RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	cASE:  PD-2016-01133
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20041001

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Weather Forecaster Journeyman, medically separated for “bipolar disorder not otherwise specified” with a disability rating of 10%.   

CI CONTENTION:  The CI made no specific contention.  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 - 20040809	VARD – 20050208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%*	Bipolar Disorder	9432	50%	20041201	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	
*PEB rated 30% with 20% deduction for contributing/aggravating factors

ANALYSIS SUMMARY:  

Bipolar Disorder.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated in March 2004 due to complaints of increased mood swings in the setting of worsening work and family stressors.  In April 2004, he received care over a period of 1 month while enrolled in a partial hospitalization program.   His treatment consisted of psychotropic medications, individual therapy and marital counseling.  His condition did not require any acute inpatient hospitalizations or emergency room (ER) treatments.  Suicidal or homicidal ideation were not present at any time.

During the 29 May 2004 MEB NARSUM examination, 4 months before separation, the CI complained of significant irritability, mood lability and difficulty functioning at work and in his marital relationship.  He noted periods of feeling down and depression “which would unpredictably change to normal or highly irritable.”  He had experienced 2 weeks of irritability, anger, decreased need for sleep, and other symptoms suggestive of bipolar disorder before entering the partial hospitalization program.  Upon discharge, his symptoms had stabilized with medication.  The mental status examination (MSE) was unremarkable with the exception of “slightly rapid speech” and depressed and irritable mood and affect.  The examiner recorded a Global Assessment of Functioning (GAF) score in the moderate range.  The Axis I diagnosis was bipolar disorder NOS [not otherwise specified] with Axis II classification of “strong cluster B and C traits [not disorders] which contribute to his Axis I condition and difficulty managing stress.” The examiner did not document the degree or extent to which the personality traits affected the bipolar disorder, but did note a “mild” premorbid personality and predisposition.

The 8 July 2004 commander’s statement, 3 months prior to separation noted the CI missed over 2 months of work due to treatment participation and could not work rotating shifts due to “conflicts with his medication schedule.”  Additionally, it was documented that he could not focus for prolonged periods due to medication effects and required significant supervision.  

At the 25 July 2004 MEB psychiatric addendum examination, 2 months before separation, the CI reported symptoms not well-controlled with medication.  He experienced frequent episodes of depressed mood and anxiety as well as periods of elevated mood, racing thoughts, decreased need for sleep and pressured speech.  He had not been hospitalized or received ER treatment.  The MSE was unremarkable with the exception of depressed and irritable mood and slightly restricted affect.  A 7 August 2004 treatment entry noted some improvement in symptoms following changes to medication.  There was no VA Compensation and Pension evaluation proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar disorder 30% and took a 20% deduction for contributing/aggravating factors, coded 9432 (bipolar disorder), citing personality traits contributing to the Axis I condition.  The VA rated the bipolar disorder condition 50%, coded 9432, based on the C&P examination 2 months after separation.  

The panel first noted there was no specific, highly stressful service related event to invoke §4.129 for a mental disorder due to traumatic stress.  The panel next considered the rating deduction.   Regarding the CI’s psychiatric assessment, the PEB specifically stated “that his personality traits contribute to his Axis I condition, and finds the member unfit and recommends Discharge with Severance Pay with a disability rating of 10% IAW DoD and VASRD guidelines.”  Members concurred that the PEB’s deduction could not be upheld for the following reasons:  First, the contribution from a notation of personality traits, on which the PEB deduction hinged, is very tenuous.  Secondly, there was no documentation of inherent personality traits or characteristics specifically contributing to the CI’s bipolar condition.  Additionally there was no evidence that his inability to manage stress was not the by-product of the primary bipolar diagnosis.  In fact, the psychiatrist did not record any symptom that was not reflective of the bipolar condition.  In other words, there were no symptoms or behaviors directly attributable to the personality traits.  Lastly, clinically extricating the disability attributed to one diagnosis versus the other in psychiatric disorder cases is overly speculative without an examiner’s directed opinion addressing the degree of contribution from each diagnosis.  No such input was provided; thus the panel could not fairly apportion a deduction even if the competing diagnosis was not in question.  The panel agreed there was sufficient documentation to support a mood disturbance in which a personality disorder may have contributed negatively; however, there was insufficient evidence to support the notion that in the absence of the personality traits, the CI’s bipolar disorder would have had no or minimal impact on occupational functioning.  All members agreed that the PEB’s deduction could not be upheld for application to the panel’s recommendation.  

The panel considered the rating recommendation IAW VARSD 4.130. A 30% rating is for “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.”  The NARSUM and addendum recorded fairly unremarkable mental status examinations, and there was no documented ER treatment or acute inpatient hospitalization.  While, the CI participated in a day hospital program with noted improvement, the commander stated he was no longer able to effectively accomplish assigned duties due to his medication and inability to focus.  Panel members agreed his condition was most reflective of the 30% disability level at the time of separation.  A higher rating 50% rating was not justified since evidence of impaired judgment, mood instability requiring acute hospitalization, suicidal ideation, or reduced reliability or productivity due to symptoms, were not documented.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating (no deduction) 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 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 Disorder 	9432	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160926, 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-2016-01133.

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.  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 Proceeding