RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00692
BRANCH OF SERVICE:  army 	DATE REMOVED FROM TDRL:  20041202

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Cavalry Scout, medically separated from the Temporary Disability Retired List (TDRL) for “bipolar disorder I” with a disability rating of 0%.

CI CONTENTION:  His condition has worsened since separation and he is still receiving treatment from the VA.  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 - 20041021	VARD - 20051108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder I	9432	0%	Bipolar 1 Disorder, In Remission	9432	30%	20040712	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bipolar Disorder I.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was admitted to an inpatient psychiatry service at a military medical center on 17 December 2002 for 7 days due to suicidal ideation, depressed mood, and non-specific homicidal ideation toward others in his command.  The CI was treated with psychotropic medication and diagnosed with major depressive disorder with psychotic features.  In June 2003, he was placed on the TDRL with a 30% disability rating.

During the July 2004 VA Compensation and Pension (C&P) general psychiatric evaluation, 5 months before TDRL removal, the CI reported he was sleeping and eating well. The CI reported his last manic episode was in December 2003 and he was hospitalized. He noted he was employed for 2 months for a transportation security agency but stopped after a [previous] manic episode when he was threatening people at work.  He began attending trade school to become a pharmacy technician and had no problems with concentration.  Mental status examination (MSE) was unremarkable, and the diagnosis of bipolar I disorder, in remission was recorded.  A Global Assessment of Functioning (GAF) score of 70+ (if symptoms are present they are transient) was recorded.  It was not clear if the CI was taking psychotropic medication at the time.

At the TDRL examination on 10 September 2004, 3 months before permanent separation, the CI reported he had experienced two manic episodes since being placed on TDRL, and that both resulted in hospitalization.  The CI indicated he had stopped taking his psychotropic medication several months after TDRL placement believing he no longer needed it.  He reported that the hospitalization in December 2003 occurred after a manic episode where he assaulted a police officer.  He was diagnosed with bipolar I disorder and discharged on a mood stabilizing medication.  He was recommended for day treatment and attended intermittently between January and April 2004.  Having stopped his medication again in the summer of 2004, he was not taking any psychotropic medication at the time of the TDRL examination. The CI reported he was a full-time pharmacy technician student, living at home with his parents and two other siblings.  Relationships were good and he had a girlfriend.  He reported that he had filed for bankruptcy after accumulating debt during manic episodes.  The MSE documented mood described by CI as “good” and he had a full affect.  There was no evidence of mood disturbance, or psychosis, and his judgment was intact.  The CI was assessed with bipolar disorder and assigned a GAF score of 75 (no more than slight impairment in social or occupational functioning, or if symptoms are present they are transient).  The examiner stated, “The service member is currently doing well but he continues to resist accepting his diagnosis and the need for maintenance medication.”

The 14 October 2005 C&P general psychiatric evaluation, 11 months after TDRL removal, noted the CI’s complaint of racing thoughts, bad temper, and “feeling stressed out.”  The CI reported he was taking a medication for sleep but was not aware of the dosage.  He had no recorded hospitalizations since the December 2003 admission, and no recorded visits to the emergency room (ER).  He had been working as pharmacy technician for 9 months, and reported that he was “lacking focus and messing up my job some days and trying not to let it show.”  He stated he had taken a few days off his job because of his symptoms.  The MSE was unremarkable with the exception of flat affect, and psychomotor retardation.  A GAF score of 57 (moderate symptoms) was recorded.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar disorder 0%, coded 9432 (bipolar disorder), citing, “Continues in remission of symptoms at this time, living with parents, and attending school full time.”  The VA initially rated the bipolar disorder 10%, coded 9432, based on the C&P examination 11 months after TDRL removal but less than a month later increased the rating to 30%, coded 9432. It was not evident to the panel why the VA increased the rating at this time.

The panel considered if there was evidence to support the higher rating of 10% for “occupational or 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.”   The panel considered the VA general examination that occurred 5 months before TDRL removal, the TDRL examination 3 months before permanent separation, and the VA examination, 11 months after TDRL removal.  At the time of TDRL removal, the CI’s condition was stable, although he was not receiving treatment, and had reportedly stopped his medication about 6 months ago.  He was performing well in school and had good relations with family and friends.  He had no hospitalizations in the 11 months before separation.  The VA examiner opined that his condition was in remission.  Both VA and TDRL examiners assessed GAF scores indicative of only slight impairment.  However, the TDRL examiner noted there was a need for maintenance medication to maintain stability.  His MSE was unremarkable during both the VA and TDRL examinations before separation.  The VA examination 11 months after TDRL removal recorded complaints of stress and problems with focusing at work.  He felt he was making mistakes; however, he did not state that these mistakes had caused any problems.  Since this examination, the CI had not been hospitalized in nearly 2 years, and there were no recorded visits to the ER for mental health-related symptoms.  It was not clear if the CI’s dose of medication for sleep was effective in managing mood symptoms.  Panel members agreed, based on the evidence at the time of separation, that the 10% rating and no higher was warranted since the CI’s condition was most reflective of the 10% level of disability.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the bipolar disorder I condition, coded 9432.  

BOARD FINDINGS:  In the matter of the bipolar disorder, the panel unanimously recommends a disability rating of 10%, coded 9432 IAW VASRD §4.130.  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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Bipolar Disorder I	9432	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160917, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170016863, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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 also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure