RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  pd-2016-00647
BRANCH OF SERVICE:  air force	SEPARATION DATE:  20040310

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Aerospace Maintenance Journeyman, medically separated for bipolar disorder, with a disability rating of 10%.  

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

RATING COMPARISON:  

SERVICE PEB - 20031229	VARD - 20040616	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar II Disorder	9432	10%	Bipolar Disorder	9432	10%	20040423	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%  	

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 condition began in April 2003.  He was having up and down periods over the previous 3-4 years.  The general pattern was 1-2 months of depression followed by 2-3 weeks of mania then 1 month of a good mood.  In March 2003, he began to feel substantially more depressed, which culminated in becoming suicidal.  

At the 31 October 2003 MEB NARSUM examination, 4 months prior to separation, the CI reported a euthymic (positive) mood, sleeping well, enjoying activities like reading and going to the gym, having hope, no guilt, normal energy level, good concentration, normal appetite and no suicidal ideation or plan.  He denied hypomanic symptoms in the week prior to interview, to include no distractibility, no impulsivity, no grandiosity, no racing thoughts, no increase in goal directed activity, no decreased need for sleep nor pressured speech.  All aspects of his mental status examination (MSE) were normal.  His current medications included daily use of lithium (anti-manic medication) and Effexor (anti-depressant medication).

At the 23 April 2004 VA Compensation and Pension (C&P) evaluation, 1 month  after separation, the CI reported he was sleeping well, although he had a past history of mood swings.. At times he became very drowsy, irritable, grumpy, and hyperactive.  At times he spent his money inappropriately, and usually he started many projects.  However, at times he also felt somewhat depressed, having low energy, low ambition, and felt sad.  He denied hearing any voices, now or in the past, and has been sleeping 7-8 hours without any problem.  He denied any paranoid symptomatology.  The CI additionally reported that he became employed as a store clerk for the first 2 months after separation and further endorsed not having any feelings of depression or mood swings while he is working in his current capacity.  His MSE was essentially normal and the listed diagnosis remained as bipolar disorder mixed type, without psychotic features.	

The panel directed attention to its rating recommendation based on the above evidence.  Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for MH conditions.  However, panel members first considered if the definition of §4.129 was met for any psychiatric condition resulting in medical separation; i.e., “a mental disorder that develops in service as a result of a highly stressful event.”  In this case, all panel members agreed that the requisite §4.129 link that the condition occurred “as a result of a highly stressful event” was not satisfied.  The panel therefore will consider only the VASRD §4.130 impairment near the time of separation.  The PEB rated the bipolar disorder condition at 10%, coded 9432 (bipolar disorder), citing definite social and industrial adaptability impairment. The VA also rated the bipolar disorder condition 10%, coded 9432 based on the C&P examination 1 month after separation, citing 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.

Panel members agreed that the PEB’s use of VASRD code 9432 was appropriate in defining the CI’s mental health condition.  Members further agreed that the 10% criteria under 9432 was easily supported by the CI’s continuous use of medication for the bipolar condition.  The panel next considered if a rating higher than the 10% adjudicated by the PEB near the time of separation was justified.  In this case, the lack of significant symptoms such as sleep disturbance, anxiety, suspiciousness/paranoia, or panic attacks would not support the higher 30% impairment.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends no change in the PEB’s adjudication for the Bipolar Disorder condition of 10%.

Alcohol dependence and tobacco abuse are conditions not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending them as unfitting.  After due deliberation in consideration of the preponderance of the evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB’s fitness determination and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bipolar disorder condition and IAW VASRD §4.130, the panel unanimously recommends no change in the PEB’s adjudication.  There are 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 20160913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAF/MRB

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00647.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings