RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
NAME:  XXXXXXXXXXXXX                                      BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1200636                               DATE OF PLACEMENT ON TDRL:  19990414 
BOARD DATE:  20130111                                     DATE OF PERMANENT SEPARATION:  20030219 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty SPC/E-4 (02C1O/Musician), medically separated for 
schizoaffective disorder.  The condition first appeared in 1998 when he required hospitalization 
for  suicidal  ideation,  and  he  could  not  be  adequately  rehabilitated  to  meet  the  physical 
requirements of his Military Occupational Specialty.  He was issued a permanent S4 profile and 
referred for a Medical Evaluation Board (MEB).  The MEB forwarded schizoaffective disorder, 
bipolar type, to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501.  
The  MEB  forwarded  no  other  conditions  for  PEB  adjudication.    The  PEB  adjudicated  the 
schizoaffective disorder, bipolar type, condition as unfitting, rated 30%, and placed the CI on 
the  Temporary  Disability  Retired  List  (TDRL).    He  was  continued  on  TDRL  with  an  interim 
reevaluation  in  2000,  and  then  underwent  a  final  evaluation  after  approximately  4  years  on 
TDRL.  At that time the PEB adjudicated schizoaffective disorder as permanently unfitting, rated 
10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI 
made no appeals, and was medically separated with a 10% disability rating. 
 
 
CI CONTENTION:  “Prior to entering the U.S. Army, I was a competent individual with no pre-
existing  mental  illness.    While  in  the  Army,  I  developed  a  mental  disorder  known  as 
Schizoaffective  disorder  w/  a  Bipolar  type  that  rendered  me  unfit  for  duty.    The  Physical 
Evaluation Board recommended a disability rating of 30% as shown in the attached DA Form 
199.  Furthermore, Veteran's Affairs rated me at 30% with a possibility of 55% if my condition 
worsened. 
I  was  overly  surprised  to  find  out  that  the  U.S.  Army  --  despite  the 
recommendations from both the PEB and the VA -- decided to rate me at 10% instead.  A rating 
at 10% doesn't even help me w/ my condition w/ regards to medical and financial help.  My 
entire post-Army career has been a struggle for me every single day I wake up.  I have to fight 
every fiber of my being to hide my mental oddities.  I constantly have to endure the multiple 
anxiety attacks each day.  My bipolar aspect of my disorder has impacted my attempt at putting 
myself  through  school.    I  would  have  failed  if  I  did  not  have  access  to  VA  Mental  Health 
professionals while under the Chapter 32 program.  When my condition is at its worst, I need to 
make certain that nobody is around me, since I have bouts of hallucinations.  Without the VA 
realizing the severity of my disability, I probably would have not received any help from the 
government.  I still do not understand why I was not rated at 30%.  I just don't understand.” 
 
 
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.  The schizoaffective disorder, bipolar type 
condition requested for consideration meets the criteria prescribed in DoDI 6040.44 for Board 
purview, and is accordingly addressed below.  Any condition 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. 
 
 
TDRL RATING COMPARISON: 
 

Service IPEB – Dated 20021219 
Condition 
On TDRL – 19990414 
Schizoaffective Disorder 
No Additional MEB/PEB Entries 
Combined:  10% 

Code 
 
9211 

Rating 
TDRL 
30% 

Sep. 
10% 

VA – All Effective Date 19990415 
Code 
Condition 
Schizoaffective Disorder 
9211* 
0% x 0/Not Service-Connected x 0 
Combined:  30% 

Rating 
30% 

Exam 
20020105 
 

*VA decision 20020128 changed code from 9435 (mood disorder) without changing rating 
 
 
ANALYSIS SUMMARY:  The CI’s opinion that he deserved the same 30% rating at the time of 
permanent  separation  as  he  had  at  the  time  of  placement  on  TDRL  was  considered  in  the 
Board’s deliberations.  The Board takes the position that subjective improvement or worsening 
during the period of TDRL should not influence its coding and rating recommendation at the 
time  of  permanent  separation.    The  Board’s  relevant  recommendations  are  assigned  in 
assessment  of  the  permanent  separation  and  rating  determination,  and  the  TDRL  rating 
assignment  is  not  considered  a  benchmark.    It  is  recognized,  in  fact,  that  PEBs  across  the 
services  sometimes  apply  an  overly  generous  initial  rating  in  order  to  meet  the  DoD 
requirement of 30% disability for placement on TDRL.  This is in the member’s best interest at 
the time and does not mean that a final lower rating is unfair, even if perceived as incongruent 
with  subjective  severity  from  one  rating  to  the  next.    Thus  the  sole  basis  for  the  Board’s 
recommendation is the optimal VASRD rating for disability at the time the CI is permanently 
separated. 
 
Schizoaffective Disorder Condition.  The Board first addressed if the tenants of §4.129 (Mental 
disorders due to traumatic stress) were applicable.  The Board noted that there was no “highly 
stressful event” for which provisions of §4.129 would apply, and therefore concludes that its 
application  is  not  appropriate  to  this  case.    Consequently,  the  Board  need  not  apply  a  50% 
minimum TDRL rating in this case.  At the time of entry onto TDRL, the CI’s symptoms could 
best be described as moderate.  An inpatient psychiatric discharge summary on 9 December 
1998  (4  months  pre-TDRL)  reported  a  positive  response  to  a  2  month  hospitalization.  
Symptoms  that  led  to  the  need  for  inpatient  evaluation  and  treatment  included  significant 
paranoid  delusions,  auditory  hallucinations  and  mood 
  Treatment  with  two 
psychotropic  medications  resulted  in  clear  symptomatic  improvement.    Psychological  testing 
after  stabilization on  medication  suggested  a  significant  degree  of  depression  and  emotional 
distress,  and  disorganized  thought  processes.    A  trial  off  of  medication  resulted  in  return  of 
psychotic symptoms within 72 hours.  Because the CI was concerned the treatment team was 
trying to kill him, it took several days until he agreed to re-start medication.  Once medication 
was re-instituted, resolution of affective instability and paranoia soon followed.  He was able to 
achieve  several  community  positions  within  the  psychiatric  treatment  program,  including 
secretary and Sergeant at Arms.  Mental status examination (MSE) performed at the time of 
hospital  discharge  showed  normal  orientation  and  appropriate  conversation  and  behavior.  
Thought  processes  were 
  He 
experienced occasional anxiety and showed little insight into his illness.  There was no evidence 
of  suicidal  or  homicidal  ideation.    Affect  was  euthymic,  though  restricted,  and  reactive  and 
congruent  with  mood.    The  Global  Assessment  of  Functioning  (GAF)  was  55,  connoting 

logical  and  goal-directed,  but  sometimes  vague. 

lability. 

linear, 

moderate  symptoms  or  impairment.    Impairment  for  social  and  industrial  adaptability  was 
considered definite.  It was recommended that the CI be followed in a partial hospitalization 
program  after  discharge.    At  an  interim  TDRL  re-evaluation  narrative  summary  (NARSUM) 
performed on 27 November 2000 (19 months after entry on to TDRL) the CI reported that he 
discontinued medications soon after his hospital discharge and lived for a year in a van.  He 
unsuccessfully attempted junior college courses and was often unaware that his TDRL money 
was being deposited into his account.  He briefly saw a civilian psychiatrist in January 2000, but 
discontinued  the  prescribed  psychotropic  medication  after  2  months.    He  returned  to  his 
parent’s home to live.  He re-attempted college, and since January 2000 claimed to be achieving 
A’s and B’s as a full-time student in a physics engineering program.  He also reported that he 
was the president of Amnesty International.  MSE revealed adequate hygiene but somewhat 
bizarre clothing.  There was no psychomotor agitation or retardation.  Speech was normal and 
he was fully oriented, although he did not appear to understand that he was on TDRL status.  
Affect  was  anxious.    Thought  processes  were  normal,  but  thought  content  showed  mild 
paranoid ideations.  He was a poor historian, but there was no evidence of hallucinations or of 
suicidal  or  homicidal  ideations.    Memory  was  intact.    Insight  was  fair  and  judgment  non-
impaired.    A  GAF  was  not  assigned.    The  examiner’s  assessment  was  chronic  mental  health 
condition  that  causes  marked  impairment  of  social  and  occupational  functioning.    Non-
compliance  with  treatment  in  individuals  with  this  illness  was  noted  to  be  a  frequent 
occurrence.    Completion  of  a  college  degree  and  sustaining  employment  were  considered 
unlikely, and continuation on TDRL was not recommended.  A VA Compensation and Pension on 
5 January 2002 (13 months prior to permanent separation) noted that the previous diagnosis 
rendered  by  the  VA  in  December  1999  was  mood  disorder,  not  otherwise  specified.    The  CI 
indicated that he had not been seen for treatment since he discontinued medications in March 
2000,  that  he  continued  to  avoid  because  he  did  not  trust  them.    He  described  pervasive 
paranoia,  with  significant  suspiciousness  and  mistrust  that 
impaired  him  socially  and 
occupationally.  Relationships with girlfriends were ended due to his suspiciousness.  He also 
reported intermittent bouts of depression and mania or hypomania.  His paranoia made him 
unable to maintain jobs, although he was still studying in college and had plans to transfer to 
Georgia  Tech.    He  denied  use  of  marijuana  in  over  a  year,  but  included  in  a  list  of  previous 
diagnoses  was  possible  psychosis  secondary  to  cannabis.    MSE  noted  a  display  of  significant 
suspiciousness and paranoia.  He was fully oriented.  Speech was coherent, mood “a little bit 
depressed”  and  affect  full  and  appropriate.    Thought  processes  were  goal  directed  with  no 
flight  of  ideas  or  loosening  of  associations.    There  were  no  apparent  suicidal  or  homicidal 
ideations,  and  no  hallucinations.    Although  concentration  was  intact,  insight  was  poor  and 
judgment impaired.  Assessment was schizoaffective disorder, bipolar type; GAF was 55.  When 
offered, the CI declined treatment.  The examiner stated: “His ability to seek treatment is also 
impaired  due  to  the  paranoia  which  has  pushed  him  to  discontinue  medications  and  avoid 
treatment.”  He opined that decompensation at some future point was likely and would require 
hospitalization.  At the final TDRL re-evaluation exam on 27 May 2002 (approximately 9 months 
prior to separation), the CI reported that he had completed the course of study in college and 
was accepted to the Georgia Institute of Technology.  He was still not receiving any psychiatric 
treatment  or  taking  any  medication.    He  endorsed  ongoing  anxiety,  confusion  and  paranoid 
ideation.  MSE revealed adequate hygiene but he displayed some bizarre and reserved behavior 
and mild psychomotor agitation.  Speech and orientation were normal.  He remained confused 
about  his  administrative  military  status.    He  remained  anxious  and  guarded  throughout  the 
interview.  Paranoia appeared to be increased from the previous TDRL exam, and he was a very 
poor  and  guarded  historian.    He  denied  hallucinations  and  suicidal  or  homicidal  ideations.  
Memory was intact, concentration adequate, but insight and judgment appeared poor.  A GAF 
was  not  assigned.    The  assessment  was  schizoaffective  disorder,  bipolar  type,  with  marked 
impairment in social and occupational functioning.  Employment and social interactions were 

made difficult by frequent and noticeable paranoia.  In an addendum dated 18 October 2002 
and  signed  by  the  CI,  the  examining  psychiatrist  responded  to  questions  from  the  PEB 
president,  indicating  that  the  CI’s  non-compliance  with  treatment  could  not  be  considered a 
direct product of his psychiatric illness, that the CI had been advised of the need for treatment 
and that he understood the need for treatment. 
  
The Board directs attention to its rating recommendation based on the above evidence.  At the 
time of entry on TDRL, the PEB and the VA assigned a 30% rating.  As mentioned above the VA 
initially  rated  under  the  9435  code  (mood  disorder),  but  subsequently  changed  it  to  9211 
(schizoaffective disorder).  The Board debated the rating at the time of entry on the TDRL, and 
noted the substantial improvement evident with appropriate treatment.  All members agreed 
that the §4.130 criteria for a rating higher than 30% were not met at the time of placement on 
TDRL.  With regard to permanent rating at the time of removal from the TDRL, Board members 
debated the history of clearly improved symptoms and functioning in a treated state.  A clear 
indication  of  the  stability  of  his  symptoms  under  treatment  was  provided  by  the  pre-TDRL 
NARSUM examiner, who reported resolution of paranoia and stabilization of mood symptoms 
when medications were taken.  Two examiners indicated that refusing treatment is a common 
manifestation of the paranoia and suspiciousness inherent in psychotic disorders, and that the 
ability to seek treatment is itself impaired by the underlying illness.  The final TDRL NARSUM 
examiner offered a different opinion in this particular case, stating that the CI’s unwillingness to 
accept treatment was not due to his illness.  The Board considered if the CI’s signature on the 
examiner’s  statement  to  the  PEB  attesting  that  he  understood  the  need  for  treatment  was 
evidence that this examiner’s opinion was correct.  Board members debated if a rating higher 
than  the  PEB’s  10%  at  the  time  of  removal  from  the  TDRL  was  warranted.    This  degree  of 
impairment  is  described  by  “Occupational  and  social  impairment  due  to  mild  or  transient 
symptoms which decrease work efficiency and ability to perform occupational tasks only during 
periods  of  significant  stress,  or;  symptoms  controlled  by  continuous  medication.”    While  the 
symptoms of impaired judgment and difficulty in establishing and maintaining effective work 
and social relationships could suggest a 50% evaluation “(Occupational and social impairment 
with  reduced  reliability  and  productivity…),”  most  of  the  elements  of  this  rating,  such  as 
flattened affect, circumstantial speech, frequent panic attacks and memory impairment, were 
absent. 
impairment  consistent  with  a  30%  evaluation 
“(Occupational  and  social  impairment  with  occasional  decrease  in  work  efficiency,  and 
intermittent periods of inability to perform occupational tasks)” was suggested by symptoms 
such as depressed mood, anxiety, suspiciousness and paranoia.  In deliberating the final rating 
however, the Board considered that the CI’s occupation was a full time student, and that he 
was performing at a very high academic level in a challenging field.  The degree of impairment 
that  would  still  allow  this  level  of  success  was  debated  at  length.    Ultimately,  the  Board 
concluded that  the  clinical  picture  was  most  accurately depicted  by  “occupational  and  social 
impairment due to mild or transient symptoms which decrease work efficiency and ability to 
perform occupational tasks only during periods of significant stress.”  After due deliberation, 
considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the 
Board  recommends  a  permanent  disability  rating  of  10%  for  the  schizoaffective  disorder 
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.    The  Board  did  not 
surmise  from  the  record  or  PEB  ruling  in  this  case  that  any  prerogatives  outside  the  VASRD 

  Board  members  agreed  that 

were exercised.  In the matter of the schizoaffective disorder condition and IAW VASRD §4.130, 
the Board unanimously recommends no change in the PEB adjudication.  In the matter of the 
schizoaffective disorder condition, 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:   
 
 
 
 

VASRD CODE  RATING 
9211 
COMBINED 

TDRL  PERMANENT 
30% 
30% 

10% 
10% 

UNFITTING CONDITION 
Schizoaffective Disorder 

 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120605, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           xxxxxxxxxxxxxxxxxxx, DAF 
           Director 
           Physical Disability Board of Review 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / xxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for xxxxxxxxxxxxxxxxxxxxx, AR20130002265 (PD201200636) 
 
 
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 
 
 
 

     xxxxxxxxxxxxxxxxxxxxxx 
     Deputy Assistant Secretary 
         (Army Review Boards)