RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02404
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20070821

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Hospital Corpsman, medically separated for “cyclothymic disorder,” with a disability rating of 10%.

CI CONTENTION:  The CI requests consideration of all conditions.  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 - 20070508	VARD - 20071227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cyclothymic Disorder	9431	10%	Cyclothymic Disorder with Anxiety, Panic Attacks, and Agoraphobia	9431	50%	20070530	
Panic Disorder with Agoraphobia	Cat II					
Generalized Anxiety Disorder	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Cyclothymic Disorder Condition.  According to the service treatment records (STR) and the mental health (MH) MEB narrative summary (NARSUM), the CI was referred to MH by her primary care manager (PCM) for concern of bipolar disorder or depression.  At that time (November 2006) she reported significant mood swings, headaches and changes in sleep, appetite and concentration.  She also provided a preservice history of mood lability, irritability and anxiety.  Additionally, she had a history of excessive worry and panic attacks.  She was prescribed medications which stabilized her symptoms overtime.  However, she continued to report mood instability, and on 8 February 2007 was diagnosed with cyclothymia (mood lability without full depressive or manic episodes) and prescribed a mood stabilizer.  The CI immediately reported significant improvement in mood lability with the mood stabilizing medication and her anxiety and panic attacks were fairly well controlled with the anti-anxiety medication.  However, because of the chronicity and severity of her symptoms and concerns regarding the potential need for ongoing mood stabilizing medication, the CI was referred to the MEB.  

At the NARSUM dated 16 March 2007, approximately 5 months before separation, the CI reported her symptoms had been present “always” but that the symptoms caused her more stress since joining the Navy about a year ago.  She denied symptoms suggestive of a major depressive disorder or bipolar disorder.  It was noted that she had never been hospitalized psychiatrically, nor treated in the emergency room (ER).  Her sleep fluctuated from insomnia to hypersomnia.  The CI noted that she had been married for a year and that her marriage was very solid.  Her husband was a good source of support and she had many friends.  The mental status examination (MSE) was unremarkable.  

The examiner documented the diagnoses of cyclothymic disorder, generalized anxiety disorder and panic disorder with agoraphobia, and noted that her conditions had not caused significant impairment in the performance of her military duties.  The examiner wrote, “The patient has generally functioned at a very high level in her military duties…there have been no indication or events in her career that showed evidence of any current clear impairment.”  Additionally, the physician stated that the MEB “agrees with the opinion that the service member is considered currently fit for service with this condition.”  The CI also indicated that she desired to remain in the service.  

The VA Compensation and Pension (C&P) mental examination was accomplished approximately 3 months before separation.  The CI noted she had continued her psychotropic medications and had not been hospitalized.  She noted that she was currently under additional stress related to leaving the Navy and a divorce from her husband.  She was having some difficulty with sleep.  She noted that her panic attacks had been less frequent with medication; however, recent attacks or frequency of attacks were not recorded.  As to impact on work, the CI noted that at times she felt stressed and during those times she had negative interactions with others.  She became upset and withdrew from her working environment to cry and calm herself.  She noted that her MH condition had not interfered with her relationships; she had “a bunch of friends.”  The MSE was unremarkable and formal cognitive testing was without errors.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the condition of cyclothymic disorder, at 10% coded 9431.  The VA, used the same code to grant a 50% disability rating.  The Board considered the Category II panic disorder with agoraphobia and generalized anxiety disorder conditions and agreed, the conditions contributed to the overall mental health pathology; however, they could not be recommended for additional rating IAW VASRD 4.14 (avoidance of pyramiding).  Regardless of diagnosis, VARSD §4.130 rates conditions based on symptoms, and therefore, all symptoms related to mental health are considered in the rating scheme.  

The Board proceeded to rate under §4.130 and compared the NARSUM, the non-medical assessment (NMA) and the C&P examination.  The NARSUM indicated the CI was fit for duty and that her condition had not impaired duty performance.  The MSE was completely normal and the CI indicated that her symptoms were transient and controlled by medication.  The NMA noted that the CI had good potential for continued service in her present physical and mental condition; however, she was non-deployable which was of concern to the command.  Therefore, the commander did not support her continuation in the service.  At the time of the C&P examination the CI was facing an additional stressor; she was in divorce proceedings and this was causing problems with sleep and some anxiety.  However, she was stable on medications and although she experienced some irritability at work she was able to manage.  The MSE and cognitive examination were unremarkable.  After careful deliberations, Board members agreed that her symptoms were mild and transient, and were well controlled by the continuous use of medication.  Therefore, there was insufficient evidence to justify a rating higher than 10% at the time of separation.  After due deliberation, and 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 cyclothymic disorder condition. 

BOARD FINDINGS:  In the matter of the Cyclothymic Disorder condition and IAW VASRD §4.130a, 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 20140515, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 22 Sep 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN