RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03156
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20030615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Food Service, medically separated for “bipolar I disorder, most recent episode manic, severe with psychotic features,” rated 30%, applying a 10% EPTS (existed prior to service) deduction, for a final disability rating of 20%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20030403	VARD - 20040423	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar I Disorder, Most Recent Episode Manic, Severe with Psychotic Features	9432	30% - 10% (EPTS)	Bipolar Disorder w/Psychotic Features	9432	30%	20030909	
Cluster B&C Traits	Cat II	No VA Placement	
Alcohol Abuse	Cat IV	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bipolar I Disorder (with Cluster B&C Traits, and Alcohol Abuse).  The Service entry physical dated 9 November 1999 did not list any mental health condition or medications.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first seen for anxiety in 2001.  He was diagnosed with social phobia in September 2002 and started on medication.  The CI was involuntarily hospitalized due to disorganized behavior at work, “not making sense,” and weapons at his residence.  The patient's wife left him approximately a month prior to hospitalization due to his heavy alcohol use and bizarre behavior.  The MEB forwarded “bipolar I disorder, most recent episode manic, severe with psychotic features; alcohol abuse; and Cluster B&C traits” for PEB adjudication.  

The MEB NARSUM examination on 10 February 2003, 4 months prior to separation, noted that during his hospital stay, the CI initially demonstrated impaired judgment and impulse control, loose associations, paranoid behavior, agitation, intrusiveness, grandiosity and non-redirectable behavior.  He required isolation and multiple doses of Ativan, Depakote, Zyprexa, and Klonopin to reduce his agitation and induce sleep.  He discontinued medication between hospitalizations due to paranoid beliefs about purpose of medication.  The CI was slow to show insight into the events leading to his commitment.  At discharge he was compliant with medications, tolerating them without any adverse reaction.  He showed no evidence of mania, hallucinations or depression, suicidal or homicidal ideation.  His insight improved and paranoid delusions remitted.  He was showing sustained improvement in outpatient treatment in all areas.  

The mental status examination (MSE) was notable only for poor eye contact, an “OK” mood, flattened affect, and poor abstraction.  There was no active suicidal ideation, delusional or hallucinatory symptoms, or other symptoms suggestive of psychosis, speech disturbance, objective cognitive impairment, or other abnormality.  The psychiatrist examiner diagnosed bipolar I disorder, most recent episode manic, severe with psychotic features with secondary diagnoses of alcohol abuse and cluster B&C personality disorder traits.  The examiner stated, that there was “moderate evidence to suggest pre-service predisposition” and “the disability did not exist prior to entry.”  The Global Assessment of Functioning was 65 (in the mild symptom range).  

At the 9 September 2003 VA Compensation and Pension (C&P) evaluation, performed 3 months after separation, and summarized in the VARD indicated that the CI reported some degree of paranoia and racing thoughts.  Psychiatric examiantion showed apparent recurrent difficulty sleeping, an anxious mood and the CI was noted to be somewhat distracted and distractible.  Thought process, insight, judgement, and memory were intact, and the CI denied hallucinations, delusions, or lethality.  

Remote VA evidence indicated a personal hearing in December 2005, 31 months after separation), and a Decision Review Officer VARD awarded a 100% rating effective retroactive to the time of separation, as well as a proposal for a finding of incompetence (later approved).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar disorder condition 30%, coded 9432 (Bipolar disorder), and reduced the rating by 10% for EPTS.  The PEB also adjudicated the cluster B&C traits condition as Category III (not separately unfitting and do not contribute to the unfitting condition); and the alcohol abuse as Category IV (do not constitute a physical disability).  These are both considered with the unfitting bipolar disorder as they are not disability conditions, not separately compensable, but may impact mental disorder conditions.  The VA rated the bipolar disorder condition 30% coded 9432, based on the VA C&P examination 3 months after separation.  

The Board noted that there was no traumatic event causing the unfitting mental health condition and therefore concluded that application of VASRD §4.129 was not appropriate in this case.  The Board next considered the §4.130 rating at the time of separation.  All Board members agreed the CI’s condition at the time of separation indicated by both the NARSUM and VA examinations, supported a 30% disability rating, and that the CI’s level of impairment was best described as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily).  The more remote VA examinations and ratings were adjudged post-separation worsening.  Although the NARSUM indicated the CI had a pre-service predisposition for her mental health condition, there was no pre-service mental disorder formal diagnosis.  Given that the entry physical showed no mental health disorder or treatment, the Board adjudged that there was insufficient evidence to support any EPTS deduction.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the bipolar disorder condition, coded 9432.  

Contended PEB Conditions:  Cluster B&C Traits and Alcohol Abuse.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting/compensable.  The cluster B&C traits and alcohol abuse are conditions not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the Board has no basis for recommending either as unfitting.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB determinations of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bipolar disorder condition, the Board unanimously recommends a disability rating of 30%, coded 9432 IAW VASRD §4.130.  In the matter of the contended cluster B&C traits (category III) and alcohol abuse (category IV) conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting/compensable.  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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Bipolar I Disorder, Most Recent Episode Manic, Severe With Psychotic Features	9432	30%	

The following documentary evidence was considered:
Exhibit A.  DD Form 294, dated 20140728, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 19 Sep 16 ICO XXXXXXXXXXXXXXXXXX   
	(c) PDBR ltr dtd 22 Sep 16 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 21 Sep 16 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 27 Sep 16 ICO XXXXXXXXXXXXXXXXXX
	(f) PDBR ltr dtd 16 Sep 16 ICO XXXXXXXXXXXXXXXXXX
	(g) PDBR ltr dtd 21 Sep 16 ICO XXXXXXXXXXXXXXXXXX
	(i) PDBR ltr dtd 19 Sep 16 ICO XXXXXXXXXXXXXXXXXX
	(j) PDBR ltr dtd 4 Oct 16 ICO  XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (j) are approved.

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:
     
     a. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.  

     b. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability severance pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.  

     c. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Temporary Disability Retired List for six months with a 50 percent disability rating effective date of discharge followed by assignment to the Permanent Disability Retired List with a final disability rating of 30 percent (increased from 10 percent).  

     c. XXXXXXXXXXXXXXXXXX, former USMC: Entitlement to disability severance pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge. 

     d. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.   

     e. XXXXXXXXXXXXXXXXXX, former USMC: An increase in disability rating from 30 percent to 60 percent for the period on the Temporary Disability Retired List followed by a final disability rating of 20 percent with entitlement to disability severance pay.

     f. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective date of discharge.

     g. XXXXXXXXXXXXXXXXXX, former USMC: Retroactive placement on the Permanent Disability Retired List with a 40 percent disability rating (increased from 20 percent) effective date of discharge.
 
3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are complete.