RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01146
BRANCH OF SERVICE:  Army 	
DATE PLACED ON TDRL:  20030906	DATE REMOVED FROM TDRL:  20060407

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Multichannel Transmission Systems Operator/Maintainer, medically separated from the Temporary Disability Retired List (TDRL) for “bipolar disorder,” with a disability rating of 10%.

CI CONTENTION:  “0% for bipolar I and 10% for right knee.”  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 – 20030527/20060316	VARD - 20030922	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Bipolar Disorder	9432	30%	10%	Bipolar Disorder Type I	9432	0%	30%	
COMBINED RATING:  30% → 10%	COMBINED RATING OF ALL VA CONDITIONS:  10% → 40%	

ANALYSIS SUMMARY:

Bipolar Disorder.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health condition began in February 2003.  The CI was apprehended by the Military Police after being found naked outside his home after a sleepless night.  He was transferred to the emergency room and admitted to a psychiatry inpatient unit.  The CI’s wife and his command provided the history due of the CI’s mental status.  He developed a sleep disturbance over the past month but over the weekend of admission he did not sleep at all and had increased energy.  He was very talkative and rambling, had racing thoughts, and expressed the belief that he was Jesus February 27-28, 2003.  He pushed a security guard at church and pushed his wife out of bed.  He was confused and incoherent and stated he had an affair with another woman and had a serious infection.  He had no history of prior psychiatric illness and the unit reported no abnormal behavior or declining work performance.  He remained psychotic for 3 days and was treated with anti-psychosis and mood-stabilizing medications.   Psychosis evaluation was negative for other causative illnesses.  Despite treatment, the condition could not be adequately rehabilitated to meet the requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “bipolar I disorder” for PEB adjudication.  

The MEB NARSUM examination on 2 March 2003, 6 months prior to placement on TDRL and performed as an inpatient on a psychiatry hospital unit, noted complaints on admission as stated above. Mental status examination (MSE) showed slowed mumbling speech with poor articulation, impaired immediate and recent memory, impaired concentration, “groggy” mood, blunted affect, loose thought processes, confusion, distractibility, incomplete sentences, and a delusion that he was Jesus Christ.  Insight and judgment were poor and he desired to leave the unit and would often check doors and locks.  He was compliant with treatment and became stable.   It was determined he could not function on active duty and was placed on limited duty to await his medical board.   Diagnosis of bipolar disorder was rendered with considerable impairment for social and industrial adaptability.  

At the 30 June 2003 VA Compensation and Pension (C&P) evaluation, performed 2 months before being placed on TDRL, the CI reported he did not think he was bipolar and probably had a reaction to medication.  He was taking medication for a positive tuberculosis skin test, back medication and weight reduction medication since 2002.  He was currently taking a mood-stabilizing medication twice daily.   He denied any psychiatric symptoms and stated he felt pretty good.  He planned to finish college after leaving the Army.  MSE was unremarkable.  A diagnosis of bipolar I disorder was rendered with a Global Assessment of Functioning (GAF) score 65 (mild symptoms, impairment.)

The Board directed attention to its rating recommendation based on the above evidence.  The CI was separated and placed on TDRL with a disability rating of 30%, coded 9432 (bipolar disorder), citing definite social and industrial impairment.  The VA rated the bipolar disorder condition 0%, coded 9432, citing symptoms not sever enough either to interfere with occupational and social functioning or to require continuous medications.  The Board first considered whether the provisions of VASRD §4.129 (mental disorders due to traumatic stress) were applicable.  The Board noted that there was no traumatic event causing the unfitting mental health condition and therefore concluded that application of VASRD §4.129 was not appropriate in this case.

The Board then considered its rating recommendation at the time of placement on TDRL.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” for a 30% rating is “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.” Both the NARSUM and the VA C&P examinations prior to TDRL placement noted the CI had become stable with medication, though still in denial of his illness.  Two months prior to separation he said he felt pretty good.   Board members agreed that his condition did not meet criteria for a rating higher than 30%.  

At the 20 April 2005 VA C&P evaluation, performed 11 months before removal from TDRL, the CI reported he was last seen in follow up on 10 June 2004 and had not seen a psychiatrist since.  His lithium had been discontinued due to side effects and his primary care physician prescribed the anti-psychosis medication, which he will go without for days.  Since his last evaluation in 2003 he denied manic episodes.  He did report mood swings, being talkative by others’ account and being sexually demanding.  Sleep was variable.  Mood was recently irritable and at times depressed though at times he felt happy and grandiose.  He denied suicidal thought.  Sometimes he had increased energy.  He did admit to hyper religious feelings at times.  He has worked full time since discharge and has worked fairly well in day-to-day activities. MSE showed depressed mood, constricted affect, no evidence of delusions or hallucinations and no panic attacks.  His diagnosis remained bipolar I with a GAF score 65.  

The MEB NARSUM examination on 27 December 2005, 3 months prior to removal from TDRL, the CI reported he continued to work full time and part-time.  He lived with his wife and children and spent time with the family, listened to music and exercised.  He denied bipolar related problems but admitted the medication helped him maintain a stable mood.  Half the time he did not take the medication due to side effects but had medication management once every two months.  He had no further hospitalizations.  MSE showed some word-finding difficulties and normal thought processes and content.  His diagnosis remained bipolar, type I.   

The Board next considered its recommendation for permanent disability rating at the time of removal from the TDRL.  The CI was removed from the TDRL with a disability rating of 10%, coded 9432 (bipolar disorder), citing mild social and industrial impairment.  The VA rated the bipolar disorder condition 30%, coded 9432, citing occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  The TDRL examination most proximal to discharge was the 27 December 2005 NARSUM examination.   The CI was gainfully employed and able to enjoy his family and other interests.  He was partially compliant with medication but continued to receive follow up care and maintain a stable mood.  MSE did not reveal significant impairment.  The Board concluded he was stable with medication, meeting 10% rating criteria.  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 adjudications for the bipolar disorder condition at TDRL removal.  

BOARD FINDINGS:  In the matter of the bipolar disorder condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication at both TDRL placement and TDRL removal.  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 20150610, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

08 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002451 (PD201501146)

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