RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	 CASE:  PD-2014-01011
BRANCH OF SERVICE: NAVY	SEPARATION DATE:  20070601

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-7 (Cryptologic Collection Technician) medically separated for bipolar I disorder.  The Bipolar disorder could not be adequately rehabilitated to meet the physical requirements of her Rating.  She was placed on light duty and referred for a Medical Evaluation Board (MEB).  “Bipolar I disorder, most recent episode (or current) manic, unspecified” and “alcohol abuse,” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “bipolar I disorder, most recent episode manic” as unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  

CI CONTENTION:  The CI contends the VA rating for her condition would have resulted in retirement.  The applicant’s 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 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 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:  

IPEB - Dated 20061106	VA* - ~5 Mos. Post-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar I Disorder	9432	10%	Bipolar Disorder	9432	10%	20071123	
Other MEB/PEB Conditions x 1 (Not In Scope)	Other x 12	
RATING:  10%	COMBINED RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20080429 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Bipolar I Disorder.  Service treatment records (STR) indicate the CI served in the Navy for 12 years before she came to the attention of mental health providers.  She was admitted to inpatient psychiatry 22 May 2006 after she reported hearing voices telling her to die.  She reported hearing the words of her “master chiefs” after a miscarriage in February 2005.  The voices increased in intensity over the past few days after her command asked her about her husband’s citizenship.  She showed disorganized and paranoid thoughts, difficulty focusing, and extreme guilt due to being unfaithful during her deployment.  She was drinking a bottle of wine per day over the past few months to “calm her nerves.”  A diagnosis of bipolar disorder I was rendered and she was treated with medications for psychosis and for mood stabilization.  She was discharged after 5 days and referred for MEB processing and outpatient care.

The narrative summary (NARSUM), dated August 2006, noted the CI was participating in individual counseling for her alcohol abuse and grief counseling and was taking medications for psychosis and for mood stabilization.  Although there were marital difficulties she remained married to her husband of 11 years.  She was close to a younger sister.  A mental status exam (MSE) was unremarkable.  A diagnosis of Bipolar I, most recent episode manic, and alcohol abuse, was rendered with a Global Assessment of Function (GAF) score 61-70 (mild symptoms.)  There was no deployment related concerns.  The non-medical assessment (NMA), dated October 2006, noted that her performance was above reproach but pressures of home and professional life overtook her ability to rationalize and make the even the easiest of work related decisions.  Depending on treatment needs, she was missing 1-2 hours of work each week up to 8 hours of work each week.  

At the VA compensation and pension (C&P) exam performed 6 months after separation, the CI reported she had gone on a mission from July 2004-February 2005.  She was in charge of 75 sailors, felt very responsible, and slept little.  Her husband reported that she returned altered.  He described symptoms of grandiosity, racing thoughts, and extremely goal oriented.  In May 2005 she brought attention to an illegal situation involving her boss and he blamed her.  She became suicidal and was hospitalized.  She was discharged in June 2007 but could not find a job so she moved to Spain, where she was receiving psychiatric treatment.  Her husband said she was more stable, but he had to slow down her impulses to spend excessively.  She reported loss of memory, difficulty with concentration, low self-esteem, irritability and mental restlessness.  The MSE noted moderate impairment of thought process, moments of impatience and irritability, had to control the speed of her thoughts, moderate anxiety and sadness about the loss of her former life.  A diagnosis of Bipolar I was rendered with a GAF score of 55 (moderate impairment).  She concurred with the PEB findings and expressed her intent to request to remain on active duty in a Permanent Limited Duty (PLD) status until 30 June 2007.  

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and the VA rated the Bipolar I condition at 10%, coded at 9432.  The Board next considered whether the provisions of VASRD §4.129 were applicable for the unfitting mental health condition.  Regardless of final PEB diagnosis, §4.129 does not specify a diagnosis of post-traumatic stress disorder (PTSD), rather states “mental disorder due to a highly stressful event,” and its application is not restricted to PTSD.  Members agreed that the requisite §4.129 link that the condition occurred “as a result of” in-service stressors was not adequately satisfied and therefore concluded that application of §4.129 was not appropriate in this case.

Board members considered if there was evidence to support a rating higher than the 10% assigned by the PEB.  The §4.130 criteria required for a 10% rating are “mild, transient symptoms, or “controlled by medication.”  The next higher 30% rating requires “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.”  The commander’s statement suggests that her symptoms were intermittent in severity and her performance at work had declined.  She was able to extend her PLD status but had not worked since separation.  She remained in treatment but continued to have anxiety, memory loss, and depression symptoms commensurate with a 30% rating.  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 I 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 I disorder condition, the Board 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, effective as of the date of her prior medical separation:  

CONDITION	VASRD CODE	RATING	
Bipolar I Disorder	      9432	30%	
RATING	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140217, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 31 Dec 15 ICO XXXXXXXXXXXXXXXXXXXX
	(c) PDBR ltr dtd 15 Jan 16 ICO XXXXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 11 Jan 16 ICO XXXXXXXXXXXXXXXXXXXX  
	(e) PDBR ltr dtd 31 Dec 15 ICO XXXXXXXXXXXXXXXXXXXX 
	(f) PDBR ltr dtd 21 Dec 15 ICO XXXXXXXXXXXXXXXXXXXX 
	(g) PDBR ltr dtd 11 Jan 16 ICO XXXXXXXXXXXXXXXXXXXX
	(h) PDBR ltr dtd 22 Jan 16 ICO XXXXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 29 Dec 15 ICO XXXXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (i) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability retirement pay with a 30 percent disability rating (increased from 10 percent) and placement on the Permanent Disability Retired List effective date of discharge.

     b.  XXXXXXXXXXXXXXXXXXXX, former USN: Assignment to the Temporary Disability Retired List on date of discharge for a period of six months with a 50 percent disability rating followed by transfer to the Permanent Disability Retired List with a final rating of 50 percent  

     c.  XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability retirement pay with a 30 percent disability rating (increased from 10 percent) and placement on the Permanent Disability Retired List effective date of discharge.

     d.  XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability retirement pay with a 30 percent disability rating (increased from 10 percent) and placement on the Permanent Disability Retired List effective date of discharge.

     e. XXXXXXXXXXXXXXXXXXXX, former USMC: Assignment to the Temporary Disability Retired List on date of discharge for a period of six months with a 50 percent disability rating followed by transfer to the Permanent Disability Retired List with a rating of 30 percent. 

     f.  XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     g.  XXXXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability retirement pay with a 30 percent disability rating (increased from 0 percent) and placement on the Permanent Disability Retired List effective date of discharge.

     h.  XXXXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability retirement pay with a 30 percent disability rating (increased from 10 percent) and placement on the Permanent Disability Retired List effective date of discharge.
     
3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.

                                       	XXXXXXXXXXXXXXXXXXXX
		Assistant General Counsel
                                      	(Manpower & Reserve Affairs)