RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00307
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080820

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E7, Recruiting Station Commander, medically separated for “bipolar disorder” with a disability rating of 0%.

CI CONTENTION:  The CI contends that his original 30% rating be restored.  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 - 20080722	VARD - 20090427	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	0%	Bipolar Disorder	9432	70%	20090402	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Bipolar Disorder.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first came to the attention of mental health (MH) in the 2000 timeframe following a suicide attempt.  He apparently did not participate in MH treatment afterwards and reported that over the next few years his mood waxed and waned, varying between depression and hypomania.  Despite this, he continued to perform well at work.  He was again hospitalized in the 2004 timeframe, involuntarily, for observation due to obsessive behavior.  He was released the same day.  Then in September 2006, he was admitted voluntarily in order to see a psychiatrist and was released the next day after an evaluation.  He was on psychiatric medications at that point and these were continued without change.  The CI was diagnosed with Bipolar Disorder and placed on the Temporary Disability Retired List (TDRL) effective 25 February 2007.  

The CI was seen in MH on 28 March 2007, while on TDRL.  He reported depressive symptoms and he was prescribed an anti-depressant.  His history was noted to be more consistent with childhood post-traumatic stress disorder (PTSD) and a major depressive disorder (MDD) than bipolar disorder.  The CI was next seen in the emergency room where he reported anxiety.  He was on no medications at that time.  An anti-anxiety medication was prescribed.  The CI was seen in primary care on 15 August 2007 and reported that he had been told that he did not carry the diagnosis of bipolar disorder and that he was off of his prescribed medications.  He was working as an account executive which was mostly a phone communication type of job.  No mental status abnormalities were documented.  A note from a social worker dated 8 October 2010 recorded that the CI had been counseled for stress management from 29 February 2008 to 19 May 2008.  

The 21 July 2008 MEB NARSUM for TDRL removal, 1 month prior to TDRL removal, was based on an examination performed on 8 July 2008.  It noted that the CI had discontinued all of his medications in May 2007 and had moved to Florida where he worked for a “headhunter” service.  He did well and had been promoted to a vice-president position in which he managed 15-20 people.  He worked 80 hour weeks, had paid off $30,000 in debt, and lived with his girlfriend of 8 months.  He maintained a relationship with his children from prior marriages.  He reported 3 ER visits for anxiety during the TDRL period including the one above for which documentation was in evidence.  It was noted that he had required minimal psychiatric support during the TDRL period and was off all medications.  A memorandum from his company president, not in evidence, commented favorably on the impressive productivity and reliability of the CI.  The mental status examination was basically normal.  He was thought to have dramatically improved and to have maintained this improvement for over the past year.  However, the MEB noted bipolar disorder to be cyclical and continuation on the TDRL was recommended.  As part of a package prepared for the PDBR, the CI, in an undated cover letter, reported that he was motivated to return to active duty and put forth an “outstanding” effort in preparation and presentation at the TDRL NARSUM evaluation.  The CI was removed from the TDRL with a 0% disability rating effective 20 August 2008.  The CI was seen in primary care for back pain one week later.  He reported that he became anxious and angry at times.  He also endorsed symptoms of sleep apnea and requested further evaluation.  He continued to work in telemarketing and remained off of psychiatric medications.  On 17 September 2008, 1 month after TDRL removal, the CI was evaluated by a sleep specialist and was found to have a history and findings consistent with sleep apnea.  This was subsequently diagnosed and the CI was begun on treatment (in December 2008).  He was not on any psychiatric medications.  He was noted to be well groomed and in no acute distress.  His affect was appropriate and no MH abnormalities were documented.  

At the 2 April 2009 VA Compensation and Pension (C&P) MH evaluation, 9 months after TDRL removal, the CI reported that he was engaged and had been in this relationship for 2 years.  He stated that he was taking multiple psychotropic medications.  It is not clear when these were started or by whom.  He reported that he had lost his job 4 months earlier when he did not show up for work for 2 days.  He endorsed depression once a month for the past year and hypomania the rest of the time except when he was overtly manic for a few days every 2 months.  He endorsed suicidal ideation without plan or intent.  The mental status examination was remarkable for an anxious mood, circumstantially and pre-occupation of thought, and over personalization of proverb interpretation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar disorder 0%, coded 9432 (bipolar disorder) based on the TDRL NARSUM 1 month prior to separation, citing that the CI's condition was not severe enough to interfere with occupational and social functioning or to require continuous medications.  The CI had been stable and he had been functioning at that level for over a year.  The VA rated the bipolar disorder condition 70%, coded 9432, based on the C&P examination 9 months after TDRL removal, citing occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and; hygiene; difficulty in adapting to stressful circumstances (including work, or a worklike setting); inability to establish and maintain effective relationships.  

The panel considered the evidence.  The NARSUM clearly shows that the CI was performing well at work and was off of medications.  He was not engaged in treatment and in a stable romantic relationship.  Additional medical evaluations for unrelated issues following TDRL removal also documented that he was not taking psychotropic medications.  The record clearly shows that at the time of TDRL removal, he was functioning well occupationally and doing well in social relationships.  The best description of the impairment at TDRL removal is that for the 0% rating adjudicated by the PEB, “a mental condition has been formally diagnosed, but symptoms are not severe enough to interfere with occupation and social functioning or to require continuous medication.”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for 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 were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that 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 20160523, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	
	AR20170015261, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX
Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

A copy of this decision has been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX

Sincerely,					      
						      					
Enclosure