RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-01305
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040529

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

CI CONTENTION:  “PTSD, anxiety-50%, Rt knee tendinitis-10%.”  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 - 20040309	VARD – 20050211	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder 	9432	10%	Bipolar Disorder	9432	30%	20040719	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Bipolar Disorder.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI experienced mood cycling and difficulty with anger management as early as age 14.  He enlisted in August 1999, and was not treated psychiatrically until a deployment in 2001 when he experienced a 2-week period of excessive sleeping for 12 hours a day and tardiness to work.  Mental health (MH) treatment was initiated with good results.  In 2002, he deployed to Iraq but was returned stateside within 2 weeks due to improper conduct. 

The 15 January 2004 MH addendum submitted as an “information memorandum” to the MEB, 4 months prior to separation, summarized the CI’s treatment intervention.  He had participated in three talk therapy sessions and a psychiatric examination, and identified work stress and partner relational issues as contributing factors.  The MH examiner diagnosed bipolar disorder with a Global Assessment of Functioning (GAF) score indicating mild symptoms/impairment.  The CI was voluntarily hospitalized from 27 February to 5 March 2004 after aggressive behavior at home.  During the admission, he reported a 3-day period without sleep followed by periods of excessive sleep.  He was prescribed mood stabilizing medication and discharged in stable condition.  The CI had three outpatient MH visits post-hospitalization.  Mental status examination (MSE) during each encounter was unremarkable and the GAF score remained in the mild range.

During the 19 July 2004 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported his mood was “okay” and that medication helped stabilize his mood.  He also described anxiety and panic symptoms without panic attack episodes.  He had started a full-time job he enjoyed and had full custody of his 2-year-old son.  He denied any recent aggressive behaviors or a history of suicidal ideation.  He noted homicidal thoughts towards co-workers at times, but no intent or plan.  There were no complaints of sleep, memory or thought disturbances, or problems with concentration.  The CI reported periods of feeling panic (no attack) while in large crowds but stated this did not cause significant impairment or require crowd avoidance.  He also had a good relationship with his girlfriend and was developing new friendships.  The MSE was unremarkable and a GAF score in the borderline mild-moderate range was assessed, with the examiner noting mild stressors.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar disorder condition 10%, coded 9432 (bipolar disorder).  The VA rated the bipolar disorder condition 30%, coded 9432, based on the C&P examination 2 months after separation.  Members first agreed that the provision of VASRD §4.129 for a “mental disorder that develops in service as a result of a highly stressful event” was not applicable.  Members next considered rating IAW VASRD §4.130, observing that a 30% disability level requires evidence of “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), 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).”   The panel noted that proximate to separation, the CI was stable on his medications and had no visits to the emergency room, panic attacks, difficulty with sleep, concentration, or significant anxiety symptoms.  He reported a supportive relationships, and enjoyed his full-time job.  Thus, members agreed that criteria for a 30% rating were not met.  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 condition.  

BOARD FINDINGS:  In the matter of the bipolar disorder condition and IAW VASRD §4.130, the panel 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 20160929, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

SAF/MRB

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-01305.

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,

Attachment:
Record of Proceedings