RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02294
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060918

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E7, Imagery Analyst, medically separated from the Temporary Disability Retired List (TDRL) for “bipolar II disorder with associated panic disorder,” with a disability rating of 10%.

CI CONTENTION:  He requests review of 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 - 20060814	VARD - 20060125	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar II Disorder with Associated Panic Disorder	9432	1%	Bipolar II Disorder, Panic Disorder with Agoraphobia	9434-9422	70%	20050913	
COMBINED RATING:  1%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Bipolar II Disorder with Associated Panic Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a long history of depression and manic like behavior, but was not diagnosed with a mental disorder until November 2004 when he was diagnosed with an anxiety disorder.  He was put on medications, but then became depressed and was diagnosed with bipolar disorder by psychiatry in December 2004.  This was determined to be medically unacceptable and he was referred for an MEB.

The 10 January 2005 MEB NARSUM examination, 7 months prior to TDRL placement noted the CI reported a long history of periods of depression and manic like behavior.  He reported a period of depression several years earlier which had resulted in hospitalization for suicidal ideation as well as inpatient treatment for alcohol abuse, the latter in 2002.  On examination, there was some psychomotor slowing and a restricted, depressed affect.  

Following his NARSUM evaluation, the CI required inpatient stabilization from 21 -27 January 2005.  His medications were adjusted and he continued these and outpatient therapy until and beyond TDRL entry.  A mental health note by the treating psychiatrist noted that the 50% disability adjudicated by the MEB (sic, PEB) was appropriate.  

At the 13 September 2005 VA Compensation and Pension (C&P) mental health evaluation, performed 6 weeks after TDRL entry, the CI reported that he had seen a civilian psychologist in the late 1990s for mental health difficulties which he wished to keep from the Army.  He reported that he was doing “significantly better” on medications since the hospitalization in January 2005.  He was working full time in a technology firm and had no problems at work from his mental health diagnosis.  He remained married to his second wife and endorsed a strong and supportive relationship.  His mental status examination was notable for being 30 minutes late which he attributed to his poor concentration.  It was otherwise fairly unremarkable.  

The CI was entered onto TDRL with a 50% rating, coded 9432 (bipolar disorder).  The VA rated the bipolar II disorder with associated panic disorder condition 70% dual coded as 9434-9422 (major depressive disorder and pain disorder), based on the VA C&P examination shortly after TDRL entry, citing VA treatment records as well as the findings from the VA Psychological examination.  Following TDRL placement, the CI continued to be followed by his military psychiatrist and reported doing well with medications and outpatient therapy.  

The TDRL removal examination was accomplished on 20 July 2006, 2 months prior to TDRL removal.  He endorsed a good response to medications and psychotherapy although he continued to report depressive symptoms and occasional episodes of hypomania, changing the diagnosis to Bipolar II disorder.  He continued to work, but reported that there were “many” days that he only worked a half day or stayed home altogether due to depression.  This was not quantified though.  He reported that he had a supportive supervisor.  His marriage remained supportive and he also reported benefit from a strong religious faith.  He and his wife had a second daughter, 10 months of age.  No difficulties with parenting were recorded.  He had not been hospitalized and there was no record of care in the emergency room.  He took medication for agitation and anxiety less than twice a week; panic attacks were not documented.  On examination, he appeared depressed and there was some psychomotor slowing.  His affect was congruent.  However, his thought processes and content, insight and judgment, and concentration were intact.  The examination was otherwise unremarkable.  His impairment was thought to be severe.  

The PEB rated the bipolar II disorder with associated panic disorder condition 10%, coded 9432 (bipolar disorder), at TDRL removal, citing mild industrial impairment based upon demonstrated function with steady employment and a stable marriage.  The panel considered the evidence.  Although the CI did maintain steady employment he also endorsed the inability to go to work due to depressive symptoms.  He had a supportive supervisor when he could not work and a supportive spouse.  This is consistent with a 30% rating IAW VASRD §4.130.  The panel observed that the impairment from the panic disorder is subsumed into the total disability from the Bipolar II disorder.  The panel did consider a higher 50% rating, but noted that the CI continued to work and maintain his marriage albeit with support from his supervisor and spouse.  There was no record of emergency room visits or hospitalization.  Agitation was noted, but not panic attacks.  Thought processes were intact.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the bipolar II disorder with associated panic disorder condition coded 9432.  

BOARD FINDINGS:  In the matter of the bipolar II disorder with associated panic disorder condition, the panel unanimously recommends a disability rating of 30%, coded 9432 IAW VASRD §4.130.  There were no other conditions within the panel’s scope of review for consideration.  The panel recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Bipolar II Disorder	9432	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150815, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012184, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXX.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,					      
Enclosure