RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03688
BRANCH OF SERVICE: Army  	SEPARATION DATE:  20041020

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Truck Driver, medically separated for “bipolar disorder,” with a disability rating of 10%.  

CI CONTENTION:  “Please consider 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 on 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 - 20040903	VARD - 20050323	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	Bipolar Affective Disorder	9432	30%	STR	
Low Back Pain	Not Unfitting	Degenerative Changes, Lumbar Spine	5242	10%		
Hypertension	Not Unfitting	Hypertension	7101	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:   

Bipolar Disorder.  According to the service treatment records (STR) and the mental health (MH) Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI was diagnosed with bipolar mania in October 2003, during deployment to Kuwait.  He responded well to medication and was able to remain on active duty.  The CI’s condition stabilized, and his medications were discontinued; however, this resulted in exacerbation of symptoms with noted decline in his behavior.  He had greater than 30 days remaining on his deployment and was exhibiting manic behaviors; therefore, in April 2006, he was referred to the MEB and was medically evacuated from theater.  The CI participated in post deployment adjustment group therapy and was under the care of a psychiatrist.  He also participated in the bipolar disorder group therapy.  A psychiatry follow-up visit dated 24 May 2004, recorded the CI’s report that he was doing “pretty well.”  He had some problems with aggravation at his coworkers, but stated he was able to control his anger.  The psychiatrist noted that he continued to demonstrate hypomanic symptoms which required medication adjustments. 

At the NARSUM, 17 June 2004, 4 months before separation, the CI noted his bipolar symptoms began in the summer of 2003 with marked irritability.  Later his symptoms evolved into sleeplessness, racing thoughts and irritability.  He had other symptoms in theater suggestive of bipolar mania.  He was initially sent to anger management classes, but his bipolar symptoms continued and he was referred for a MH assessment and was diagnosed with bipolar disorder.  He noted he had responded very well to medication and his symptoms abated.  After stabilization, the medication was discontinued and his symptoms returned.  The medication was re-introduced and most of his symptoms were controlled; however, he had some continued problems with irritability and anger.  He had some difficulties with a couple of people in the medical hold unit, and continued to be hypomanic, but was less loud and intrusive.  The CI denied a prior MH history of bipolar, but noted he was treated for attention deficit hyperactivity disorder in childhood.  The psychiatrist documented a mental status examination (MSE) that was performed on 19 April.  It was noted at the time he demonstrated mild looseness of association and distractibility, and his affect was bright, and his mood was described as “hyper.”  The examiner noted that since the 19 April MSE, his medication was adjusted and looseness of association was no longer an issue.  The psychiatrist noted that his condition had caused him some problems in Iraq, but since he performed his duties well, the unit preferred to keep him in country rather than to medically evacuate him.  It was noted that he still had problems with irritability on the job, and that he required continuous medication to address his condition.  The Global Assessment of Functioning (GAF) score of 65 for mild symptoms and or impairment was assessed.  The examiner noted his GAF had not changed since the onset of his condition.

The CI was non-attendant to the VA Compensation and Pension (C&P) examination.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition of bipolar disorder, most recent episode mixed, coded 9432 (bipolar disorder) at 10%, with the notation that his condition had stabilized and required continued therapy.  The VA, used the STR and granted 30% disability rating under the same code.  First, the Board noted there was no specific, highly stressful service related event to invoke §4.129 for a mental disorder due to traumatic stress.  There was no documented traumatic stressor in the treatment record.  All Board members agreed the provisions of §4.129 were not applicable.   The Board reviewed the evidence and proceeded to rate under VARSD §4130.   The NARSUM recorded absence of psychiatric hospitalizations and noted the CI’s mood rapidly stabilized with treatment.  His GAF score was indicative of mild symptoms and or impairment.  Although he continued to have some irritability, there were no other prominent mood symptoms resulting in decreased occupational or social functioning.  The CI noted that he was engaged to marry and had custody of his grade school age son who was living with the fiancée.  There was no report of violence or chronic sleep impairment affecting his ability to perform his duties.  The Board noted the normal MSE recorded 2 months after separation at the VA MH intake evaluation.  At the time he was living with the fiancée and his son, and was looking for work.  He noted that he had no difficulty with sleep and slept for 7-8 hours uninterrupted, and he was stable on medication.  Board members agreed that his symptoms were well controlled by the continuous use of medication and, 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 bipolar disorder condition. 

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that hypertension and low back pain conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The hypertension and low back pain conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.   Both were reviewed and considered by the Board.   There was no performance based evidence from the record that either condition significantly interfered with satisfactory duty performance.  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 fitness determination for the any of the contended conditions and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the Bipolar Disorder condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension and low back pain conditions, 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 20140717, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

MEMORANDUM FOR Commander

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXX, AR20160011587 (PD201403688)

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