primarily by her need to continue to take medication and to be followed as an outpatient in order to prevent future recurrences. There was no indication of prolonged stability. The Board considered that at the time of separation, given her recent hospitalization for psychotic symptoms and the fact that the NARSUM writer had indicated a level of functioning most closely aligned with a VASRD §4.130 rating of 30%, that a 30% rating could be reasonably justifiably IAW §4.3 and §4.7. Members then discussed whether VASRD §4.129 applied in this case and determined that the applicant’s abortion and subsequent return home to her family in Miami could have represented a sufficiently significant stressor for the CI that ultimately resulted in the unfitting condition and separation from service. Application of §4.129 warrants placement on constructive Temporary Disability Retired List (TDRL) for a 6-month period with a disability rating of 50% with subsequent reevaluation at the end of that time for determination of permanent disability. Although there is scant evaluation data from 6 months after separation, the exam most proximal to the 6-month period in the available record is the NARSUM. Since that exam had warranted a 30% rating as mentioned above, members concluded that a permanent 30% rating was appropriate and appeared to fit the episodic dysfunction inherent in the disorder as described by the VA examiner almost 2 years later, following her second hospitalization. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that the available evidence supported application of §4.129 requiring a period of 6 months of constructive TDRL at a 50% disability rating followed by permanent retirement with a 30% disability 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. As discussed above, PEB reliance on AR 635-40 for rating the MH condition was operant in this case and the condition was adjudicated independently of that instruction by the Board. In the matter of the major depression with psychotic features condition and IAW VASRD §4.130, the Board unanimously recommends application of §4.129 with a 6-month period of constructive TDRL starting from the date of separation at 50% disability rating followed by permanent retirement with a 30% disability rating. 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 to reflect a 6-month period on TDRL with a disability rating of 50% (IAW §4.129), and then permanent retirement with a disability rating of 30%:

UNFITTING CONDITION	VASRD CODE	RATING
		TDRL	PERMANENT
Major Depression with Psychotic Features Condition	9434	50%	30%
COMBINED	50%	30%

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120621 and 20130810, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review

SFMR-RB

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXX, AR20140005187 (PD201201192)

1. Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to constructively place the individual on the Temporary Disability Retired List (TDRL) at
50% disability for six months effective the date of the individual’s original medical separation for disability with severance pay and then following this six month period recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30%.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

         a. Providing a correction to the individual’s separation document showing that the individual was separated by reason of temporary disability effective the date of the original medical separation for disability with severance pay.

         b. Providing orders showing that the individual was retired with permanent disability effective the day following the six month TDRL period.

         c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will account for recoupment of severance pay, provide 50% retired pay for the constructive temporary disability retired six month period effective the date of the individual’s original medical separation and then payment of permanent disability retired pay at 30% effective the day following the constructive six month TDRL period.

         d. Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Encl                                                  XXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

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AF | PDBR | CY2012 | PD2012 01192

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