RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02063
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080627

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O-1 (Quartermaster Officer) medically separated for Bipolar disorder.  The condition could not be adequately rehabilitated to meet the requirements of his military duties.  He was issued a permanent S3 profile and referred for a Medical Evaluation Board (MEB).  The condition, characterized as “bipolar type 1” and “MRE manic with psychotic features presently in remission” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated his condition as unfitting and rated it at 0%.  

CI CONTENTION:  “Please review all conditions.” 

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 Military/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 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:  

Admin IPEB – Dated 20080225	VA* - (~27 Months Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar I Disorder…	9432	0%	Bipolar Type I	9432	50%	20100814	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 0	
RATING:  0%	RATING:  50%	
*Derived from VA Rating Decision (VARD) dated 20100919 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Bipolar Type I Disorder.  Service treatment records note the CI graduated from college, was commissioned through ROTC in May 2007 and was admitted to Bellevue Hospital 24 May 2007.  Police took him to the hospital after he was caught trying to steal a tip jar.  He had a 1-3 month history of increasing euphoria, grandiosity, impulsiveness, irritability, an increase in goal directed activity, paranoia, risk-taking behavior and sleep decreased to 2 hours per night due to racing thoughts.  He denied suicidal and homicidal ideation or attempts.  There was a history of alcohol abuse in the past 2 weeks.  Recent stressors included death of a friend, final exams and graduation, and wedding of older brother for whom he was to be best man.  He was initially uncooperative and required chemical restraint as he tried to lock himself in a bathroom.  He was treated with a mood stabilizing medication, an antipsychotic medication, and an antianxiety medication.  A diagnosis of Bipolar disorder I, manic with psychotic features was rendered with a Global Assessment of Functioning (GAF) score of 25 (hallucinations, serious impairment in judgment, inability to function in almost all areas.)  He showed good behavioral control, though still paranoid and delusional and was medically transferred June 2007 to Walter Reed inpatient psychiatry for further treatment.  

Treatment included group and individual psychotherapy, occupational and art therapy, and medications as described above.  Mental status exam (MSE) was normal except for impaired insight due to alexithymia (inability to identify and describe emotions in the self.)  He responded well and was transferred to Psychiatric Continuity Service (PCS) partial hospitalization and intensive outpatient program on 27 June 2007 for continued treatment.  

The NARSUM exam, dated 7 September 2007, was conducted while the CI was completing the program.  He denied most of the psychiatric symptoms and was hoping to remain in the Army.  The examiner noted the CI did not work during the MEB process but opined he was “fully capable to work full-time civilian employment.”  He received a S3 profile.  At the time of this exam, he was taking two psychotropic medications for psychosis and mood stabilization.  The examiner noted he had to have ready access to specialized healthcare providers and be allowed to attend all medical appointments.  A diagnosis of Bipolar I, manic with psychotic features, in remission was rendered with a GAF of 60 (moderate bordering on mild impairment, symptoms).  

The commander’s statement, dated 30 August 2007, noted the CI worked 4 hours per day per week doing administrative work and attended appointments daily.  He had completed outpatient psychiatric treatment and was interested in employment or online college.

At the VA Compensation and Pension (C&P) exam performed 27 months after separation, the CI reported he has been hospitalized in 2009 and in 2010 for active manic symptoms.  He was receiving joint healthcare between the VA and his private healthcare providers and has continued to see his private counselor who he had seen since 2007.  He was taking three psychotropic medications.  He was living with his parents and had never married.  He began to work in either late 2008 or early 2009 but stopped due to the hospitalizations.  He planned to attend school for speech therapy.  He had incurred a charge that was considered minor and charges were dropped.  MSE was unremarkable; he denied psychosis, depression, panic attacks or suicidal/homicidal ideation.  A diagnosis of Bipolar I was rendered with a GAF of 53 (moderate impairment, symptoms.)  His doctor had not released him to return to work.  The examiner opined there was reduced reliability and productivity.  

The Board directed its attention to its rating recommendation based on the above evidence.  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 therefore will consider only the VASRD §4.130 impairment present at separation for a single rating recommendation.  The PEB assigned a 0% rating under the 9432 code (Bipolar disorder), stating that symptoms were “controlled by continuous medication.”  The VA used the same code, relying on the VA C&P examination 27 months after separation and also used the 9432 code but considered that the condition was best characterized as “reduced reliability and productivity,” and therefore justified a 50% rating.  

The Board considered if a rating higher than 0% was warranted at the time of separation.  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 commander’s statement suggested the CI worked part time in August 2007, while he attended partial hospitalization as recorded in the STR.  The NARSUM examiner noted the CI was capable of civilian employment yet had not worked during the MEB process.  He assigned him a GAF of 60, connoting moderate impairment and symptoms and listing stressors as “any type of stress, impending deployment.”  The CI had required 2 months of hospitalization with recommended partial hospitalization to stabilize symptoms.  Historical data provided by the C&P exam indicated he was able to work only a short period before he required further hospitalization(s.)  The Board agreed there was evidence of reduced reliability and productivity at the time of separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 50% 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 condition, the Board recommends a disability rating of 50%, 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 his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Bipolar Disorder I	9432	50%	
COMBINED	50%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140513, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

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 XXXXXXXXXXXXXXXXXX, AR20160004372 (PD201402063)

1. Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual's separation as a permanent disability retirement with the combined disability rating of 50% effective the date of the individual's original medical separation for disability with severance pay.

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:

a. Providing a correction to the individual's separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

b. Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 50% effective the date of the original medical separation for disability with severance pay.

d. Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

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:

Enclosure
CF:
( ) DoD PDBR
( ) DVA