RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxx	CASE:  PD1300473
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20130903
SEPARATION DATE:  20050610

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-5 (2S051/SUPPLY) medically separated for bipolar disorder.  The CI initially presented to the Air Force’s Life Skills Support Center, 3 months prior to a deployment, reporting symptoms of depression since the age of 12.  She had previously successfully deployed.  The bipolar disorder could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty.  She was issued a temporary S4T profile and referred for a Medical Evaluation Board (MEB).  The bipolar condition, characterized as bipolar disorder, was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal IPEB (IPEB) adjudicated bipolar disorder, existed prior to service (EPTS) without service aggravation as a Category II condition, one that can be unfitting but is not currently compensable or ratable and recommended discharge under provisions other than Chapter 61, Title 10, U.S.C.  The CI appealed to the Formal PEB (FPEB) which reversed the IPEBs findings and adjudicated the bipolar disorder as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI was medically separated.

CI CONTENTION:   “My anxiety caused by the military has disrupted my entire life.  I have been in counseling since I have been in the Air Force off and on to some degree.  Migraines have completely taken over, because of the anxiety.  It has manifested in other ways.  I have had a hard time at work and at school.  A hard time in relationships.  I have used my own insurance to get counseling and seek help.  I felt that I was not helped, but harmed while in the Air Force buy the mental health doctors.  They drugged me and (can’t make out words) to me.  The duress made me worse and I attempted to not take them but they made me sick.  I was disappointed by my treatment.  It only added to my fear of doctors and overall anxiety.” 

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 bipolar disorder is addressed below.  The migraine condition is not 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 contention 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 (DVA), operating under a different set of laws.  The Board considers DVA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence.  Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.

RATING COMPARISON:

Service FPEB – Dated 20050426	VA - (3 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
BIPOLAR DISORDER	9432	10%	BIPOLAR DISORDER	9432	30%	20050922	
No Additional MEB/PEB Entries	Other x 0	20050927	
Combined:  10%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20051114 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

BIPOLAR DISORDER.  Service treatment records indicated prior to service treatment for a mood disorder and posttraumatic stress disorder (PTSD).  The CI initially sought care in July 2004 for symptoms of depression and anxiety.  She was diagnosed with major depression, mild and a rule out of bipolar II.  On 28 July 2004, a comprehensive psychiatric evaluation determined the CI was suffering from bipolar disorder and anxiety.  The CI reported a 4-month history of anxiety attacks, lasting from 5 to 10 minutes; a history of depression off and on since age 12; recent worsening of depressive symptoms; indicated she was fatigued, overwhelmed emotionally and was on edge continuously.  The CI described history of episodic impulsive spending, periods of elevated mood, with increased self-esteem/self-image, “endless energy,” racing thoughts, excessive shopping and distractibility.  Mental status examination (MSE) revealed a normal mood with full range of affect and no evidence of a thought disorder, psychosis or mania.  Insight and judgment were intact.  A Global Assessment of Functioning (GAF) score of 60 was assigned and mood stabilizing medication was continued.  Treatment records recorded a total of five therapy sessions with a psychologist and three medication management visits with psychiatrist prior to separation.  The last recorded psychiatry entry on 22 November 2004, 6 months prior to separation, noted a stable mood and normal MSE with a GAF of 70 (mild).  Record entry on 27 January 2005 indicated no concerns for CI’s security clearance.  The next recorded entry, 4 months later, indicated the CI did not appear for scheduled therapy session.  There was no evidence in the treatment record of suicidal ideation, self-harm behaviors, manic or hypomanic episodes, mood instability, emergency room visits, panic attacks, abnormal MSE or hospitalizations.  The CI was profiled as S4, and thus, not deployable.  The commander statement, dated 14 February 2005, stated although she was not deployable, “her daily impact to the home station mission is invaluable and her medical condition has absolutely no impact on her ability to get the job done.”  Recommendation was to retain the CI with goal of returning her to worldwide deployable status.  A performance report (20 September 2003 through 19 September 2004) rated the CI’s overall performance as exceptional in many areas and recommended promotion.  At the narrative summary, dated 29 January 2005, approximately 4 months prior to separation, the CI reported history of mood cycling from depression to mania with mania having occurred 25% of the time.  On MSE she was fully oriented, well groomed, with normal speech and mood.  Her affect was full range and there was no evidence of psychosis, or a formal thought disorder and no problems with concentration.  She denied suicidal and homicidal thoughts and insight and judgment were intact.  The examiner diagnosed bipolar disorder and anxiety disorder not otherwise specified.  A GAF score of 60 (moderate impairment) was assigned; however, the examiner noted the CI had performed well despite her symptoms and her condition had responded well to medication, but noted the condition has periods of exacerbations that may lead to social and occupational impairments, which may be minimal given her successful work history.  The examiner opined social/industrial impairment was definite and military impairment was marked, but that the condition EPTS and was not permanently aggravated by service.  At the VA Compensation and Pension (C&P) exam completed on 22 September 2005, 3 months after separation, the CI reported a history childhood sexual abuse, foster placement and psychological treatment.  She indicated that at age 16, she had been diagnosed with PTSD but had not been prescribed medication.  The CI stated since being discharged from the military she has sought treatment and has continued with therapy and medication.  She indicated she continued to have symptoms of bipolar disorder with mood swings and periods of mania where she shops excessively and spends money.  The CI was working as a waitress several days per week and indicated she often missed days due to depressive symptoms and unable to get out of bed.  She indicated she worked the night shift due to frequent inability to sleep.  MSE recorded she was well groomed and pleasant, speech was rapid but slowed when asked.  All other aspects were within normal limits.  The examiner diagnosed bipolar II, assigned a GAF of 51, and stated the CI had periods of depression and mania impacting her occupational functioning, but social functioning was intact.

The Board directs its attention to the rating recommendation based on the evidence just described.  The MEB recorded bipolar disorder as EPTS and not permanently aggravated by service; the CI did not concur.  The condition was forwarded to the PEB, the PEB initially adjudicated the condition as a Category II (conditions that can be unfitting but are not currently compensable or ratable).  The case was referred to the FPEB who adjudicated the case as unfitting and assigned a disability rating of 10% coded 9432.  The VA, using the same code, rated the condition at 30%.  The Board first unanimously agreed that VASRD §4.129 was not applicable in this in the absence of a highly stressful causative event.

Both the NARSUM and the C&P examinations reported similar MSE and GAF scores.  The NARSUM examination recorded a completely normal examination and noted the condition was stable and that there had been no impairment in the CI’s ability to perform occupational tasks.  However, it was noted the condition cycles into periods that may have minimal impairment given her successful work history; but indicated military impairment was marked.  At the time of separation the Board agreed that the §4.130 threshold for a 50% rating (occupational and social impairment with reduced reliability and productivity) was not approached.  A rating of 30% requires “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.”  The records noted the CI had not received any letters of counseling, reprimands or articles.  The commander opined she should be retained and noted her condition did not impact her ability to perform her duties.  The CI was never hospitalized, never expressed suicidal ideations, and was stable on medications at the time of separation.  VA examination, 3 months after separation, indicated the CI continued to have symptoms of bipolar but remained in treatment, was stable on medication, and was employed, and had demonstrated the ability to remain safe and to commit to safety.  At the time of separation, the 30% rating was not supported by the evidence at hand.  The 10% description, “occupational and social impairment due to mild or transient symptoms which decrease work efficiency only during periods of significant stress, or; symptoms controlled by continuous medication,” more accurately reflects the CI’s condition at separation.  All evidence considered there is not reasonable doubt in the CI’s favor supporting a change from the PEB’s rating decision for the bipolar condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the FPEB adjudication for the bipolar 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 were exercised.  In the matter of the bipolar condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the FPEB adjudication.

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	
Bipolar Disorder	9432	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130513, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

Dear XXXXXXXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-00473.

	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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

Attachment:
Record of Proceedings