RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01247
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20080726

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Military Police, medically separated for “bipolar disorder” with a disability rating of 10%.  

CI CONTENTION:  The CI contends for her bipolar disorder and five other conditions not considered by the disability evaluation system.  The applicant’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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 based upon a 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:  

SERVICE PEB - 20080522	VARD - 20100326	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	Major Depressive Disorder, Recurrent, also Claimed as
Bipolar Disorder	9434	70%	20090803	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Bipolar Disorder Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bipolar disorder began after being raped in June 2003, 6 months prior to reporting for initial entry training.  She was diagnosed with bipolar disorder and treated with a mood stabilizing medications.  She reported she was happy and stable while taking two medications until she developed suicidal ideation that began shortly after her return from her second deployment in December 2007 with a plan to shoot herself.  
She overdosed instead on one of her medications and was hospitalized for 1 day at a psychiatric inpatient unit.  She reported combat exposures but denied symptoms of PTSD.  She reported symptoms consistent with hypomania that included elevated mood, decreased need for sleep and depressive episodes.  She was stabilized with medication and was treated after discharge as an outpatient with an anti-depression medication and a mood-stabilizing anti-convulsion medication.  Mental status examination (MSE) was unremarkable.  A diagnosis of bipolar II was rendered with a Global Assessment of Functioning (GAF) score of 60 (moderate bordering on mild symptoms, impairment.)  

At the MEB examination (recorded on DD Form 2807 and 2808) dated March 2008, 5 months prior to separation, the CI reported anxiety, trouble sleeping, and depression.  A diagnosis of bipolar I was rendered.  The commander’s statement noted she was coming to work daily, communicated well, related well with supervisors and peers, did not need special supervision, displayed good judgment and had an outstanding work ethic.

At the VA Compensation and Pension (C&P) examination on 03 August 2009, performed 12 months after separation, the CI reported she was trying to make friends but felt extremely anxious in social situations and did not have any close friends.  She reported psychiatric symptoms, including limited sleep, but not have current treatment.  She had not worked for 1 to 2 years.  MSE noted she had passive daily suicidal ideation and some problems with recent memory.  A diagnosis of major depressive disorder was rendered with a GAF score of 53 (moderate impairment, symptoms.) 

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 9432 code (bipolar disorder), citing mild and transient symptoms, controlled by medication.  The VA assigned a 70% rating using the 9434 code (major depressive disorder) based on the VA C&P examination 12 months after separation, citing moderate to severe social and occupational impairment due to MH symptoms.  Application of VASRD §4.129 is considered by the Board for all cases of service connected psychiatric conditions resulting in separation.  In this case, all members agreed that the ‘highly stressful event’ requisite for §4.129 was not satisfied.  Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for MH conditions.  The Board then considered if there was evidence for a §4.130 rating higher than the 10% assigned by the PEB.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  The NARSUM examination was more proximal to separation and therefore of more probative value than the C&P exam.  The NARSUM examiner noted she was stable and taking her medications.

The commander noted the CI was highly functional in her work, worked well with others and did not require special supervision.  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.  

BOARD FINDINGS: In the matter of the bipolar condition 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.  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 20140304, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXX AR20160016224 (PD201401247)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA