RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01496
BRANCH OF SERVICE:  marine corps 	SEPARATION DATE:  20060831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E3, Rifleman, medically separated for “bipolar disorder” with a disability rating of 10%.   

CI CONTENTION:  “Review all conditions.”   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 - 20060720	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bipolar Disorder.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health (MH) condition first surfaced in September 2004 while his unit was engaged in annual training in Japan (2 years before separation).  This was manifest as a depressive episode with vegetative symptoms and a self-aborted suicide plan. It was discovered that he was under the care of a civilian provider and already being treated with a mood stabilizer (Lamictal).  It was also disclosed at that time the CI had a family history of psychiatric disease; his grandfather was bipolar and both parents suffered depression.  This was not noted on the service entry physical; and, on an annual certificate of physical condition on 16 May 2004 just preceding the above annual training the CI denied “family or mental problems which might restrict your performance on active duty or prevent your mobilization.”  
The depression improved, but the CI developed mood swings with hypomanic episodes (excess energy, decreased need for sleep, mild grandiosity, and spending sprees).  It was not clear exactly when a diagnosis of bipolar disorder was established, or when the MEB was initiated.  The STR documented there was no suicidal ideation, psychotic or other acute symptoms, serious disciplinary or legal issues, alcohol or substance abuse, or psychiatric hospitalization.  

The 5 June 2006 MEB NARSUM examination, 3 months prior to separation, was corroborated by a comprehensive outpatient entry a month earlier (3 May) by the same provider (a clinical psychologist).  These constituted the only direct psychiatric clinical assessments in evidence from the available STR.  Probative evidence from the NARSUM is excerpted below:
“Since being on Lamictal, the Service Member reports his depressive episodes are less severe, shorter-lasting (a couple of weeks at a time) and he can "push through" the episodes.  However the Service Member is still unable to maintain employment for more than a few months. He reports that once his depression starts he is unable to perform to the level that he is used to and prior to being fired he will quit his employment position.”
The examiner further noted a decrease in manic/hypomanic episodes “now down to perhaps a couple of weeks per occasion” without specifying a frequency.  As an example of recent hypomanic behavior, the NARSUM cited “recently taking 19 credits of college courses and working full-time, but has since had to drop some classes.”  A past history of panic attacks was reported, but there was no indication these were still present.  Social functioning was not elaborated.  The CI was compliant with medication (Lamictal only) and weekly outpatient psychotherapy.

The mental status examination recorded a “calm to mildly anxious” mood with “a full range of affect,” and was otherwise normal (no suicidal ideation, delusional or hallucinatory symptoms, speech disturbance, cognitive impairment, etc.).  The Axis I diagnosis was “bipolar disorder, most recent episode depressed of moderate to severe severity, chronic.” The Global Assessment of Functioning (GAF) assignment was 45-55, which is in the serious range of impairment on that scale.  The examiner elaborated that the CI’s “symptoms are not completely under control as he continues to have mood swings making him incapable of performing as an active duty Marine … [but]…should be able to work in a civilian occupation, with moderate social and occupational dysfunctions in the future if his medications are further adjusted.”

The commander’s non-medical assessment did not reference any active MH symptoms, only the diagnosis; and, indicated the CI was still working within his infantry military occupational specialty.  A separation document listed proficiency and conduct scores of 4.3 each (upper end of average).  There was no VA Compensation and Pension evaluation proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s 10% rating under code 9432 (bipolar disorder) did not cite a rationale; although, the VASRD §4.130 criteria for that rating are  “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.”  The panel first considered whether the provisions of VASRD §4.129 for any “mental disorder that develops in service as a result of a highly stressful event” were applicable to this case.  Members agreed that, although there may have been contributory stressors from military service, bipolar disorder is inherently an organic mental illness not caused by any service-connected event consistent with the meaning and purpose of §4.129.  

The panel turned to deliberation of a fair rating recommendation at the time of separation.  Members first agreed the evidence would not support the §4.130 criteria for a 50% rating; i.e., “occupational and social impairment with reduced reliability and productivity” with reference to such symptoms as flat affect, stereotyped speech, frequent panic attacks, deficits in comprehension and memory, impaired judgment, mood disturbance, and difficulty with establishing relationships.  The service evidence suggested that, although the diagnosis mandated separation, there was no indication the CI was performing poorly within his assigned duties at the time of separation.  Other than mood disturbance, none of the typical symptoms exampled in the 50% rating description were present.  Deliberations thus settled on recommendations for a 10% rating, or a 30% rating for which the criteria states: “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.”  

The evidence regarding the actual MH impairment at separation was somewhat contradictory.  The NARSUM provider opined there was at least moderate occupational and social impairment and assigned a GAF score reflecting that opinion; but, at the same time indicated the CI was overachieving in college in addition to being employed full time.  Members agreed that, even though this high level of functioning was ascribed to the CI’s manic tendencies by the examiner, a conclusion that the functioning would deteriorate to a significant degree with better control of the mood swings was somewhat illogical and overly speculative.  The CI was changing jobs frequently, but this was based on his own performance assessment; thus, it could not be ascertained whether any significant occupational impairment was actually present.  The evidence from the commander that the CI continued to serve as an infantryman, as well as the good conduct and proficiency scores, were also suggestive that the MH impairment was not significantly disabling at the time of separation.  

Members agreed there was insufficient evidence in support of the above 30% criteria.  There was no objective basis for concluding that there was a significant decrease in work efficiency, nor were there any discernible periods of inability to function at work or in school.  It was further noted the CI’s failure to disclose his diagnosis and family history imposed an unfair burden on the service to provide administrative remedy or optimal treatment; and, the apparent lack of need for continuing evaluation and treatment after discharge mitigated a conclusion that there was MH impairment severe enough to justify a higher disability rating.  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 of the bipolar disorder.

BOARD FINDINGS:  In the matter of the bipolar disorder and IAW VASRD §4.130, the panel unanimously recommends no change in the PEB adjudication.   There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150614, w/atchs
Exhibit B.  Service 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

      In accordance with reference (a), I have reviewed the cases listed below and 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:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

		
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	     				     Acting