RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00758
BRANCH OF SERVICE:  army	SEPARATION DATE:  20041012

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a reserve O1, awaiting entry to active duty, medically separated for “bipolar disorder, recurrent, in remission” with a disability rating of 0%. 

CI CONTENTION:  The CI was given a higher rating for his conditions by 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 -20040913	VARD - 20051129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	0%	Bipolar Disorder	9432	10%	20051026	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY: 

Bipolar Disorder According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bipolar disorder condition began August 2002.  The CI has two psychiatric hospitalizations for manic episodes in August 2002 and May 2004.  During the 2 June 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported “vivid nightmares of sexual assault,” a fear of enclosed areas and a worry about how the MEB would affect his history.  At the 14 June 2004 MEB psychiatric NARSUM examination, 4 months prior to separation, the examiner noted resolution of manic episode with medications.  The medications noted were Lithium, Risperdal and Klonopin.
At the 26 October 2005 VA Compensation and Pension (C&P) evaluation, 12 months after separation, the CI reported off-and-on use of his psychotropic medications.  He reported that his medications had been helping.  The CI admitted to completing EMT licensure and was currently in paramedic school and unemployed. The CI denied manic or depressed phase episode since discharge from the military.  He reported low stress and a balanced lifestyle.  The mental status examination, showed the CI had a “passive” mood, affect appropriate to context, and spontaneous speech with normal rate, volume and tone. The CI’s thought process and content were within normal range, and his insight and judgement were determined to be fair.  The examiner opined mild symptoms.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar disorder condition 0%, coded 9432 (bipolar disorder), citing the CI was on mood-stabilizing, anti-depressant and anti-anxiety medications and was followed by mental health providers with complete resolution of symptoms.  The CI was competent to manage legal, financial and medical affairs.  The VA rated the bipolar disorder condition 10%, coded 9432, (bipolar disorder) based on the C&P examination 12 months after separation, citing some mild symptoms controlled by medication.  

The panel noted that the NARSUM examiner opined that the CI’s manic episode was resolving with medication and would require “indefinite use of mood-stabilizers.”  At the time of separation, the CI used three psychotropic medications for control.  Members agreed that the evidence met criteria for a 10% rating for symptoms controlled by continuous medication.  Although the CI had two hospitalizations within 2 years, the hospitalizations were during times of significant stress.  The panel also noted, within 12 months of separation, there were no further hospitalizations or emergency department visits because the CI controlled his stress and continued intermittent use of his psychotropic medications.  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 condition, coded 9432.  

The panel recommends that 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	9432	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160914, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170017581, 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