RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04220
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20020725
DATE PLACED ON TDRL:  20020726	DATE REMOVED FROM TDRL:  20050506

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Musician, medically separated from the Temporary Disability Retired List (TDRL) for “bipolar disorder” with a disability rating of 10%.

CI CONTENTION:  The PEB’s mental health rating should have been at least 30%.  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 - 20020418/20050429	VARD - 20020806	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL
Removal			TDRL
Placement	TDRL
Removal	
Bipolar Disorder	9432	30%	10%	Bipolar Disorder	9432	30%	--	
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Bipolar Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was diagnosed with mental health conditions (ADHD and depression) in March 1999.  His condition stabilized with medication in February 2001; however, in March his symptoms began to worsen after his command responsibilities were re-initiated.  His symptoms of anger, mood irritability, intolerance, frustration, agitation and aggression led to Command complaints and hospitalization in June 2001.  During hospitalization, the CI’s mental health (MH) diagnosis was changed to bipolar disorder type I.  Despite psychotropic medication, psychotherapy and hospitalization, the CI’s condition could not be rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred to an MEB.  The MEB forwarded bipolar I disorder to the PEB for adjudication.

At the MEB NARSUM performed in April 2002, 4 months before TDRL placement, the CI reported since his hospital discharge in June 2001, he was intolerant of work related military demands and efforts to adjust his medications were challenging.  He was taking a mood stabilizer and an antidepressant with inadequate treatment response primarily due to side effects.  The examiner noted that the CI appeared emotional.  The mental status examination (MSE) documented mild psychomotor retardation (slowness in movement and thought) and depressed mood and affect.  There was no evidence of a psychotic process, he appeared above average in intelligence and had good insight and judgment.  Suicidal or homicidal ideation was absent.  The Global Assessment of Functioning (GAF) score was assessed in the borderline mild to moderate range.  The diagnoses of bipolar I disorder, mixed, narcissistic character traits and psychological defenses, and irritable bowel syndrome were documented.

A VA Compensation and Pension (C&P) examination was not performed for the CI’s VA mental health disability claim.  

The Board first considered its rating recommendation at the time of placement on TDRL.  The PEB rated the bipolar disorder at 30%, coded 9432 (bipolar disorder), and placed the CI on the TDRL List.  The VA also rated the bipolar disorder 30%, coded 9432, based on the CI’s STR.  The Board found insufficient evidence that showed findings consistent with the 50% disability level.  After due deliberation, in consideration of all 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 at TDRL placement.

The CI underwent two TDRL examinations prior to TDRL removal.  At the first TDRL examination performed in February 2004, 15 months before TDRL removal, the CI reported he had not been able to gain employment.  He had worked briefly in heating and air conditioning but had problems making it work because of his irritable bowel syndrome.  He left car sale jobs because he had problems getting along with co-workers.  He noted that he tended to do okay with customers but the day to day interaction with co-workers, and his mood issues interfered with work.  The psychiatrist recorded the diagnosis of bipolar I disorder, mixed, and narcissistic traits was recorded as Axis II.

At the TDRL removal examination performed in February 2005, 3 months before separation, the CI reported he was employed full-time as a sheet metal laborer for a construction company where he began working in April 2004.  He was also working on his Bachelor’s degree through a correspondence program.  There were no hospitalizations since TDRL placement and no indication that the CI was ever treated in the emergency room (ER) for MH problems during the TDRL period.  The MSE was unremarkable.  The examiner recorded the diagnosis of bipolar disorder, type I, mixed.  A GAF score in the mild range was recorded.  

The Board next considered its recommendation for permanent disability rating at the time of removal from the TDRL.  The PEB rated the bipolar condition at 10%, coded 9432, citing the CI was employed full-time and attending college, and removed the CI from the TDRL List.  The Board considered the evidence and noted the CI had no hospitalizations in the 4 years prior to TDRL removal and was not treated in the ER.  He reported significant mood symptoms at work and was involved in a physical altercation, but had no legal history.  There was no report of domestic violence.  The Board acknowledged the CI’s reported issues at work; however, he was able to maintain employment for 12 months prior to separation.  He also completed his college degree during the TDRL period.  By the CI’s own report in the rebuttal letter to the PEB in March 2005, his condition had improved.  He stated that since starting a new medication post-TDRL removal examination, he had experienced “a pronounced difference” in his mood stability and an increased ability to control his anger.  Board members agreed, the record demonstrated, at the time of permanent separation, the CI’s condition was stable, and was best reflected in the 10% disability rating for mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication.

Thereupon, 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 disorder, type I condition at TDRL placement or removal.

BOARD FINDINGS:  In the matter of the Bipolar Disorder, type I condition, and IAW VASRD §4.130, the Board 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 20141009, 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, AR20160018291 (PD201404220)

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