RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00724
BRANCH OF SERVICE:  air force	SEPARATION DATE:  20040913

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Tactical Air Command Post Apprentice, medically separated for “bipolar disorder” with a disability rating of 10%.  

CI CONTENTION:  The CI contended that he was missed diagnosed.  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 at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20040608	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bipolar Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a history of rapid speech, distractibility and anxiousness prior to his deployment to Iraq in 2003.  However, while in Iraq, his symptoms worsened, and he was returned home for further evaluation after having completed 2 months of deployment.  His condition had not required the use of psychotropic medications, treatment in the emergency room (ER) or hospitalization.

During the 5 February 2004 NARSUM, 7 months prior to separation, the CI noted he had been a very high achiever in the past and had generally been able to perform well; however, under the stress of combat situation he became acutely stressed and found it difficult to carry out his job duties.  He was noted to have a couple of incidents while stressed.  One incident involved an accidental shooting where he ended up with an injury to his neck, and another incident occurred during deployment, where he was running into the bunker and didn’t notice the wall and ended up running into the wall having significant facial injuries.  The CI was returned home from Iraq after he was observed in a semi-fetal position while in a foxhole.  The NARSUM documented an incident after a period of bombings where the CI was observed to be in a semi-fetal position in his bunker reportedly sitting in a corner sucking his thumb.  This incident was denied by the CI.  His symptoms included distractibility and pressured speech.  The mental status examination (MSE) recorded that he was “hyper-alert,” spoke with a shaky voice and his speech was overly inclusive and expansive.  He appeared anxious, and his mood was normal but his affect was “slightly expansive.”  His thought process was tangential, his cognition was intact, and his judgment was not impaired.  The examiner noted the CI was able to function well in a non-stressful, non-combat environment, but in a combat environment his mental health condition become exaggerated and he decompensates.  The examiner assigned a Global Assessment of Functioning (GAF) score of 60-70 for “some mild symptoms.”  It was noted that the CI was doing well within the garrison environment and that he was likely to be able to perform well in a non-stressful/garrison environment with little difficulty unless he goes through an acute exacerbation.  The examiner also noted the CI had not met full criteria for bipolar disorder; however, a trial of a mood stabilizing medication was recommended.  The examiner recommended considering reclassification.  There was no VA Compensation and Pension mental examination proximate to separation in evidence.

The panel directed attention to its recommendations based on the above evidence; and, first considered whether the provisions of VASRD §4.129 for any “mental disorder that develops in service as a result of a highly stressful event,” and panel members agreed they were not applicable to this case.  The PEB rated the condition of bipolar disorder, coded 9432 at 10%, citing mild social and industrial adaptability impairment.  The panel considered if a rating higher than 10% was warranted based on the evidence. 

The panel noted that at the time of the NARSUM, the CI had no acute symptoms, had no complaints regarding disturbance of sleep, cognition, anxiety or panic attacks, or mood.  He reportedly was functioning well in the absence of stressful environment.  His MSE noted symptoms construed as evidence of hypomania; however, noted significant occupational or social impairment was not present.  Treatment records were silent post NARSUM, and evidence of impairment from his symptoms beyond deployment was absent.   However, given his history of mental impairment during deployment described in the commander’s statement, he was no longer deployable.  The CI’s condition was not treated with psychotropic medications, and there was no evidence of inpatient treatment or emergency treatment.

All panel members agreed, based on the evidence in the record, his condition was best reflected in the 10% disability rating 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.”  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 condition.  

BOARD FINDINGS:  In the matter of the bipolar disorder condition and IAW VASRD §4.130, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommended modification of the disability rating 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160114, w/attachments
Exhibit B.  Service Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00724.

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