RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01458
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071010

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

CI CONTENTION:  The CI contends that posttraumatic stress disorder was misdiagnosed as bipolar I disorder and improperly rated.  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 on 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 - 20070626	VARD - 20080820	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar I Disorder	9432	10%	Bipolar Disorder	9432	10%	20080530	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Bipolar I Disorder Condition.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bipolar I condition began in July 2005 after deployment to Iraq from December 2003-March 2005. He became depressed and was treated at the Soldier Assistance Center.  He began anti-depression medication in July 2006 for depression, anxiety and aggression.  He had three psychiatric hospitalizations in October 2006 due to paranoia, bizarre behavior, aggressive, pressured speech, grandiosity, euphoria, hallucinations, homicidal ideation, detachment, hyper religiosity and isolation with impaired social functioning.  A diagnosis of bipolar disorder was rendered.  Medications were changed and he improved but he became non-compliant.  The April and the May 2007 MEBs forwarded bipolar I disorder for PEB adjudication.   

The MEB NARSUM examination on 8 May 2007, 2 months prior to separation, noted the CI was relatively stable on a high dose of mood-stabilizing medication, anti-psychotic medication and a sleep medication.  He was compliant with medications and denied hallucinations and suicidal/homicidal behavior.  He was hopeful of the future but had no concrete plans and wanted to remain isolative. He remained in therapy with psychologists and received medication management from psychiatrists.  A final diagnosis of bipolar affective disorder, severe with psychosis, was rendered with a current Global Assessment of Functioning of 50 (moderate symptoms, impairment.)  The examiner opined the impairment for social/industrial adaptability was moderate.  Mental status examination (MSE) showed he wore slightly dirty Army combat uniform and mood was “alright.”  The remainder of the examination was unremarkable.  

At the 30 May 2008 VA Compensation and Pension (C&P) examination, performed 7 months after separation, the CI reported he was compliant with medication and doing much better.  He was stable for months and rarely had racing thoughts, generally slept eight hours per night, and concentration was quite good.  He felt happier and had no suicidal thoughts.  Depression for 5-7 days occurred every 2-3 months.  He slept 10-12 hours and was quite lethargic.  He reported depression was mild but he came out of it and was ok.  He worked daily and did things with the kids and his girlfriend.  MSE was unremarkable.  

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the bipolar I disorder condition 10%, coded 9432, citing mild impairment. The VA also rated the bipolar condition 10%, coded 9432, based on the VA C&P examination 7 months after separation. Application of VASRD §4.129 is considered by the Board for all cases of Service connected psychiatric conditions resulting in separation; but, all members agreed that the ‘highly stressful event’ requisite for §4.129 was not satisfied in this case.  The Board then considered if there was evidence for a §4.130 rating higher than the 10% awarded 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,” while criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  

The NARSUM examination noted the CI was relatively stable on three medications with good compliance though his stability was tenuous, likely needing further hospitalizations.  The CI had a strict profile that allowed him to work 40 hours per week.  Members agreed he met criteria for a 10%% disability.  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 20140110, 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 XXXXXXXXXXXXXXXXXXXXXAR20160013470 (PD201401458)

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