RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00425
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20060201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Fire Control Technician, medically separated for “bipolar disorder” with a disability rating of 10%.  “Panic disorder with agoraphobia” was determined to have existed prior to service (EPTS) and was not rated.  

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 it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20051205	VARD - 20070403	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	Bipolar Disorder and Panic Disorder with Agoraphobia	9432-9412	20%	20070227	
Panic Disorder with Agoraphobia	EPTS					
Gastroesophageal Reflux Disease	Cat III	Irritable Bowel Syndrome	7319	10%	20070227	
Alcohol Dependence 	Cat IV	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bipolar Disorder.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first came to the attention of Mental Health (MH) clinicians in June 2005.  The CI reported a history of recurrent depressive episodes that typically lasted a week during childhood, depression as a teenager and daily manic-like episodes that began in October 2002 (prior to service).  The CI was referred to a psychiatrist and was diagnosed with bipolar disorder, not otherwise specified.  

The 1 September 2005 MEB NARSUM, 5 months prior to separation, noted periods of increased energy, elevated mood, increased sexual behaviors, decreased need for sleep, mood swings, daily panic attacks that included increased heart rate, sweating, shortness of breath, dizziness and fear of having a heart attack.  The CI was taking a mood stabilizer and a medication to treat anxiety on as needed basis.  There was no indication that he ever sought help in the emergency room (ER) for his attacks.  Mental status examination (MSE) was unremarkable.  There was no evidence of psychosis or thought disorder and cognitive function was intact.  He denied suicidal or homicidal ideation.  The diagnoses of bipolar disorder not otherwise specified, panic disorder with agoraphobia, and alcohol dependence in early remission were assessed with a Global Assessment of Functioning (GAF) score of 45 for serious symptoms and/or impairment.  However, the examiner opined the CI’s total impairment from all of the MH conditions was moderate, and his conditions had been unresponsive to treatment.  

During the 27 February 2007 VA Compensation and Pension (C&P) evaluation, 13 months after separation, the CI complained of daily anxiety symptoms.  He had not received any form of MH treatment during the year after separation and was first seen by the VA in January 2007.  He was prescribed medication, which he stated was helpful.  He reported his bipolar symptoms were fairly well managed with medication, but his panic attacks had continued daily.  The CI had been attending school full-time, but was currently looking for work and was not attending school.  He reported taking five college classes, did well in two, dropped two and failed one.  He was living with a roommate and had a couple of friends with whom he associated.  He noted that due to his limited income, social activities were restricted, but he played video games, watched TV and occasionally went out to eat with friends.  He also noted he occasionally smoked marijuana recreationally.  MSE was unremarkable with the exception of anxious mood.  A GAF score of 70 was assessed related to the bipolar condition.  The examiner opined that both the bipolar disorder and panic disorder existed prior to service and both conditions “more likely than not” were permanently service aggravated.

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 PEB also determined the comorbid panic disorder existed prior to service and was not rated.  The VA initially did not service-connect the disorders after CI failed to present to the evaluation.  However, 16 months after separation, the VA combined the bipolar disorder with the panic disorder and rated them 20%, coded 9432-9412 (bipolar disorder with panic disorder and/or agoraphobia), based on the C&P examination 13 months after separation, citing symptoms that warranted a 30% rating at time of the rating with a 10% deduction made for the condition at time of entry into the Navy.  

Although one of the MH disorders was rated and the other was not, the panel noted that IAW VARSD §4.130, rating is based on the overall mental health condition independent of the number of diagnoses.  Recommending an additional rating for either disorder, whether or not the disorder existed prior to service, is not permitted IAW VASRD 4.14 (avoidance of pyramiding).  Panel members agreed the provision of VASRD§ 4.129 for a “mental disorder that developed in service as a result of a highly stressful event” was not applicable.

The panel next considered its rating recommendation.  There were no ER visits or hospitalizations noted in the STR or evidence of medication treatment during the 12 months following separation.  The NARSUM examiner indicated the CI’s symptoms were serious but assessed moderate impairment.  The genesis of the examiner’s opinion is unclear since there was no report of current symptoms such as sleep disturbance, disturbance in mood, impairment in cognition or workplace behavioral issues.  Both the NARSUM and VA MSEs were unremarkable.  The panel considered the absence of treatment in the 12 months after separation and noted the CI had attended school full-time and was participating in social activities.  Panel members noted that although the CI complained of daily panic attacks, his condition never required treatment in the ER and there was no report of missed time from school due to MH symptoms.  The C&P examiner indicated the CI’s condition was stable and well controlled with medication.  His impairment was noted as mild.

The non-medical assessment (NMA), 3 months before separation, made no mention of MH symptoms interfering with duty performance, offering no insight into the effect of the CI’s condition on duty performance.  The STR was silent regarding MH visits in the 5 months before separation and there was only three MH encounters in the record.  Panel members noted the CI’s sole complaint at the NARSUM and C&P examinations was panic attacks that were apparently controlled enough to allow him to work, go to school and participate in social activities.  Therefore, panel members agreed, the 10% rating and no higher was justified for “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.”  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 for the bipolar disorder.

Contended PEB Condition:  Gastroesophageal Reflux Disease (GERD).  The panel’s main charge is to assess the fairness of the PEB’s determination the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded 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.  

Contended PEB Condition:  Alcohol Dependence.  Alcohol dependence is a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending it as unfitting.  

BOARD FINDINGS:    In the matter of the comorbid bipolar and panic disorders and IAW VASRD §4.130, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended GERD and alcohol dependence, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20160630, 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 USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN