RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01744
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20040615

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

CI CONTENTION:  Condition has worsened significantly.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040202	VARD - 20050713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	Bipolar Disorder	9432	10%	20050517	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Bipolar Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI sought both psychiatric and psychologic treatment well before commencing military service.  In January 2003, the CI self-requested additional psychiatric treatment in order to “get problems under control”.  The CI reported rapid mood changes, feelings of worthlessness and of superiority, and problems with anger control.  After a trial of numerous medications, psychiatry referred the CI to an MEB.  

The 1 August 2003 MEB NARSUM examination, 10 months prior to separation, noted complaints of spontaneous sadness, hypersomnia, anhedonia (loss of pleasure), hopelessness, high energy, and suicidal ideations.  All aspects of his mental status examination (MSE) were normal except for a “flat” and “serious” affect.  There was no evidence of a thought disorder.  He denied being suicidal or homicidal.  His medications included daily use of Effexor (anti-depressant medication) and Zyprexa (anti-psychotic medication).  His Global Assessment of Functioning (GAF) was 80 and very near to his highest level of 85 over the preceding year.  On 26 September 2003, 9 months prior to separation, psychiatry noted that the CI’s condition was characterized by periods of hyper-irritability, with racing thoughts followed by periods of almost moderate dysphoria (state of unease or dissatisfaction).  There was no comment with regards to suicide or homicide ideations.  On 20 February 2004, 4 months prior to separation, a primary care encounter noted that the CI was “stable” with his bipolar condition and “presently controlled with medication”.  

At the 16 May 2005 VA Compensation and Pension (C&P) examination, 11 months after separation, the CI’s current psychiatric complaints included rapid speech, racing thoughts, insomnia, lack of motivation, isolation, and suicidal thoughts.  The CI’s psychiatric MSE noted rapid speech, a constricted affect, mild impulsivity, mild sleep impairment, and occasional thoughts of suicide and or homicide.  There was no history of panic attacks, loss of recent memory, delusions, or violent behavior.  His GAF was assessed at 65 and thus was interpreted as “mild symptoms, i.e. constricted affect, pressured speech, sleep disturbances, but generally functioning pretty well.”     

The panel directed attention to its rating recommendation based on the above evidence.  Disability associated with any psychiatric condition, regardless of the diagnosis or multiple diagnoses, is subsumed under a single rating using the same criteria IAW VASRD §4.130 general rating formula for MH conditions.  However, panel members first considered if the definition of §4.129 was met for any psychiatric condition resulting in medical separation; i.e., “a mental disorder that develops in service as a result of a highly stressful event.”  In this case, all panel members agreed that the requisite §4.129 link that the condition occurred “as a result of a highly stressful event” was not satisfied.  The panel therefore considered only the VASRD §4.130 impairment near the time of separation.  The PEB rated the bipolar disorder condition 10%, coded 9432 (bipolar disorder).  Utilizing the same code, the VA also rated the bipolar disorder condition 10%, based on the C&P examination, citing mild decreased efficiency, productivity, reliability, and inability to perform work tasks during periods of stress.  

Panel members agreed that the PEB’s use of VASRD code 9432 was appropriate in defining the CI’s mental health condition.  Members further agreed that the 10% criteria under 9432 was easily supported by the CI’s continuous use of medication for the bipolar condition as documented at the NARSUM examination.  The panel next considered if a rating higher than the 10% adjudicated by the PEB near the time of separation was justified. 

Panel members extensively deliberated as to the severity of the CI’s bipolar condition and concluded that the various comments within the STR with regards to suicide and or homicide ideations were simply mentioned as part of the CI’s history and not actual symptom criteria near the time of separation.  Additionally, the absence of any hospitalization and or emergency room visits for said condition would indicate a minimum level of severity.  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 condition. 

BOARD FINDINGS:  In the matter of the bipolar 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.  Therefore, the panel recommends 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 20161029, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN

					XXXXXXXXXXXXXXXXXX
	     				Acting