RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2017-00559 BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20060323

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, ATWCS [Tomahawk] Launch Control Group Replacement Operator and Maintainer Technician, medically separated for “bipolar disorder, type II” with a disability rating of 10%.

CI CONTENTION: The condition continues to worsen and negatively affects daily activities. 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 - 20060113	VARD - 20061219	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder, Type II	9432	10%	Bi-Polar Disorder, Type II	9432	0%	STR	
Borderline Personality Traits	Cat II	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 0%	

ANALYSIS SUMMARY:

Bipolar Disorder, Type II. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bipolar disorder approximately began July 2005 due to his mother’s illness and subsequent death. He expressed guilt over not being able to provide emotional support to younger siblings. He lost his security clearance due to outstanding debt and wanted to “end things.” A treatment note on 19 September 2005 documented a history of alcohol abuse and suicidal ideation, and at an emergency room visit in September 2005, the provider indicated the

CI was depressed and diagnosed normal grieving. He subsequently checked himself into the hospital in October 2005 where he was treated with therapy and medication. While in the hospital a history of mood symptoms emerged and was notable for alternating periods of hypomania, for which he self-medicated with alcohol, as well as major depressive episodes marked by hypersomnolence, intense guilt and decreased energy. He also endorsed anhedonia, avolition (decreased motivation), feelings that everything was pointless, and a dysphoric mood on more days than not for years, although interspersed with many months of euthymia. The CI stated that, in the past when he stayed up for several days, he was not aware that he did not sleep. The provider noted poor affect and tolerance/anger control, fear of abandonment, chronic emptiness and chaotic relationships. During inpatient care, the CI he demonstrated improved insight and made positive and constructive plans for the future. At the time of discharge, he was not suicidal, homicidal, psychotic, manic or clinically depressed, and his Global Assessment of Functioning (GAF) score was 61 (some mild symptoms) and improved from a GAF of 50 (serious symptoms) on admission. He continued pharmacologic treatment with an antipsychotic medication and antidepressant as well as individual psychotherapy. He was transferred for treatment of his alcohol dependence and remained successfully abstinent from all alcohol.

The 28 December 2005 MEB NARSUM examination, 3 months prior to separation, recorded complaints of hypomanic and depressive episodes along with a history of hypothyroidism (not in scope of review). The provider noted that serial mental status examinations while hospitalized revealed no evidence of psychosis, organicity or anxiety disorders. The Axis I diagnosis was “bipolar disorder, type II, most recent episode depressed, severe, without psychotic features” with a GAF score of 63 (some mild symptoms) at the time of the NARSUM preparation. Industrial and military impairment was assessed as severe, and for civilian performance, moderate. There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bipolar disorder 10%, coded 9432 (bipolar disorder). The PEB listed “personality disorder traits” as a Category II condition (contributes to the unfitting condition but not separately ratable), and the panel concluded that this diagnosis is not considered a disability and therefore non-compensable or ratable. Members first agreed that the preponderance of evidence did not support the application of §4.129 (mental disorders due to traumatic stress), although the CI did experience grief and stress when his mother passed away. The panel next discussed whether the mental health condition more nearly approximated a 10% versus the 30% rating. Social and occupational impairment consistent with a 30% evaluation requires “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).” Explicit details of mental status examinations were not available for review; however, the examiner indicated that at the time of separation, the CI was not suicidal, homicidal, psychotic, manic or clinically depressed. Proximate to separation he continued pharmacologic treatment and individual psychotherapy and remained successfully abstinent from alcohol. Therefore, despite the single hospitalization during service, the CI’s condition was more consistent with a 10% rating, which requires “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 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 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 20170215, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY  REFER  TO:
1850
CORB: 003 20May20

From: Director, Secretary of the Navy Council of Review Boards

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr <ltd 29 Oct 18

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate  action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.