RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-01742
BRANCH OF SERVICE:  Army  	BOARD DATE:  20140819
DATE OF PLACEMENT ON TDRL:  20030406
Date of Permanent SEPARATION:  20041109

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (11B/Infantryman) medically separated for bipolar disorder.  The bipolar disorder 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).  Bipolar I disorder, single manic episode was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other condition for PEB adjudication.  The Informal PEB adjudicated bipolar disorder as unfitting rated 30%, with likely application of the VA Schedule for Rating Disabilities (VASRD).  The remaining condition was determined to be not unfitting. The CI made no appeals and was placed on the Temporary Disability Retired List (TDRL) effective on 6 April 2003.  Upon re-evaluation in July 2004, the PEB determined the bipolar condition remained unfitting, but was stable for rating purposes and assigned a rating of 10%.  

CI CONTENTION:  “I was medicaly [sic] separated from the U.S. Army with a 30% disability, but was not granted retirement with the military when separated….”

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 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.

RATING COMPARISON:

Final Service PEB - 20040930	VA (3 Wks Post Sep) - Effective 20030406	
On TDRL - 20030406	Code	Rating	Condition	Code	Rating	Exam	
Condition		TDRL	Sep.					
Bipolar Disorder	9432	30%	10%	Bipolar Disorder 	9432	50%	20030429	
Other x 1  (Not in Scope)	Other x 2	20030429	
Rating:  30% → 10%	Combined: 50%	
*Reflects VA rating exam proximate to TDRL placement; no VA rating evidence proximate to permanent separation.

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.
Bipolar Disorder.  The narrative summary (NARSUM) reports the CI’s mental health (MH) symptoms to begin after an injury in Germany during which he reportedly hit his head without loss of consciousness.  The CI’s unit noticed no change in behavior until the day following the jump when the CI expressed manic symptoms of expansive mood, pressured speech and aggressive behavior with visual hallucinations.  Special X-rays (CT scan) revealed no evidence of intracranial injury as a cause.  The CI was treated with psychotropic medication and returned to CONUS.  With hospitalization and medication the CI’s condition improved.  While hospitalized, the CI was described as friendly to other patients and cooperative with staff.  At the psychiatric NARSUM exam performed on 4 August 2002, 5 months prior to separation, the CI reported no depression, irritable mood, panic attacks, obsessions or compulsions, or suicidal (SI) or homicidal (HI) ideation.  The MEB mental status exam (MSE) noted the CI to be alert and oriented.  He was cooperative and appropriate during the interview.  Eye contact was frequent and speech was pressured with agitation.  Thought processes were circumstantial and tangential and insight was minimal.  Hallucinations, illusions, SI and HI were absent.  Cognitive level screening demonstrated the CI to require minimal assistance in completing difficult tasks.  Global Assessment of Function (GAF) was 35 (GAF 40-31 - some impairment in reality testing or communication or major impairment in several areas such as work, school, family relations, judgment, thinking or mood).  The examiner opined that “although some persons have changes in behavior due to traumatic brain injury, this does not seem to be the case.  His first manic episode is most likely due to underlying bipolar disease that was triggered by the (physiologic) stress of the injury.”  At the VA Compensation and Pension exam performed on 29 April 2003, 3 months after TDRL placement, the CI reported occasional “flares” of slight anxiety and occasional flashbacks of parachutes jumps.  On examination the CI was alert and responsive.  The examiner noted no evidence of gross psychiatric complaint and no exhibition of any major abnormalities at this time.  MSE performed on 12 May 2003 was normal.  On a psychiatry clinic evaluation on 24 November 2003, the CI reported being in school and doing “alright” on medication.  On exam his responses were normal with normal mood and affect.  Thought processes were organized and linear.  The examiner opined the bipolar condition was “stable under medication.”  The TDRL re-evaluation was performed on 20 July 2004.  At this time, the CI was continuing on medication and receiving outpatient psychiatric care every 2 months.  He was performing in school and was employed as a firefighter.  He lived with his parents and had “stable relationships with friends and family” and a girlfriend.  The CI noted episodes of racing thoughts and increased irritability when out of medication in the past, but was currently taking medication.  He noted neither current manic symptoms nor problems with pressured speech, racing thoughts, sleep or appetite.  He volunteered that he “enjoyed things.”  The examiner concluded the CI to be functioning well while on medication with a new job, school and maintaining personal relationships and work.  A GAF of 60 was assigned (GAF 60-51 - moderate symptoms or moderate difficulty in social, occupational, or school functioning; GAF 61-70 - some mild symptoms, but generally functioning pretty well; has some meaningful relationships).

The Board directs attention to its rating recommendation based on the above evidence.  

TDRL Placement: The PEB rated the MH condition 30%, coded 9432 (bipolar disorder).  This rating requires occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  A higher rating of 50% requires occupational and social impairment with reduced reliability and productivity.  The original VA rating decision (VARD) was not available for review by the Board, but was quoted in a remote VARD performed on 11 August 2013, as 50% coded 9432.  The Board first agreed that VASRD §4.129 was not applicable in this case as no highly stressful psychological event was identified.  The Board concurred that the CI had a severe single episode of bipolar decompensation, but responded well to medication and psychiatric treatment.  The Board unanimously agreed that the preponderance of evidence in record supported the CI to be responding well to this treatment, and to support an occupational and social impairment of 30%, but no higher, at time of TDRL placement.  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 condition at TDRL placement.  

TDRL Removal:  The Board unanimously agreed that the CI was functioning well on medication and outpatient psychiatric care.  The Board concurred that the record supports the occupational and social impairment criteria for a 10% rating, but no higher.  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 for the bipolar condition at TDRL removal.  The Board recommends no change in the PEB adjudications for TDRL placement or upon permanent separation.

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 §4.130, the Board unanimously recommends a rating of 30% at TDRL placement and a rating of 10% at TDRL removal.  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 determinations.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131014, 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 XXXXXXXXXXXXXX, AR20150007047 (PD201301742)

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