RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00041
BRANCH OF SERVICE:  ArMY 	SEPARATION DATE:  20050303

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Personnel Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “bipolar II disorder” with a disability rating of 0%.  

CI CONTENTION:  “Review all conditions.”  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 - 20041208	VARD - 20021107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar II Disorder	9432	0%	Major Depressive Disorder	9434	100%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  100%	

ANALYSIS SUMMARY:  

Bipolar II Disorder.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s mental health condition began in February 2002 when she presented with depressive features and suicidal thoughts and was hospitalized.  She was placed on the TDRL for “major depressive disorder, single episode, severe with mood-congruent psychotic features” on 6 November 2002.  The record mentioned an April 2003 TDRL evaluation, but this was not in evidence, and per the PEB, was never submitted for adjudication.  

Based on VA treatment records and the 29 April 2004 VA mental health initial assessment, 10 months prior to TDRL removal, the CI was admitted for inpatient psychiatric treatment from November-December 2003, and also from February-March 2004 after she stopped taking her medications.  The psychiatrist indicated her hospitalization was for mood swings, and although she was service-connected for depressive disorder, her usual presentation during inpatient care was for mood upswing.  She was on two psychoactive medications (Seroquel and Depakote).  The mental status examination (MSE) was unremarkable with the exception of “fair” insight.  The diagnosis was bipolar affective disorder Type I with a Global Assessment of Functioning (GAF) of 43 (serious symptoms).  An outpatient VA treatment note on 26 August 2004 documented weight gain attributed to medications and Depakote was replaced with Tegretol. A 6 October 2004 VA psychiatrist’s note, 5 months prior to separation, indicated the CI quit her job due to stress and was “going to do work study with the VA because of her disability.”  

At the 22 October 2004 TDRL evaluation, 4 months prior to separation, the psychiatrist noted the CI’s diagnosis had been changed at the conclusion of the first TDRL evaluation to bipolar disorder Type II.  The interim history indicated she “had a resolution of many of the symptoms that led to her original MEB…”  She was enrolled in a bachelor of social work program with average grades and worked with developmentally disabled adults through a work study program.  She planned to attend graduate school to become a social worker.  The CI was being followed by a VA psychiatrist and counselor every 2-3 months and taking Tegretol every night.  On MSE, her mood was “better” and affect euthymic.  There were no suicidal ideations, delusions, hallucinations or other symptoms suggestive of psychosis, speech disturbance, objective cognitive impairment, or other abnormality.  The psychiatrist indicated the CI seemed to be in remission on mood stabilizing medications, and diagnosed “bipolar II disorder--severity moderate with full intra-episode recovery.” Impairment for military duty was “marked” and impairment for social and industrial adaptability was “definite,” with a GAF of 90 (minimal or absent symptoms) rendered.  

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated bipolar II disorder 0%, coded 9432 (bipolar disorder), citing “rated in remission.”  The VA rated major depressive disorder 100%, coded 9434 (major depressive disorder), based on the STR proximate to TDRL entry.  There was no VA rating change proximate to TDRL removal.  

Members noted that there was no traumatic event causing the unfitting mental health condition and therefore concluded that application of VASRD §4.129 was not appropriate in this case.  The panel next considered the §4.130 rating at the time of TDRL removal, and agreed that while the threshold for a 50% rating was not approached (agreement on full remission between episodes), the criteria for a 0% rating were well exceeded (the CI required chronic medications).  The deliberation settled on arguments for a 30% versus a 10% permanent rating recommendation. A 30% rating requires evidence of “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks” 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 TDRL psychiatrist’s assessment did not reference or mention any evidence of the two VA psychiatric hospitalizations following the CI’s first TDRL assessment, and the CI did not relate that history to the examiner (NOTE:  VA mental health evidence was not found in the STR or disability documents, but obtained by the PDBR).  The TDRL evaluator’s statement of “full intra-episode recovery,” did not indicate complete remission, and given the missing evidence, did not accurately reflect the frequency, severity, or timing of the CI’s episodes.  

In accordance with VASRD §4.126 (evaluation of disability from mental disorders), the panel must “assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination.”  With the additional VA pre-separation information regarding hospitalizations and the TDRL psychiatrist’s assessment of definite social and industrial adaptability occupational impairment, the CI’s disability picture at separation best supported the 30% rating criteria.  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 II disorder condition, coded 9432.  
BOARD FINDINGS:  In the matter of the bipolar II 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 II Disorder	9432	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161210, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180003277, 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 and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure