RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00588
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080811

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard E4, Security Forces Journeyman, medically separated for  “bipolar I disorder” rated 10%.

CI CONTENTION:  The CI contends for his unfitting mental health condition along with a number of other conditions not identified by the Medical Evaluation Board (MEB) or Physical evaluation Board (PEB).  The applicant’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 – 20080626	VARD – Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar I Disorder	9432	10%	Bipolar Disorder	9499-9432	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Bipolar I Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bipolar condition began in January 2008 while attending Security Forces Technical training.  At the time of presentation, the CI reported increased stress, anxiety, anger, depressed mood, diminished concentration, and an inability to sleep.  In late January he reported suicidal ideation (SI) with a plan to drive his car into a lake.  The CI reported he was admitted to psychiatry inpatient unit for 24-hour observation where he stated that he had never planned to act on his suicidal thoughts and had no history of suicide attempts.  However, there is no record of a hospitalization, but there was a note from a civilian medical center that recorded the CI had been under observation overnight in the emergency room and discharged since he was of no danger to self.  The CI’s bipolar condition was treated with medication which provided significant improvement.  However, his condition did not improve sufficient enough to allow for continued service and he was referred to MEB.  The MEB forwarded “bipolar I disorder, most recent episode mixed, moderate and personality disorder NOS” to the Physical Evaluation Board (PEB) for adjudication.

The MEB NARSUM dated 27 February 2008, 6 months before separation, reported the CI spent 6 months flying in and out of Liberia as part of “operation shining star”, and that this was very stressful due in part to the number of coffins he loaded onto his aircraft.  At the time of the NARSUM, the CI endorsed anxiety symptoms suggestive of panic attacks with agoraphobia, and generalized anxiety.  He indicated his anxiety symptoms had been present since age 8.  He denied any trauma exposure or PTSD symptoms.  The CI noted he had continued to take psychotropic medication; however, not in the dosage prescribed, and lab measurements were consistent with non-compliance.  He denied current alcohol use or legal history.

Mental status examination was unremarkable.  The diagnoses of bipolar I disorder, most recent episode mixed, moderate, and personality disorder NOS were recorded with a Global Assessment of Functioning (GAF) score of 60 for mild symptoms.  The examiner wrote the CI had “demonstrated past symptoms suggestive of a mixed bipolar, although at the time of interview at DGMC these had resolved.”  An addendum to the NARSUM dated 22 April 2008, approximately 4 months before separation, noted there had been no change in the CI’s condition since the NARSUM.  The CI did not present to the VA Compensation and Pension (C&P) mental evaluation.

The Board directed attention to a rating recommendation based on the above evidence.  The PEB rated the bipolar disorder at 10%, coded 9432 (bipolar disorder), citing “bipolar symptoms had resolved at the time of your interview, it appears that they cause 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.”  The VA did not service-connect a MH condition.  The Board next considered if the provisions of VARSD 4.129 were applicable and all Board members agreed 4.129 was not applicable in this case.  The Board next proceeded with the rating recommendation.  The higher rating of 30% is not warranted unless there is clear demonstration of “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to symptoms such as weekly panic attacks, depressed mood, anxiety, chronic insomnia, etc.  The Board considered the NARSUM psychiatrist statement that the CI’s symptoms of bipolar had resolved, the commander’s statement, and the normal MSE despite absence of treatment compliance.  All Board members agreed, there was insufficient evidence to support the higher rating of 30%.  There were no recorded panic attacks, no symptoms documented in the commander's statement, no psychiatric in-patient treatment and no visits to the emergency room.  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 condition

Contended PEB Conditions:  The Board’s main charge is to assess the fairness of the PEB’s determination that the Personality Disorder NOS condition was not unfitting.  IAW DoDI 1332.38, personality disorders do not constitute a physical disability, and are therefore, not compensable or ratable.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bipolar disorder, mixed episode condition and IAW VASRD §4.130, the Board recommends no change in the PEB adjudication.  In the matter of the contended personality disorder NOS condition, the Board recommends no change from the PEB determination 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 20150602, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00588.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings