RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX  	CASE:  PD-2016-01105
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20040809

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Submarine Nuclear Propulsion Plant Mechanical Operator, medically separated for “bipolar I disorder” with a disability rating of 10%.   

CI CONTENTION:  No specific contention made.  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 - 20040707	VARD - 20050308	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar I Disorder	9432	10%	Bipolar Disorder	9432	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Bipolar I Disorder.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bipolar disorder condition began in March 2004 after experiencing depressive symptoms related to marital stress.  This led to an acute episode of alcohol intoxication as well as erratic behavior allegedly associated with incoherence, visual hallucinations, and suicidal ideation 2 weeks prior to hospitalization.  He was admitted on 18 March 2004 with the complaint that “I am depressed and I see things.”  During hospitalization he reported having hallucinatory experiences as early as age 4, but never had treatment.  He became stressed when his wife pressured him to not deploy and to get out of the Navy.  He was treated with an antipsychotic medication and felt less anxious and under better control.  His Global Assessment of Functioning score was 65 (some mild symptoms) compared to 25 (serious impairment) on admission.  At the time of discharge on 26 March 2004, his mood was good and he was forward looking.  He recognized he would not be going back to his boat due to his psychiatric inpatient care, diagnosis, and inability to adjust to submarine duty.  

At a medical clinic follow-up on 1 April 2004, the CI denied current auditory or visual hallucinations or suicidal or homicidal ideation.  He described his mood as “stressed” and his affect was congruent.  He was determined to be not physically qualified for shipboard or underway duty.  At a 15 April 2004 mental health visit, the CI’s GAF score was 55 (moderate symptoms), and on 28 April 2004, he reported his mood was still “down” but that he was sleeping better.  He had mood swings but no hypomania.  Mental status examination revealed a “good” mood with a euthymic affect and no suicidal or homicidal ideations.  Thought processes were logical, linear and goal-directed with no pressured speech or distractibility.  His GAF score was 70 (some mild symptoms).  An anticonvulsant and mood-stabilizing agent was added to the bipolar disorder treatment protocol.  

The 30 April 2004 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of recurring depressive episodes alternating with normal mood intervals, followed by manic episodes (lasting up to 3 to 4 days), that began with a period of wavering depression from ages 10-12.  His “down-times” were characterized by thoughts that were “not [his] own,” spells that lasted for about a week once a month, and intense hypersomnia.  During “up times,” which he likened to religious experiences, he felt “very content” and “energetic” with 4-5 hours of sleep, but frequently needed to sit down from lightheadedness with racing thoughts.  About once a year, he went completely without sleep for a few days.  Mental status examination showed the CI to be adequately groomed and dressed in a working uniform with no psychomotor activity. Speech was fluent with a normal rate, pitch, and volume.  He made good eye contact and was cooperative and related in a normal fashion with appropriate social maturity.  He was fully oriented with concentration and memory intact.  Abstractions and fund of information were within normal limits and intelligence was in the average range of ability.  His mood was euthymic, with concerned affect, and thought processes were logical and goal-directed.  He acknowledged visual hallucinations in the past, but did not demonstrate evidence of a delusional state.  He denied current suicidal and homicidal ideation, plan, and intent.  Insight, impulse control, and judgment appeared adequate.  The Axis I diagnosis was “bipolar I disorder, most recent episode, depressed.”  The examiner noted the CI’s condition existed prior to entry into the Navy, but was aggravated by events in the naval environment.  His impairment for military duty was severe and his abilities to adapt socially and industrially were moderately impaired.

During the 1 June 2004 MEB examination (recorded on SF Forms 93 and 88), 2 months prior to separation, the CI reported having bipolar disorder and sometimes nervous attacks/dizziness since joining the Navy.  The examiner noted he was diagnosed with bipolar disorder and with an unremarkable mental examination that day.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar I disorder condition 10%, coded 9432 (bipolar disorder).   The VA also rated the bipolar disorder condition 10%, coded 9432, based on the STR before separation, citing the condition, which existed prior to military service was permanently worsened as a result of service with occupational and social impairment due to mild or transient symptoms.  Panel members noted the CI had an acute mental health episode after depressive symptoms as a result of marital stress and a bout of intoxication.  Because of the hospitalization for bipolar disorder and continued medication use, the CI was unable to return to his submarine duties.  A 10% rating, which requires “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, or symptoms controlled by continuous medication,” was assigned by the PEB and VA, and not reasonable since the CI’s stress emanated from family pressure not to go to sea rather than from duties associated with his military specialty or work environment.  A 30% rating requires evidence of “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks” due to  such symptoms as:  depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).”  Members noted that although the CI had a history of depressed moods prior to service entry, symptoms improved with medication.  Upon separation, pressure to not go to sea or to remain in the Navy as a stress inducer was no longer a driving force to contribute to symptoms related to the bipolar disorder.  Furthermore, while the CI had other symptoms such as sleep impairment as a manifestation of the bipolar disorder in the past, symptoms were under control with medication.  Panel members agreed the CI’s condition at the time of separation did not support a higher 30% disability rating.  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 I disorder condition.  

BOARD FINDINGS:  In the matter of the bipolar I disorder condition and IAW VASRD §4.130, the panel unanimously recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20160925, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 	

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC

		
	XXXXXXXXXXXXXXXXXXX  					
         Acting