RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01346
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E5, Civil Affairs Specialist, medically separated for “bipolar I disorder,” with a disability rating of 0%.  

CI CONTENTION:   The CI contended for a mental health condition.  The CI’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 - 20050222	VARD - 20060725	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bi-Polar I Disorder	9432	0%	Bi-Polar Disorder	9432	NSC	STR	
			Posttraumatic Stress Disorder	9411	NSC		
			Borderline Personality	9499-9435	NSC		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  ---%	

ANALYSIS SUMMARY:   

Bipolar Disorder.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) mental health narrative summary (NARSUM) the CI had 2 psychiatric hospitalizations prior to deployment in 2004.  In May 2002, she experienced a psychotic depression several months after the birth of her child, and in June 2002, her psychotic symptoms returned and she was diagnosed with bipolar disorder.  Her condition went into remission and she was subsequently able to deploy to Iraq in 2004.  During her deployment she began exhibiting symptoms that suggested a return of her bipolar condition which prompted medical evacuation to the U.S.  She was started on a mood stabilizing medication prior to returning to U.S. and the medication had improved her symptoms.  The NARSUM indicated that the CI had an 18-month history of increased energy, decreased need for sleep, grandiosity, and impulsivity, all evidence of bipolar mania.  In January 2004, she disobeyed an order not to leave the state of North Carolina prior to deployment after having a vision from Mother Theresa.  She also noted a childhood history of mood swings and unstable relationships.

The NARSUM was accomplished while the CI was on the psychiatry inpatient unit, 5 months before separation.  The CI noted at the time of her deployment she went on a $700.00 internet shopping spree and was hypersexual.  This period lasted for a week and then she “crashed.”  She was sleeping over 12 hours a day and had other depressive symptoms.  She arrived in the U.S. on 27 September 2004, with direct admission to psychiatry unit.  The psychiatrist noted the CI was stable at the time of admission.  She was noted to have some depressive features, and indicated that the medications prescribed during inpatient care had improved her sleep, concentration, and energy.  The examiner noted that she had responded well to medication.  It was noted that her symptoms were exacerbated with military service and had begun with the pregnancy in 2001.  At the time of discharge, her depressive and psychotic symptoms had improved, and her Global Assessment of Functioning (GAF) score was 40 (on the cusp of serious symptoms and or impairment, and major impairment in most areas. 

STRs noted the CI presented to the VA on 30 April 2005 (1 month after separation), and was triaged for psychiatry consultation, secondary to reported difficulty with being alone.  She indicated she had problems with sleep and noted that she had discontinued all psychotropic medication due to drowsiness; however, on the night prior to the evaluation she was able to get some sleep and noted that she felt better after sleeping.  The mental status examination (MSE) noted she was anxious but recorded no other abnormality.  The VA Compensation and Pension (C&P) mental examination was conducted 2 years after separation.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the condition of bipolar I disorder 9432 (bipolar disorder) rated at 0%, with the notation that the condition existed prior to service (EPTS) with evidence of permanent service aggravation.  The Board noted the PEB took no deductions in rating secondary to ETPS.  The VA, used the STR and determined the condition was not service connected and was not permanently aggravated by service.  

Next, the Board noted there was no specific, highly stressful service related event to invoke §4.129 for a mental disorder due to traumatic stress.  The Board proceeded to rate under §4.130 and considered the NARSUM and the STR post-NARSUM.  The NARSUM noted the CI’s condition had improved; however, it represented her condition at hospital discharge.  Treatment records demonstrated the CI’s condition stabilized and she remained stable for approximately 1 year after hospitalization, and was stable with medication.  She was hospitalized twice within 6 months after separation; the first admission was self –initiated.  The CI noted she had not taken her medication for a couple of weeks and deteriorated.  Her complaint was that she had a problem with attachment; she was having relational problems, and was unemployed.  The second admission noted she had experienced psychotic symptoms, and she had discontinued her medications.  She was enrolled in college and was not employed.  Treatment records going forward indicated she was compliant with treatment and remained stable for more than 12 months after the September 2005 admission.  It was noted that her stability was attributed to the medications.  Board members agreed that her symptoms were well controlled by the continuous use of medication and, met the 10% disability level of impairment but no higher than 10% at the time of separation.  After due deliberation, the Board recommends a 10% rating for the bipolar I condition.

BOARD FINDINGS:  In the matter of the bipolar I condition, the Board unanimously recommends a disability rating of 10%, coded 9432 IAW VASRD §4.130.  There were no other conditions within the Board’s scope of review for consideration.  

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	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140412, w/atchs
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 XXXXXXXXXXXXXXXXXXXX, AR2016001 0634 (PD201401346)

1. 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,
accept the Board's recommendation to modify the individual's disability rating to 10%
without re-characterization of the individual's separation. This decision is final.

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.

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:

CF:
( ) DoD PDBR
( ) DVA