RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00505
BRANCH OF SERVICE:  army	SEPARATION DATE:  20070614

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Veterinary Food Inspector, medically separated for “bipolar I disorder…” with a disability rating of 10%. 

CI CONTENTION:  The CI requests that all conditions be considered.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20070307	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar I Disorder…	9432	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bipolar I Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had deployed to Iraq from May 2004 to January 2005 and initially sought psychiatric care in Kuwait at a post-deployment debriefing.  The CI presented for care in September 2006 complaining of a worsening history of depressed mood, loss of interest, aggressive anger and thoughts of death and suicide.  The MEB NARSUM examination was a compilation of outpatient visits (dated 22 and 29 September and 6, 12, and 20 October 2006) with the last being 8 months prior to separation.  The initial mental status exam (MSE) noted easy distraction, increased rate of speech, expansive mood with labile affect, and tangential and circumstantial thought processing with flight of ideas.  The CI was irritable and grandiose.  Insight and impulse control improved over time.  A diagnosis of bipolar disorder, most recent episode manic, moderate was rendered with a Global Assessment of Functioning (GAF) score of 30 on initial presentation, which improved to a GAF of 55 (moderate symptoms, impairment) at the last visit (20 October 2006).  At that last visit the CI complained of increased irritability, grandiosity, hyper-religiosity, pressured speech, racing thoughts, tangential thoughts, and modest paranoia regarding his command and the President.  He said he was going to shoot himself in the head with a cannon.  The CI had one instance of perceptual disturbances and had recently attacked spiders with sticks.  His medication was increased again.  The examiner noted the CI was functioning adequately in a limited role but had frequent conflict with his peers. He was able to perform small duties adequately as a food inspector but had no collateral responsibilities, and had poor potential for promotion.  

There were no VA Compensation and Pension (C&P) examinations or Rating Decisions in evidence.  The commander’s statement dated 8 January 2007 (5 months prior to separation) noted the CI’s duty performance had been exceptional.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar I disorder 10%, coded 9432 (bipolar disorder), citing mild industrial impairment.  There were no VA examinations or Rating Decisions in evidence.  Application of VASRD §4.129 is considered by the panel 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 clearly satisfied in this case.  The panel next considered whether there was evidence for a §4.130 rating higher than the 10% assigned by the PEB.  The §4.130 criteria for a 10% rating includes “symptoms controlled by continuous medication,” while those for a 30% rating include “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  The most recent outpatient visit documented a return of symptoms requiring an increase of medication, and was notable for a functional score (GAF) of 55 (denoting moderate symptoms).  The commander, though, noted exceptional performance, efficiency, and military discipline, and that the bipolar disorder was “virtually invisible to this command.”  There were no further documented outpatient visits.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the bipolar I disorder.  

PANEL FINDINGS:  In the matter of the bipolar I disorder and IAW VASRD §4.130, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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

AR20170006494, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure