RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-01388
BRANCH OF SERVICE:  Army	BOARD DATE:  20141216
DATE OF PLACEMENT ON TDRL:  20020826
Date of Permanent SEPARATION:  20040112

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5/Motor Transport Operator medically separated for bipolar disorder.  The CI was initially treated for mental health symptoms in 2001.  His condition did not improve adequately to meet the requirements of his Military Occupational Specialty.  He was issued a permanent L2/S3 profile and underwent a Medical Evaluation Board (MEB).  The bipolar disorder was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) found the bipolar disorder unfitting, but not sufficiently stable for permanent adjudication.  The CI was placed on the Temporary Disability Retirement List (TDRL) with a 30% disability rating.  In October 2003, a second IPEB was convened.  The bipolar disorder was found unfitting and rated at 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI did not accept the IPEB findings and demanded a formal hearing, but later withdrew his request.  In January 2004, the CI was medically separated with a permanent disability rating of 10%. 

CI CONTENTION:  The CI makes no specific contentions.  His complete submission is at Exhibit A.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  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.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

Final Service PEB – 20031023	VA (25 mos. Post Initial Adjudication) – Effective 20020827	
On TDRL - 20020321	Code	Rating	Condition	Code	Rating	Exam	
Condition		TDRL	Sep.					
Bipolar Disorder	9432	30%	10%	Schizoaffective Disorder	9211	10%	20030506	
No Additional MEB/PEB Entries.	Other x 10	20030506	
Combined:  30% → 10%	Combined: 30%	
 Derived from VA rating decision (VARD) dated 20030517 (most proximate to date of permanent separation from service)

ANALYSIS SUMMARY:

Bipolar Disorder.  In January 2001, the CI began exhibiting bizarre behavior.  He was admitted to an inpatient psychiatric unit.  After 6 days, he was discharged and was followed-up on an outpatient basis.  The CI was treated with oral Zyprexa, for its mood stabilization and anti-psychotic properties.  In spite of treatment, his psychiatric symptoms persisted and an MEB was initiated.  The MEB psychiatric narrative summary was dated 12 February 2002.  On mental status exam (MSE), the CI was cooperative and fully oriented.  Eye contact was intermittent.  He denied any suicidal or homicidal ideation.  The Axis I diagnosis was bipolar disorder, primarily manic.  The Global Assessment of Functioning (GAF) score was 75, indicating no more than slight impairment in social or occupational functioning.  As noted above, the CI was found unfit, but the mental condition was not sufficiently stable for permanent adjudication.  The CI was placed on the TDRL with a 30% disability rating.

The Board carefully examined all available evidence, and determined that a higher rating at that time was not warranted.  The CI’s mental disorder was not the result of a highly stressful event, so VASRD §4.129 (Mental disorders due to traumatic stress) did not apply.  Furthermore, IAW the VASRD §4.130 General Rating Formula for Mental Disorders, a rating of 50% would require occupational and social impairment, with reduced reliability and productivity due to such symptoms as: flattened affect, abnormal speech pattern, panic attacks, difficulty understanding commands, impaired memory, impaired judgment, impaired thinking, disturbances of motivation and mood, or difficulty in work and social relationships.  Since the treatment record did not show sufficient evidence of these findings, the Board had no basis to recommend a rating higher than 30%, when he was initially placed on TDRL.

On 6 May 2003, the CI had a VA mental health Compensation and Pension exam.  He reported that sleep, appetite and concentration were good.  He denied any mood swings or depression.  He was not anxious, and had no problems with temper.  There was no history of suicide attempts or panic attacks.  He denied nightmares, flashbacks, or intrusive thoughts.  He was working full-time, doing security work.  On MSE, he was alert, cooperative and neatly dressed.  His mood was a bit tense.  There was some pressured speech, with some tangentially and loose associations.  Affect was appropriate.  He denied suicidal or homicidal ideation.  He denied any hallucinations or suspiciousness.  Insight and judgment appeared to be marginal.  The examiner’s Axis I diagnosis was: schizoaffective disorder.  The GAF score was 50, indicating moderately serious impairment in social functioning.

On 18 August 2003, after 12 months of TDRL, the CI had another psychiatric evaluation.  He reported that he was still living alone, and was managing his own finances.  He was successfully employed full-time as a security officer and had held that job for 9 months.  He denied any problems at work.  Since leaving active duty, there had been no psychiatric hospitalizations, suicide attempts, or self-injurious behavior.  He was compliant with his Zyprexa therapy and denied any significant side effects.  He was sleeping eight hours per night, and waking in the morning feeling fully rested.  His appetite and weight were stable.  He denied any auditory or visual hallucinations.  He denied suicidal or homicidal ideation.  He denied any depressive or anxiety symptoms.  He denied any manic or hypomanic episodes since leaving the military.  He denied any current psychiatric symptoms of any kind.

On MSE, the CI was alert and oriented.  Speech was fluent and non-pressured.  Eye contact was good.  There was no psychomotor agitation.  Behavior was appropriate at all times during the interview.  Memory was intact.  Judgment and insight appeared fair to good.  The examiner’s Axis I diagnosis was bipolar disorder, currently in remission.  GAF score was 80-85, indicating good functioning in all areas, and socially effective.  Four months later, on 12 January 2004, the CI was removed from the TDRL and permanently separated from military service with a disability rating of 10%.

On 12 January 2004, the CI was seen by his psychiatrist.  He was still employed in security, and living alone.  He reported that he was doing fine, and he voiced no major problems or concerns.  On MSE, he was alert and oriented.  He appeared calm, pleasant, and cooperative.  There was no evidence of agitation or violent thoughts.  Speech was normal in rate and content.  Mood was euthymic (normal), and affect was appropriate.  The CI denied feeling depressed.  There was no evidence of overt psychosis, depression, or anxiety.  He denied any suicidal or homicidal ideas or plans.  The examiner’s diagnosis was bipolar disorder, well controlled on meds.  The GAF score was 65, indicating some mild symptoms, or some difficulty in functioning, but generally functioning pretty well.  The examiner wrote: “This patient has a college degree, but has lost two jobs in the past because of his chronic mental illness.  He lost his job at the Post Office and his job at the school system, because he decompensates under minimal stress and is not able to function.”  The Board carefully reviewed all available evidence.  The best sources of data upon which to base the final rating recommendation were the August 2003 examination and the January 2004 examination.

The August 2003 examination was a very thorough evaluation, and was performed just 21 weeks prior to separation.  Therefore the Board determined that it had significant probative value.  At that exam, the CI denied any psychiatric symptoms of any kind.  He was without any symptoms, and was functioning well.  This was evidenced by his effective employment, and the absence of any problems at work.  The examiner concluded that the mental disorder was in remission.  The GAF score of 80-85 indicated good functioning in all areas.

The January 2004 examination was a briefer clinical interaction, and a less thorough evaluation.  However, it occurred on the date of separation and therefore had significant probative value.  At that exam, the CI was still employed in security and was generally functioning pretty well. With regard to the permanent psychiatric rating recommendation, all Board members agreed that 10% was appropriate.  The Board determined that the CI may experience decreased work efficiency and decreased ability to perform certain tasks, during periods of significant stress. IAW the VASRD §4.130 General Rating Formula for Mental Disorders, a rating of 30% would require occupational and social impairment, with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks, sleep impairment, or memory loss. Since the treatment record did not show sufficient evidence of these findings, the Board had no basis to recommend a rating higher than 10%, when he was removed from TDRL and permanently separated.

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 PEB adjudication of the bipolar 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 were exercised.  In the matter of the Bipolar disorder 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130910, w/atch
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
SAMR-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 XXXXXXXXXXXXXXXXX, AR20150006648 (PD201301388)

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						 
CF: 
(  ) DoD PDBR
(  ) DVA