RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00451
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20070615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Warehouseman, medically separated for “bipolar disorder not otherwise specified” with a disability rating of 10%.

CI CONTENTION:  “PTSD, insomnia, and anxiety are still prevalent in day to day activity.” 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 - 20070404	VARD - None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder NOS	9432	10%	No VA Claim	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bipolar Disorder Not Otherwise Specified (NOS). According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health condition was recognized when his primary care manager requested a mental health evaluation for “mood liability changes from hour to hour.”  Despite treatment, the mental health condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “bipolar I disorder, single manic episode” for PEB adjudication.  

On 17 November 2006, the CI presented with complaints of depression, difficulty focusing and working and no desire to work.  He reported that he had been compliant with taking his medications.  The examiner observed the CI to exhibit limited eye contact, at this time.  On 29 November 2006, the CI was admitted for inpatient treatment for worsening symptoms of frequent panic attacks.  The CI had fleeting thoughts of suicidal ideation without attempt.  He was admitted for stabilization and medication adjustment.  The mental status examination showed the CI presented with an anxious mood, labile and congruent affect, slightly loud and verbose and also had thoughts characterized as logical in content with linear processing.  The CI was stabilized on the ward with an adjustment in medications.  He was appropriately discharged 3 days later. At the time the CI was discharged, he was not suicidal, homicidal or psychotic and was stable for outpatient mental health treatment and services.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated December 2006, 6 months prior to separation, the CI reported shortness of breath caused by anxiety attacks, frequent trouble sleeping, excessive worry and depression, being admitted to a psychiatric ward from 29 November 2006 to 1 December 2006 and being treated and diagnosed with Bipolar I Disorder.  The CI admitted to taking Lamictal, Seroquel, Klonopin and Ativan for his condition.  The CI reported having a family history significant for bipolar disorder, attention deficit hyperactivity disorder and schizophrenia.  

The MEB NARSUM examination on 6 March 2007, 3 months prior to separation, noted complaints of frequent mood swings to include hyperactivity, depression, extreme anger and constant state of worry.  The CI also complained of worsening sleep disturbance, irritability, agitation, racing thought, accelerated speech and rapid cycling for the past month to two months.   He denied any suicidal or homicidal ideation, however he reported an episode of wanting to cut himself while depressed.  The CI stated that none of these symptoms existed prior to his enlistment in military service.  The CI was diagnosed with Bipolar Disorder.  The CI’s condition was controlled with medication (Ativan, Lithium, Klonopin and Seroquel).  These medications allowed the CI’s condition to be currently stable, however his prognosis was poor.  On physical examination the CI was agitated, worried demonstrated pressured speech with accelerated thought processes, some psychomotor agitation and had a range of affect that was restricted aligned with congruency with his mood.  The CI has not applied or received a disability rating from the VA.    

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated bipolar disorder not otherwise specified condition 10%, coded 9432 (Bipolar disorder), relying heavily on the report of the MEB dated 6 March 2007, 3 months prior to separation, which stated that the CI “is unlikely to recover to a consistent level that will render him fit for continuing military service,” and “he is likely to require continuing psychiatric treatment for the rest of his life.”  There was not any VA claim documentation in the CI’s file available for review.  Next, the Board directed its attention to the criteria which must be met to satisfy a rating of either 10 percent or 30 percent under code 9432, Bipolar Disorder IAW VASRD §4.130, schedule of ratings for mental disorders.  A rating of 10 percent is assigned for 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.  At the MEB NARSUM examination on 6 March 2007, 3 months prior to separation, it was noted that the CI’s condition was controlled and currently stable with medication, therefore meeting criteria for a 10 percent rating.  A rating of 30 percent is warranted if the CI exhibited 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), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, recent events).  The CI did not meet criteria for a 30 percent rating due to the fact that he admitted to not having any work related (occupational) problems (impairments) or relationship (social) problems (impairments) 8 months prior to separation on 4 October 2006 or had not mentioned any such problems at any other examinations, however he did report panic attacks.  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 not otherwise specified condition.  

BOARD FINDINGS:  In the matter of the Bipolar Disorder Not Otherwise Specified condition and IAW VASRD §4.130 the Board unanimously 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 20150602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 16 Nov 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXX
	     				  	  Assistant General Counsel
						  (Manpower & Reserve Affairs)