RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02552
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20090803

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

CI CONTENTION:  The CI made no specific contention.  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 - 20090413	VARD - 20091216	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar II Disorder	9434	10%	Bipolar II Disorder	9434	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bipolar II Disorder.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI presented in August 2008 for evaluation of an ever-worsening depressed and irritable mood over the previous month.  He was recently married and his symptoms precluded his “getting underway” on his submarine.  He was returned to his home port, was seen in psychiatry on 18 September 2008, diagnosed with bipolar disorder and begun on medications.  The CI continued outpatient treatment in mental health with medication adjustments and reported improvement in his symptoms.  No emergency room (ER) visits or hospitalizations were in evidence.  

The 16 March 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of self-reproach since removal from the submarine.  He denied the presence of hallucinations or delusions.  At the time of the MEB examination, his mood was slightly anxious, but thought content was intact.  The mental status examination was otherwise unremarkable.  The CI described some mild and/or intermittent improvements in mood, however his overall status did not improve during the 6 months he was in treatment.  He stopped all but one psychiatric medication.  His impairment was thought to be moderate and his risk for future relapse unacceptable for continued service.  It was noted the disorder interfered with satisfactory duty performance.  He did not meet retention standards due to his requirement for ongoing psychotherapy and medications.  The 25 March 2009 non-medical assessment stated the CI was not able to meet the strenuous requirements of submarine duty unless his medical condition was resolved.  The commander stated, “the assignments he has been tasked with require minimum physical effort.” Difficulty with alternate duties was noted when the CI reported he was frustrated with his “job” (cleaning toilets) particularly the interpersonal conflicts that invariably occurred.   There was no VA Compensation and Pension examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar II disorder condition 10%, coded 9434 (major depressive disorder).  The VA also rated the bipolar II disorder condition 10%, coded 9432 (bipolar disorder), based on the STR.  For a higher 30% rating, there must be intermittent periods of inability to perform occupational tasks.  While the CI was unable to return to submarine duties, the demands for this profession exceed those of a typical civilian occupation.  There was no STR evidence of hospitalization or ER visitation for this condition.  However, the NARSUM noted the disorder was severe enough to interfere with satisfactory duty performance and the prognosis for return to full functional status was poor.  The panel majority determined evidence supported a disability closer to the 30% level of impairment at separation than the 10% adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 30% for the bipolar II disorder condition, coded 9432.  

BOARD FINDINGS:  In the matter of the bipolar II disorder condition, the panel majority recommends a disability rating of 30%, coded 9432 IAW VASRD §4.130.  The minority voter elected not to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows and 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 20151117, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

MEMORANDUM FOR DEPUTY COMMANDANT (Manpower and Reserve Affairs)
COMMANDER, NAVY PERSONNEL COMMAND

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
        (b) PDBR ltr dtd 03 Jan 18 ICO XXXXXXXXXXXXXXXXXX        
        (C) PDBR ltr dtd 07 Jan 18 ICO XXXXXXXXXXXXXXXXXX
        (d) PDBR ltr dtd 22 Dec 17 ICO XXXXXXXXXXXXXXXXXX
        (e) PDBR ltr dtd 03 Jan 18 ICO XXXXXXXXXXXXXXXXXX
        (f) PDBR ltr dtd 03 Jan 18 ICO XXXXXXXXXXXXXXXXXX

1. Pursuant to reference (a), the recommendations of the Physical Disability
Board of Review set forth in references (b) through (f) are approved. The
official records of the following individuals are to be corrected as follows:

a. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the
Permanent Disability Retired List with a 30 percent rating (increased from 10
percent) effective date of discharge.

b. XXXXXXXXXXXXXXXXXX, former USMC: Placement on the
Permanent Disability Retired List with a 30 percent rating (increased from 10
percent) effective date of discharge.

c. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to
disability separation pay with a 20 percent disability rating (increased from
10 percent) effective date of discharge.

d. XXXXXXXXXXXXXXXXXX, former USN: Placement on the
Permanent Disability Retired List with a 30 percent rating (increased from 10
percent) effective date of discharge.

e. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent
Disability Retired List with a 30 percent rating (increased from 10 percent)
effective date of discharge.

2. Please take action to implement these decisions and provide notification
to the above individuals once those actions are complete.

XXXXXXXXXXXXXXXXXX
Acting