RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03214
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070307

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E5, Infantryman, medically separated for “bipolar II disorder” rated at 10%.

CI CONTENTION:  The CI requests that all conditions be considered.  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 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:  

SERVICE PEB – 20070129	VARD - 20070823	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar II Disorder	9434	10%	Bipolar Disorder	9434	10%	20070502	
Bilateral Lower Leg Pain, Shin Splints	Not Unfitting 	PFPS…Right Knee w/ Shin Splint		NSC	20070329	
		Shin Splint, Left Knee				
Mild Hyperlipidemia		No VA Placement	
Back Pain		Thoracolumbar Spondylosis…	5010-5239	10%	20070329	
Intermittent Headaches		S/P TBI w/ Headaches…	8045-8100	10%	20070417	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Bipolar II Disorder.  According to the Medical Evaluation Board (MEB) mental health addendum to the narrative summary (NARSUM), dated 13 December 2006, 3 months prior to separation, the CI reported that he had always been emotional and had presented for anger management in 2003 while overseas.  He was offered medications on return from deployment in 2005 based on his responses in the Soldier Readiness Program, but declined due to spontaneous improvement in mood.  The CI self-referred to mental health from the emergency room after his First Sergeant suggested that he do so following an episode in which he chased another soldier with a crowbar following a minor provocation.  He began medications following the crowbar incident, but had deterioration.  Further inquiry revealed a history, which initially had been denied, consistent with manic episodes.  He also reported a family history of bipolar disorder.  Other than a feeling of despair, his mental status examination was normal.  The commander’s statement was dated 18 December 2006.  It noted that the CI was in the MEB process.  Nonetheless, he worked 50+ hours in support of the rear detachment command.  He “can be trusted to complete any and all tasks independent of supervision and frequently engages and solves problems above his rank and grade.  He conducts all his duties in a military manner.”  In a separate document, the commander noted that the CI had behavioral changes from pre-deployment to post-deployment.  At the VA Compensation and Pension (C&P) mental health examination on 2 May 2007, 2 months after separation, the CI reported a long history of depression dating to his teens.  He reported anger issues and manic symptoms after his return from deployment.  He endorsed sleep disturbances since 2003.  He denied hospitalization and had only made one trip to the emergency room (above).  He denied employment, but at the general medical C&P on 29 March 2007, 3 weeks after separation, he reported that he was working in construction.  His mental status examination was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the bipolar II disorder at 10%, coded 9434 (major depressive disorder) and 9432 (bipolar disorder) respectively.  The Board considered if the CI met the requirements of a higher (30%) rating which are “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal).”  The evidence does not support this level of dysfunction.  Rather, the evidence shows that he continued to function at a level higher than average.  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 II disorder condition.  The Board also determined that the criteria for VASRD §4.129 (mental disorders due to traumatic stress) were not met.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the bilateral lower leg pain, mild hyperlipidemia, back pain, and intermittent headaches were not unfitting.  The listed conditions or implicated in the commander’s statement and were not judged to fail retention standards.  None were permanently profiled other than the bilateral lower leg pain (shin splint condition).  It had been considered the previous summer in a separate MEB and cross-training recommended.  The Board noted that the VA attributed the headaches to a traumatic brain injury (TBI).  Review of the records shows that the CI was seen for headaches 3 times in the 18 months prior to separation and was treated with medications to be taken as needed.  There was no record of lost duty from the headaches.  All were reviewed and considered by the Board.  There was no performance-based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended conditions, so no additional disability ratings are recommended.  The Board notes for the record that hyperlipidemia is a laboratory finding and not a physical disability.  

BOARD FINDINGS:  In the matter of the bipolar II disorder condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended bilateral lower leg pain, mild hyperlipidemia, back pain, and intermittent headaches, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140606, 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), 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160011316 (PD201403214)

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
( ) OVA