RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00626
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20071110

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Air Transportation Specialist, medically separated for “bipolar disorder” with a disability rating of 10%.  

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 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 - 20070926	VARD - 20080929	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	Bipolar Disorder	9432	30%	20080929	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bipolar Disorder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI received an outstanding Enlisted Performance Report (EPR) in May 2005 (5/5 promotion recommendation, the range is 1-5).  Four months later, the CI and her spouse were involved in a domestic violence incident involving alcohol.  The CI was referred to mental health and found to have bipolar disorder.  Shortly thereafter, the CI was involved in another alcohol related incident as well as additional incidents of domestic violence for which the CI received non-judicial punishment.  At some point the CI began medical treatment and continued treatment over the next year.  An EPR in May 2006 was downgraded due to the CI’s off duty actions and she received a 3/3 rating.  A psychiatric evaluation on 21 March 2007 noted she was stable on Lithium, but due to a recent change in the Air Force Instruction an MEB was required.  The final EPR in the record closed out in May 2007.  She again had an overall 3/3 assessment, but was noted to perform her duties in a satisfactory fashion.  In primary care on 10 May 2007 the CI reported that her symptoms were well controlled on Lithium.  In psychiatry on 5 June 2007, the mental status examination (MSE) was normal other than, by history, poor judgement.  She was noted to have significant problems, but did not have severe occupational impairment.  The contribution from the bipolar disorder could not be separated from her interpersonal problems.  

The commander noted on 18 July 2007 that the CI was able to meet all in garrison duties, but could not deploy.  She had missed minimal duty time due to over-sleeping, but not secondary to medical recommendations.  The 28 August 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of mood elevation 12 times a year as well as periods of irritable mood and aggression which were triggered by events at work.  The MSE was remarkable for poor judgement, by history.  It was thought her impairment was mild, but that she was not fit to deploy.  In primary care, 5 months after separation, the CI was noted to be off medications and asymptomatic.  She reported no occupational or social impairment.  

At the 29 September 2008 VA Compensation and Pension (C&P) evaluation, 10 months after separation, accomplished by an orthopedic surgeon, the CI reported that she had remarried in January 2008.  After separation, she had initially worked as a bartender and aircraft loader, but had her own business since January 2008.  She reported she no longer took the Lithium (stopped it at discharge) and was sleeping 3-4 hours per night.  She denied depressive symptoms or episodes of mania.  She reported she could “fly off the handle” when under stress such as traffic.  The MSE showed she was hyperactive and emotionally labile as well as sublimely irritable.  She was thought to be hypomanic.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar disorder 10%, coded 9432 (bipolar disorder), citing mild social and industrial impairment.  The VA rated the bipolar disorder 30%, also coded 9432, based on the C&P examination.  The panel noted that for a 30% rating there must be occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  This was not evident in the record.  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

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00626.

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.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have 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.  Accordingly, I accept their recommendation that your application be denied.

						Sincerely,

								XXXXXXXXXXXXXXXXXX								                          Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings