RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-01702
BRANCH OF SERVICE:  Army	BOARD DATE:  20140617
SEPARATION DATE:  20050615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty MSG/E-8 (91W/Chief Ward Master of Mobil Hospital) medically separated for a bipolar condition.  The condition could not be adequately rehabilitated to meet the occupational requirements of her Military Occupational Specialty.  She was issued a permanent S4 profile and referred for a Medical Evaluation Board (MEB).  The bipolar condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  Three additional conditions were submitted by the MEB.  The Informal PEB adjudicated “bipolar disorder” as unfitting, rated 10%, citing criteria of the VA Schedule for Rating Disabilities (VASRD).  The remaining conditions, asthma, osteochondritis, left talar dome and labral tear, right hip was determined to be not unfitting, not rated.  The CI made no appeals and was medically.

CI CONTENTION:  “PTSD was not rated”

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 condition is addressed below and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  The posttraumatic stress disorder (PTSD) requested in this application is outside the Board’s defined scope of review, and remains eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service  IPEB – Dated 20050420	VA - ( **Day of Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	Bipolar Disorder	9432	30%	20060615	
Other MEB/PEB Entries x 3	Other x 22		
Combined:  10%	Combined:  60%	

ANALYSIS SUMMARY:  The Board acknowledges the presence of PTSD as a service-connected condition by the VA, but notes that the scope of its recommendations does not extend to conditions which were not diagnosed or in evidence at the time of medical separation.  Sub-clinical conditions cannot be correlated with a fitness determination requisite for a rating which includes conditions which may have had early manifestations during active service.

Bipolar Disorder Condition.  Available treatment records evidence that the applicant first noted psychiatric symptoms in March 2004 of poor appetite, guilt, decreased concentration and poor sleep for over 2 weeks.  The applicant did not seek mental health care.  The narrative summary (NARSUM) notes a 7-day hospitalization with a diagnosis of psychotic disorder, not otherwise specified (NOS).  The admission symptoms were auditory hallucinations, delusions and mania.  The mania was described as increased energy, despite sleeping less than 3 hours per night (including 48 hours without any sleep), grandiosity, distractibility, difficulty concentrating, psychomotor agitation and racing thoughts.  At the time of the NARSUM the CI reported improvement of her psychiatric symptoms with a structured environment and mediations.  The mental status examination was normal except for a significantly restricted affect and depressed mood.  The examiner recommended that if returned to duty the CI should not be deployed for a year and be placed in a medical center where she can be followed and a supportive command.  The examiner opined that the applicant “may be able to perform the duties of her rank and experience” with careful follow-up, high compliance and duty limitation.  The NARSUM examiner noted a marked impairment for military duty and definite social and industrial impairment.  The VA Compensation and Pension mental disorder examinations performed proximate to separation and approximately 5 years after separation were not in evidence, however; VA rating decisions reference these examinations in rating determinations for bipolar disorder, NOS at 30% from date of separation and the diagnosis was changed to PTSD at 50% from 28 January 2010.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB adjudicated the bipolar disorder condition as unfitting with a disability rating of 10%.  The Board determined that the diagnosis of bipolar disorder was the appropriate diagnosis at the time of separation and that the diagnosis of PTSD was not rendered until after separation.  The Board placed high probative value on the NARSUM psychiatric evaluation performed 4 months prior to separation as indicative of the CI’s functional impairments due to a mental disorder most proximate to separation.  The NARSUM examiner noted a marked impairment for military duty and definite social and industrial impairment.  The 10% rating criteria is based on “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.”  The Board determined a rating higher than 10% rating was supported by the evidence.  The CI was psychiatrically hospitalized and was determined to require careful follow-up, high compliance and duty limitation.  The Board determined that the evidence supports a 30% rating for “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.”  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 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 condition, the Board unanimously recommends a disability rating of 30%, coded 9432, 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 her prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Bipolar disorder	9432	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131023, w/atchs
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, AR20150007111 (PD201301702)

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 recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

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 permanent disability retirement 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 date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	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						
CF: 
(  ) DoD PDBR
(  ) DVA