RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01750
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3, Cannon Crewmember, medically separated for “bipolar disorder, type 1” with a disability rating of 10%.  

CI CONTENTION:  The applicant contends that he should also be rated for additional conditions; left hand injury, post-traumatic stress disorder, and a nasal cyst.  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 - 20061019	VARD - 20070713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder, Type I	9432	10%	Bipolar Disorder	9432	10%	20070407	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bipolar Disorder, Type I Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bipolar condition began in June 2006 while he was deployed to Iraq.  He was medically evacuated for agitation, auditory and visual hallucinations, paranoia, and looseness of associations.  He had been unable to sleep for 3 days when symptoms began.  The CI’s command reported his behavior in Iraq was paranoid, aggressive and confrontational to command.  The CI reported he was admitted to an inpatient psychiatric unit in Germany where he tested positive for marijuana.  He was already on probation for marijuana use in April 2006.  He was treated with medication and transferred to an inpatient psychiatry unit at Walter Reed stabilization and observation.  He felt his problems were “due to weed.”  He was admitted to a German hospital in March 2006 with “similar symptoms” and admitted using marijuana and alcohol.  After leaving the hospital against medical advice, he was shortly readmitted and diagnosed with substance (cannabis) induced psychosis.  He was stabilized and returned to Iraq.  

During the hospitalization at Walter Reed the CI eventually refused medication, stating he could deal with his problems himself.  Psychosis returned, including ideas of reference.  He finally accepted medication and psychotic symptoms resolved though he continued to have an expansive mood.  At discharge he was referred for substance abuse treatment.  He was readmitted in July 2006 due to relapse of mania with return of psychosis due to failure to keep appointments and take medications as prescribed.  Urine drug screen was negative.  Axis I diagnoses of cannabis-induced psychotic disorder, bipolar I disorder, and cannabis abuse and alcohol abuse partially treated and improved, were rendered with a Global Assessment of Functioning (GAF) score of 60 (moderate symptoms, impairment).  

At the VA Compensation and Pension (C&P) examination in April 2007, performed 3 months after separation, the CI reported his symptoms were under control and he denied mania or depression.  He reported he was taking his anti-psychotic medication and his anti-depression medication daily.  He was involved with vocational rehabilitation and was not working but planning to return to school.  He denied excessive alcohol and reported he drank in the past during manic phases to go to sleep.  Mental status examination (MSE) was unremarkable.  A diagnosis of bipolar I disorder was rendered with a GAF score of 50 (moderate symptoms, impairment).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 9432 code (bipolar disorder), citing mild industrial and social impairment.  The VA also assigned a 10% rating using the 9432 code (bipolar disorder) based on the VA C&P examination 3 months after separation, citing mild or transient symptoms. 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 considered whether there was a pathway to a higher rating.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” and for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  

A review of the record suggests the CI had a bipolar disorder that was triggered during his deployment to Iraq, as evidenced by a 3 day lack of sleep.  He attempted to self-medicate with illegal substances, which exacerbated the bipolar disorder.  Both the NARSUM and C&P exams showed moderate functional impairment but he was taking his medication, denied active mania or psychosis and was attending vocational rehabilitation.  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 disorder, type 1 condition, the Board unanimously recommends a disability rating of 10%, coded 9432 IAW VASRD §4.130.  In the matter of the bipolar disorder, type 1 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 20131219, 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, AR20160014794 (PD201401750)

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