RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00872
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Aerospace Con & Warning System Journeyman, medically separated for “bipolar II disorder” rated 10%. 

CI CONTENTION:  “I have paranoia now, and hallucinations.  In April of 2016, I had a huge mental breakdown.  I am barely able to have meaningful relationships and have severe mood swings.  Anger issues too.  I have bouts of depression so severe that I want to kill myself.”  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 - 20031124	VARD - 20040707	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar II Disorder	9432	10%	Bipolar Disorder/Panic Disorder	9432	30%	20050809	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY: 

Bipolar Disorder According to the service treatment record (STR) and the Medical Evaluation Board (MEB) Psychiatric narrative summary (NARSUM), the CI’s initial contact with a mental health provider was in October 2001.  The CI underwent a psychiatric hospitalization. The discharge diagnosis was major depressive disorder, and psychotropic medications were prescribed (Effexor, Trazodone).  

The 8 October 2003 MEB NARSUM examination, 4 months prior to separation, noted complaints of status post protracted hospitalization for depression with suicidality.  The examiner noted that the CI was hospitalized for 34 days due to fluctuating moods, alternating periods of increased energy, impulsivity, increased goal-directed activity, racing thoughts and decreased need for sleep, and generally followed by a "crash" and periods of depressed mood, decreased energy, physical and mental slowing and anhedonia.  The periods of increased energy and depressive episodes lasted for several days to weeks. Suicidal thoughts were prevalent during primarily the depressive periods, though the CI stated she was generally able .to resist these impulses, and experienced relief by inflicting superficial scratches on her arm. The CI said that she was often very loud and inappropriate during the energetic periods.  The CI also reported periods of recurrent, unexpected panic attacks and acute anxiety associated with feelings of impending doom, sweating, palpations, dizziness, and nausea that lasted approximately one hour.  The CI was prescribed multiple psychotropic medications (Lithium Carbonate, Effexor, Remeron soltabs, Seroquel, Klonopin) and Ambien for insomnia.  Mental status examination of the CI demonstrated mild dysphoria and a restricted affect with marginal insight and judgement.  However, the CI presented with clear, logical and goal-directed thinking and had no psychosis or homicidal or suicidal ideation.  The CI’s Lithium level was 0.40.  

At the 10 May 2004 VA Compensation and Pension (C&P) Mental Health (MH) evaluation, 3 months after separation, the CI reported that she was in an outpatient therapy about every 2.5 weeks.  The CI admitted taking antidepressants and antipsychotics.  She stated that she was diagnosed with bipolar and panic disorders.  Mental status examination showed the CI’s mood swings were managed with Depakote, there was no indication of any thought disorders or hallucinations, however the CI admitted to delusions of an ability to fly.  The CI admitted to sleeping approximately 5 hours of broken sleep per night and feeling sad at times.  There was no personality disorder diagnosis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar disorder condition 30% with a 20% deduction for contributing/aggravating factors for an overall rating of 10%, coded 9432 (Bipolar Disorder) citing definite social and industrial adaptability impairment.  The VA rated the Bipolar disorder/panic disorder condition 30%, coded 9432, (Bipolar Disorder) based on the C&P examination 3 months after separation, citing occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal).

The panel considered the contributing or aggravating factors which resulted in a 20% deduction.  The NARSUM alluded to dependent traits, secondary gain, and questions regarding the validity of the suicidal ideations expressed; however, the documents referenced were not in evidence.  Although the NARSUM lists personality disorder, NOS as an Axis II diagnosis, the primary mental health disability resulted from depression and mania secondary to bipolar disorder.  The panel noted that the CI was hospitalized 3 times in 3 years for depression (2001) , bipolar disorder (2003), and suicidality (Dec 2003).  The panel noted that the VA did not render an Axis II diagnosis 3 month after separation.  Panel members agreed that the evidence did not support a deduction for contributing or aggravating factors.  Panel members agreed that the evidence supports a 30% rating for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the Bipolar Disorder condition.  

BOARD FINDINGS:  In the matter of the Bipolar Disorder condition, the panel unanimously recommends a disability rating of 30% coded 9432 IAW VASRD §4.130.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Bipolar II Disorder	9432	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160705, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00872.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  The Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at XXXXXXXXXXXXXXXXXX to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings