RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01378
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040430

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, CH-47 Helicopter Repairman, medically separated for “bipolar disorder” with a disability rating of 10%.

CI CONTENTION:  The VA gave him 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 it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB – 20040430	VARD – 20050408	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	Bipolar Disorder	9432	50%	20050315	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Bipolar Disorder.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated for mental health issues in June 2003 while deployed.  He reported a negative mood, insomnia, fatigue, decreased concentration, decreased appetite, irritability and feelings of guilt.  Although he was treated with Zoloft, he was hospitalized on 30 June 2003 and then evacuated to Landstuhl 5 days later.  He was in the hospital from 4 - 8 July 2003.  He reported a history of depressive symptoms.  He made a suicide attempt about 18 months prior to admission with an overdose of three anti-depression medications.  A civilian psychiatrist had seen him 2 years previously for “depression and racing thoughts.”  He had been treated for clinical depression for short periods in the past 5 years and had responded to a variety of antidepressants.  He had racing thoughts “all the time” since junior high, and trouble falling asleep for about 5 years.  He denied early morning awakening.  He reported periods of increased energy that lasted about 8 hours.  He had brief episodes of impulsive spending and possible hypomania symptoms, but there was no conclusive evidence of a preexisting bipolar disorder prior to deployment.  However, there was a strong family history for mood disorder.  After discharge from Landstuhl, he was treated with an anti-depression medication and air-evacuated to Fort Sam Houston for follow-up.  After 2 weeks, his bipolar symptoms returned and he developed a pattern of rapid cycling under the influence of anti-depression medication.  His mood stabilized with introduction of Topamax (an anticonvulsant medication). 

At the 8 December 2003 MEB NARSUM examination, 5 months prior to separation, the CI reported discrete cycles of feeling “on top of the world.”  He described periods of high energy and decreased need for sleep followed by irritability, worry and anxiety.  With sleep, the cycle repeated itself at 3 week intervals.  He endorsed a history of thoughts of suicide coinciding with depression.  He was able to resume limited duties in a rear detachment assignment near his home.  He had been married for 6 years, his wife was supportive and the marriage was stable.  Mental status examination (MSE) showed rapid, interruptible speech, multiple thoughts delivered at a highly accelerated pace, continuous, intense eye contact, and rigid posture.  He reported feeling “very anxious and depressed” at times, but “better than before.”  Affect was constricted, and reinforced by a monotone delivery and staring expression.  He had an accelerated flow of ideas without psychotic distortion.  Thought content included obsession fears, worry about his inadequacy and a negative self-image.  He reported no current suicidal or homicidal ideation and his memory was intact.  A diagnosis of bipolar I disorder was rendered, citing stressors of mobilization and deployment to a combat environment and use of antidepressant medication.  Global Assessment of Functioning (GAF) score was 60 (moderate impairment, bordering on mild symptoms).  The examiner noted the CI’s condition was stable and recovery expected.  The 5 January 2004 commander’s statement indicated the CI was “very unpredictable and [couldn’t] be allowed to have access to firearms.”  

At the 15 March 2005 VA Compensation and Pension (C&P) evaluation, 11 months after separation, the CI reported he was divorced (he said, due to his mental condition), but working since January 2005.  He was receiving mental health services including medication and therapy but was wanting to transfer his care and had an appointment for a mental health assessment at the VA.  He was having difficulty modulating severe bouts of depression and anxiety.  He reported three previous suicide attempts, two by overdose and one by handgun, the latter was interrupted by his spouse.  He saw his son twice a week, got along with most people and had intimate relationships with females.  He was also “gainfully employed.”  At the MSE, the CI reported that he had 8/10 depression and 8/10 anxiety.  He reported no suicidal ideation and had coherent thought processes.  He appeared depressed throughout the interview.  Diagnoses of PTSD due to childhood sexual trauma and bipolar disorder were rendered with a GAF score of 51 (moderate impairment, symptoms.) 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar disorder at 10%, coded 9432 (bipolar disorder), citing the need for medication management and therapy.  The VA rated the bipolar disorder 50%, also coded 9432, based on the C&P examination 11 months after separation, citing subjective complaints of depression, obsessional thinking, insomnia, emotional instability, anxiety and history of suicide attempts.  

Application of VASRD §4.129 is considered by the panel for all cases of service-connected psychiatric conditions resulting in separation; but, all members agreed the ‘highly stressful event’ requisite for §4.129 was not satisfied in this case.  The panel then considered if there was evidence for a §4.130 rating higher than the 10% assigned by the PEB at time of separation.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” the criteria for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks,” while criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.”

The NARSUM noted cycling of depression, anxiety, irritability, high energy and sleep issues.  The CI admitted to past episodes of suicidality but denied current suicidal ideation.  MSE showed rapid speech and flow of ideas but he reported he was feeling better than previously when anxiety and depression were prominent symptoms.  He was able to resume limited duties in the rear detachment near his home.  The psychiatric examiner noted an abnormal MSE, in which the CI continued to endorse anxiety and depression and presented with a flat, constricted affect and impairments in thought content and process.  Panel members concluded the CI’s symptoms most nearly approximated the criteria for a 30% disability.  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, coded 9432. 

BOARD FINDINGS:  In the matter of the bipolar disorder, 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%	

AR20180001410, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear  XXXXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of
Review (DoD PDBR) to re-characterize your separation as a disability retirement with the
combined disability rating of 30% effective the date of your medical separation for disability with severance pay. Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.
The re-characterization of your separation as a disability retirement will result in an
adjustment to your pay providing retirement pay from the date of your original medical
separation minus the amount of severance pay you were previously paid at separation.
The accepted DoD PDBR recommendation has been forwarded to the Army Physical
Disability Agency for required correction of records and then to the U.S. Defense Finance and
Accounting Service to make the necessary adjustment to your pay and allowances. These
agencies will provide you with official notification by mail as soon as the directed corrections
have been made and will provide information on your retirement benefits. Due to the large
number of cases in process, please be advised that it may be several months before you
receive notification that the corrections are completed and pay adjusted. Inquiry concerning
your correction of records should be addressed to the U.S. Army Physical Disability Agency,
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557.
A copy of this decision has also been provided to the Department of Veterans Affairs.