RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01210
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20041025

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Security Forces Journeyman, medically separated for “bipolar disorder, not otherwise specified” with a disability rating of 10%.

CI CONTENTION:  Used evidence and current condition support a higher rating.  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 – 20040811	VARD - 20050527	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder, Not Otherwise Specified	9432	10%	Bipolar Disorder	9432	10%	20050309	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Bipolar Disorder, Not Otherwise Specified (NOS).  According to service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health (MH) condition began in October 2002 when he developed a pattern of no sleep for periods of 3-4 days with an increase in activities.  He did not feel tired during these periods but was unable to complete the activities due to distractibility.  After several days without sleep, he noticed racing thoughts and an increased rate of speech.  He then would become confused and “brain dead,” and would eventually “crash,” sleeping 12-16 hours.  This cycle continued to repeat until his condition eventually stabilized with psychotropic medication.  

At a 29 January 2004 life skills appointment, the CI stated he had “learned” to put himself asleep but was experiencing problems with work stress.  He had received an Article 15 on 21 January 2004 for reporting late for work after being involved in a motor vehicle accident, and felt angry and frustrated.  At a 26 April 2004 follow-up MH visit, the CI reported he had run out of medication after missing an appointment earlier in the month, and had not continued taking it.  He stated he was “doing well” and had “gotten to the root of his problem” by recognizing he had not properly grieved his mother’s death August 2002; he felt he no longer required medication.  

At the 30 April 2004 MEB NARSUM examination, 6 months prior to separation, the provider referred to the 26 April 2004 MH visit and noted the CI was “sleeping 6 ½ hours per night, good interests, no irritability or guilt, ‘stabilized’ energy levels, good concentration, and good appetite.”  He denied racing thoughts, suicidal and homicidal ideation, symptoms of depression, anxiety, and psychotic symptoms, and was not taking psychotropic medication. The examiner also referred to the 26 April 2004 mental status examination (MSE), which recorded normal mood, affect and speech with no evidence of psychosis or thought disturbance.  His judgment was intact, but insight was poor.  The examiner assessed that the CI’s condition had not involved depressive symptoms at any time, but were suggestive of a bipolar diathesis.  A diagnosis of “bipolar disorder (NOS) exhibited by recurrent hypomanic episodes” was rendered with a Global Assessment of Functioning (GAF) score of 71-80 (mild, transient symptoms).  The examiner opined that the CI would require close monitoring throughout his lifetime to address hypomanic and possible manic episodes.

The 29 May 2004 commander’s statement, 5 months before separation, noted the CI had been relieved of security forces duties due to “life skills and other medical issues with no apparent resolution,” but specific mental health symptoms were not mentioned.  There was no indication that the CI had displayed mood or destructive behavioral symptoms that interfered with job performance.

During the 9 March 2005 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported he was in the third week of his 90-day seasonal employment job and working full-time without difficulty.  He was not receiving any treatment and had problems with sleep, concentration, and mild depression.  He had periods of insomnia but noted his sleep disturbance did not impair normal functioning.  The CI denied any hospitalizations or emergency room treatment, legal history or problematic substance use. He lived alone, had friends, and enjoyed working on cars, watching TV, and reading.  The MSE was unremarkable with the exception of anxious mood and constricted affect.  His insight and judgment were intact.  A GAF score of 75 was assessed, and the examiner indicated his symptoms of hypomania were mild and not currently distressing.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar disorder 10%, coded 9432 (bipolar disorder), citing mild social and industrial adaptability impairment.  The VA also rated the bipolar disorder 10%, coded 9432, based on the C&P examination 5 months after separation.

Members first agreed that the provisions of VASRD§ 4.129 for a “mental disorder that develops in service as a result of a highly stressful event” were not applicable. The panel next considered the rating recommendation IAW VASRD§ 4.130.  The panel noted the absence of emergency room visits, hospitalization, and medication treatment in the 6 months before separation.  The NARSUM and the C&P examinations both documented the CI’s condition as stable and mild.  At the time of the C&P evaluation, the CI had not received any mental health treatment and had been without psychotropic medications for 11 months.  He was working without difficulties, and although he reported symptoms, he indicated these did not impair his ability to function normally.  The commander did not specifically mention mental health symptoms, and no significant social impairment was documented in the STR; mood symptoms were stable in the 6 months prior to separation. Members agreed that the 10% rating and no higher, was justified 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, or; symptoms controlled by continuous medication.”  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.

BOARD FINDINGS:  In the matter of the bipolar disorder 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

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-2016-01210.

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,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings