RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00199
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20071015

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an E6, Machinist Mate, medically separated for “bipolar II disorder” with a disability rating of 10%.

CI CONTENTION:  “Please 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 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 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 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 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 - 20070709	VARD - 20160210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar II Disorder	9432	10%	Mental Health Condition	 9400	NSC	STR	
Asthma	Cat III	Asthma	6602	NSC	STR	
Hypertension	Cat III	Hypertension	7101	10%	STR	
Allergic Rhinitis	Cat III	No VA Placement	
Gastroesophageal Reflux Disorder (GERD)	Cat III	No VA Placement	
Hyperlipidemia	Cat IV	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bipolar II Disorder.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bipolar disorder began in approximately 1998.  He had episodes consistent with major depressive disorder that included increased appetite, increased need for sleep, feelings of worthlessness, severe depression, and suicidal thoughts with various plans.  His depressive episodes occurred approximately twice per year and lasted up to 1-1/2 months.  He also had recurrent hypomanic episodes that included feelings of either euphoria or anger and irritability and were associated with decreased need for sleep, racing thoughts, increased energy, and these episodes lasted a week or more.  He sometimes had rapid cycling in that he would feel energetic in the morning and then depressed in the afternoon.  He was started on medication but continued to have recurrent mood lability of both depressive and hypomanic episodes.  The 17 May 2005 MEB NARSUM examination, 5 months prior to separation, noted no current complaints and was doing well with no symptoms since March of 2005.  Mental status examination showed that the CI was alert, pleasant, and cooperative.  He was neatly groomed and dressed.  His speech and motor activity were unremarkable.  His affect was serious, restricted, but appropriate to expressed ideation.  He denied current suicidal or homicidal ideation.  His thought process was logical, linear, and goal directed.  His thought content was devoid of evidence of psychosis.  His insight, impulse control, and social judgment were presently deemed intact.  His orientation, memory, and concentration were deemed grossly intact.  His global assessment of functioning (GAF) was 45.  The examiner noted that the CI’s degree of industrial and military impairment related to the diagnosis of bipolar II disorder was deemed severe.  The patient continued to have recurrent episodes of major depressive disorder as well as hypomanic episodes.  These would place him at risk for both suicide and for poor judgment.  The examiner opined that the CI’s bipolar II disorder will likely be a lifelong condition and may evolve into even more severe bipolar 1 disorder.  The total degree of civilian performance impairment from all sources is deemed mild to moderate if his mood is stable, but severe if he has significant major depressive disorder episodes or significant hypomanic episodes.  His Non-Medical Assessment (NMA) from the Officer in Charge of the Naval Support Unit Saratoga Springs, showed that he was no longer working in his primary rating within a nuclear department and was a “good worker” assigned to the First Lieutenant's Division as the Leading Petty Officer in charge of up to ten personnel.  He displayed initiative and ability to effectively direct the work of maintenance teams assigned and ensured that assignments were completed in a safe and timely manner.  He was also noted to be working out of his specialty.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar disorder 10%, coded 9432 (bipolar disorder).  The VA did not rate the bipolar condition until 9 years after discharge after the CI failed to show for his scheduled evaluation.  The panel majority agreed that a 10% rating, was justified for bipolar II disorder with 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.  There was no evidence of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events) to justify a rating of 30% or higher.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bipolar disorder.  

Contended PEB Conditions:  Asthma, Hypertension, Allergic Rhinitis, and GERD.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  These conditions did not carry attached duty limitations, were not implicated in the non-medical assessment and were not judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

Contended PEB Condition:  Hyperlipidemia.  This is not a ratable condition, but rather an abnormal lab finding.  After due deliberation, the panel 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 and IAW VASRD §4.71a, the panel majority recommends no change in the PEB adjudication.  In the matter of the contended asthma, hypertension, allergic rhinitis, and GERD conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  In the matter of the contended hyperlipidemia condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  The single voter for dissent recommended re-characterization and did not elect to submit a minority opinion.  There are no other conditions within the panel’s scope of review for consideration.  The panel, 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 20160406, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

		
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