From: To:

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
12 Feb 20

Director, Secretary of the Navy Council of Review Boards 
PD-2017-01648

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 22 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy of 15 October 2019 for appropriate  action.

2.	On 31 January 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.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-01648
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20070731

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

CI CONTENTION: In addition to his mental health (MH) disorder, the CI also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20070118	VARD - 20080515	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	Bipolar Disorder, Mixed with Delusions	9432	50%	20080404	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:

Bipolar Disorder. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bipolar disorder began in August 2006 when he was observed by his chain of command to have been awake for more than 36 hours and exhibited behaviors suggestive of mania. The CI spent a week in the psychiatric inpatient unit and was stabilized with medication.

At the 11 December 2006 MEB NARSUM examination, 7 months prior to separation, the CI reported no complaints. The examiner noted the CI had presented with acute mania and was prescribed a mood stabilizer at the time of admission. He responded well to medication. The CI indicated he was not in need of medication and requested to discontinue it. At the time of the NARSUM, the CI was being maintained on a very low dose of a mood stabilizer. The mental status examination (MSE) noted a circumstantial and tangential thought process but no indication of disturbed thought process. Memory was intact, and there was no evidence of psychosis. The examiner reported that judgment and insight were lacking in regards to his current condition, given that the CI was hesitant to engage in treatment and had been reluctant to be examined. His Global Assessment of Functioning (GAF) score was 71-80 (transient symptoms).

The 15 May 2007 psychiatry follow-up visit, 2 months before separation, noted the CI had no complaints. The CI stated that his mood had remained stable and that he was functioning well, taking two college courses and performing well. He stated he stopped all medications in December 2006 and had not had any return of symptoms. The examiner informed the CI that treatment with mood stabilizers could prevent the return of symptoms, but CI continued to report a desire to remain off all medications, and was not interested in any medication at the time. The MSE was unremarkable, except the examiner opined that insight was lacking, but judgment was intact. A GAF score of 80-90 was recorded. The STR demonstrated absence of psychiatric hospitalization or emergency room (ER) care in the 10 months before separation. There was no report of homicidal or suicidal ideation at any time during service.

At the 4 April 2008 VA Compensation and Pension (C&P) mental examination, 9 months after separation, the CI reported no participation in any form of MH treatment since discharge from the Service. He reported periods of depressive symptoms, and had experienced sensation of being choked by another person (his father). He stated that he had periods of irritability or euphoria that were triggered by events such as stock market fluctuations or examinations. The CI was enrolled in college, and had completed a 4-month program for Outdoor Leadership. He was socially isolated but did engage in leisure activities such as working out and hiking. There was no evidence that his symptoms required psychiatric care or ER intervention. The MSE recorded affect that fluctuated between irritability and mild sadness. Concentration was impaired.  A GAF score of 55 for moderate symptoms and or impairment was assessed.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the MH disorder 10%, coded 9432 (bipolar disorder). The VA rated the MH disorder 50%, coded 9432, based on the C&P examination, citing the §4.130 rating criteria for a 50% rating.

Panel members first agreed that the provisions of VASRD §4.129 for a “mental disorder that develops in service as a result of a highly stressful event” were not applicable. The panel next considered the rating recommendation. The panel considered the absence of ER treatment or hospitalizations and the apparent stability of symptoms in the absence of treatment during the 10 months before separation and the 8 months after separation. The NARSUM examiner and the treating psychiatrist indicated the condition was stable and symptoms were transient. There were no reports of chronic sleep impairment, problems with memory, anxiety or panic attacks in the 10 months before separation. The commander’s statement did not mention a MH condition. There was no mention of difficulties with supervisors or co-workers, or mood instability. Although the CI reported episodic mood symptoms suggestive of an unstable mood at the C&P examination, he was not receiving any MH treatment or psychotropic medication. The CI was not employed, but was able to perform well in school.

Panel members agreed that at the time of separation, the 10% rating and no higher was justified for “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.”

After due deliberation, considering all 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 MH disorder.

BOARD FINDINGS: In the matter of the MH 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.