RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04238
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030311

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Military Police (MP), medically separated for “bipolar disorder,” determined to exist prior to service (EPTS) without permanent service aggravation (PSA) and therefore it was not rated.  

CI CONTENTION:  The CI contends his condition was incurred in service.  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 - 20030114	VARD - 20030623	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder 	9432	EPTS	Bipolar Disorder with Panic Disorder	9432	30%	20030416	
COMBINED RATING:  EPTS NO PSA	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bipolar Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bipolar disorder condition began in the summer of 2002 after difficulties with his command.  He self-referred to mental health (MH) on 13 August 2002 as a walk-in, reporting being “overly stressed out” at work by his new squad leader who had reprimanded him for making mistakes.  At his intake on 26 August he reported mornings filled with “jitteriness, anxiety, and nausea.”  He had trouble with difficulty sleeping, decreased energy, decreased motivation to do his job and increased appetite.  He had similar feelings when he was 18 years old following a relationship with a martial arts student who became pregnant by him and had an abortion despite his objections.  He became very depressed and attempted suicide.  He had seen a high school counselor in ninth grade but was uncertain why.  A Post Deployment Health Assessment, dated February 2001 documented that the CI had been under care for suicidal gestures but the mental health (MH) officer stated “no follow up was needed, well adjusted.” 

He visited MH in August 2001 when he became angry and depressed while deployed to the Sinai after his wife had an abortion.  He cut his wrists in a suicide attempt and was placed on unit watch with a no weapons profile.  In July 2002 he had a 2-3 week period of increased energy, decreased need for sleep and appetite with rapid speech and racing thoughts.  Consideration was given to diagnoses of depressive disorder and bipolar II disorder.  He was placed on anti-depression medication in September 2002 and developed behavioral changes that included writing more traffic tickets than usual, high libido, increased writing projects and what appeared to be an auditory hallucination.  The MEB forwarded Bipolar II Disorder for PEB adjudication. 

The MEB NARSUM examination on 31 October 2002, 5 months prior to separation, noted the first anti-depression medication prescribed had precipitated hypomania.  It was discontinued and a mood stabilizing medication was started.  He was issued a no weapons profile and was reportedly able to function in details he was assigned to at his unit.  He was stable on his medication but still had episodes of depression.  A mental status exam (MSE) was essentially normal.  A diagnosis of bipolar II disorder was rendered with a Global Assessment of Functioning (GAF) score of 55-60 (moderate symptoms, impairment).  The examiner opined the CI would be able to function adequately with medication in a non-military environment.

At the VA Compensation and Pension (C&P) examination in April 2003, performed 1 month after separation, the CI reported he had been hospitalized for 4 days in January 2003 with depression and suicidal ideation.  He was looking for a job.  He had a close relationship with relatives and had one close friend.  MSE showed decreased libido and energy level.  He enjoyed martial arts and watching movies.  His last hypomania episode occurred in February 2003 when he was up about 50 hours.  Periodically he had a panic attack, the last one had been 4 months previous.  Diagnoses of bipolar disorder and panic disorder mild, were rendered with a GAF of 51 (moderate symptoms, impairment).  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB determined the bipolar disorder condition existed prior to service (EPTS), coded 9432 (Bipolar Disorder), citing a history of depression and suicidal attempt prior to entry on active duty and no evidence of permanent service aggravation.  The VA assigned a 30% rating using the same 9432 code based on the VA C&P examination 1 month after separation, citing occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  Application of VASRD §4.129 is considered by the Board for all cases of service connected psychiatric conditions resulting in separation; but, all members agreed that the ‘highly stressful event’ requisite for §4.129 was not satisfied in this case.  

The STR showed no findings at entrance into the Army of bipolar disorder and noted he had been diagnosed and treated for adjustment disorder on August 2001.  The NARSUM noted that bipolar disorder was not diagnosed until September 2002 and the diagnosis was made in relationship to the use of an anti-depression medication, Wellbutrin.  These findings do not support the EPTS designation by the PEB.  The Commander noted the CI frequently went on sick call since his diagnosis of bipolar disorder and he was unable to perform his duties as an MP since his profile.  He was able to perform normal daily duties of area beatification and vehicle maintenance.  According to the NARSUM, he was essentially stable on mood-stabilizing medication and had no episodes of hypomania.  The examiner opined the CI would be able to function adequately with medication in a non-military environment.  The Board considered an appropriate §4.130 rating.  The §4.130 criteria for a 10% rating is “occupational and social impairment due to 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.” A 30% rating requires “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.” 

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the bipolar condition, coded 9432.  

BOARD FINDINGS:  In the matter of the bipolar condition, the Board unanimously recommends a disability rating of 10%, coded 9432 IAW VASRD §4.130.  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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Bipolar Disorder	9432	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141106, 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 XXXXXXXXXXXXXXXXXXXXX, AR20160018298 (PD201404238)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA