RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-01937
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20070907

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E1, Avionic Systems Helper, medically separated for “bipolar disorder” with a disability rating of 10%.

CI CONTENTION:  The VA gave him a higher rating.  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 - 20070828	VARD - 20080523	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	Bipolar Disorder	9432	50%	20080421	
Antisocial Personality Traits	Category III					
Alcohol Abuse	Category III					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:

Bipolar Disorder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bipolar disorder began in 2006.  The CI had been in the Air Force for 1 year and had multiple duty problems.  His November 2005 entry examination did not record or render a mental health condition.  In March 2007, the CI received a substance abuse program evaluation and his commander requested a special examination which led to psychiatric treatment with prescription of Zyprexa (mood stabilization).  

The 16 April 2007 MEB NARSUM psychiatry addendum, 5 months prior to separation, noted complaints of being easily distracted and having trouble finishing what he started.  He reported being very energetic at bedtime and was so impulsive that he went gambling when he was supposed to be at work.  He enjoyed drinking even if it caused work problems.  He felt extremely self-confident despite work problems and his military service uncertainty.  The mental status examination noted the CI gave vague responses and was difficult to follow.  There was increased psychomotor agitation (mental tension and anxiety).  His mood was confident and affect congruent.  His intellect was above average based on interview and vocabulary.  Thought processes were vague with many ideas and loose associations.  Insight was limited and judgment poor.  An Axis I bipolar disorder and alcohol abuse diagnosis was rendered with Axis II anti-social traits.  A Global Assessment of Functioning (GAF) score of 65 (moderate symptoms, impairment) was assessed.  The examiner noted the CI had manic symptoms consistent with bipolar I disorder which impaired the CI’s ability to perform his military duties.  The 20 April 2007 commander’s statement noted the CI received two Article 15s, was demoted two grades, required close supervision and was unable to perform his primary duties “for the past month.”

During the 26 April 2007 MEB NARSUM psychiatry addendum, 4 months prior to separation, the CI became motionless and would not communicate with anyone (catatonia) at work on 20 April 2007.  He was admitted to the hospital where his interview was noted as bizarre.  The CI reported his work behavior on 20 April was to protest his work requirements.  The mental status examination showed poor grooming and an unkempt uniform.  His mood was good and affect congruent.  He was alert and his immediate recall, short-term and long-term memory were intact.  His thought process was evasive with refusal to answer several questions.  Insight and judgment were poor.  The examiner noted the CI appeared to have a catatonic episode.  The bipolar disorder and alcohol abuse diagnoses were continued.  The CI was discharged 3 days after admission without medication because he disagreed with the bipolar disorder diagnosis and refused to take medication.

At the 21 April 2008 VA Compensation and Pension (C&P) evaluation, 8 months after separation, the CI reported no symptoms of emotional distress.  He was seen by a private psychiatrist and was treated with, Abilify (antipsychotic) and an anti-seizure medication since January 2008.  The CI reported being treated for bipolar disorder prior to service and had alcohol problems since 2001.  He left college due to alcohol problems and poor grades.  The CI did not want psychiatric treatment or medication.  He reported being fired or quitting six jobs since his military discharge.  The CI’s father was present at the interview and stated the CI used alcohol heavily; hallucinated; and exhibited mood swings, paranoia and violent behavior.  The CI was able to engage in normal activities of daily living and spent time at home watching television and listening to the radio.  He had virtually no social activities, no friends and no transportation.  The mental status evaluation documented the CI as reserved, defensive, anxious, agitated, tense and fearful.  His thought processes were logical but he was uncooperative and his social skills were poor.  His affect was flat and blunted and reasoning was poor.  The CI denied anxiety, depression and psychotic symptoms.  Bipolar disorder and alcohol abuse diagnoses were rendered with a GAF score of 45 (serious symptoms, impairment).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar disorder 30%, coded 9432 (bipolar disorder), but deducted 20% for less aggravating/contributory factors resulting in a final 10% rating.  The VA rated the bipolar disorder 50%, also coded 9432, based on the C&P examination, citing occupational and social impairment with reduced reliability and productivity.

The panel first considered if application of VASRD §4.129 (service discharge as a result of a mental health condition due to a higher stressful event) was required.  The panel agreed that a highly stressful event was not the cause of the CI’s mental health disorder.  The panel next considered if the PEB’s deduction for contributory/aggravating factors was appropriate.  The PEB determined the CI’s antisocial personality traits and alcohol abuse were Category III conditions which are not separately unfitting and not ratable; and the basis for the 20% deduction.  Per DoDI 1338.38 alcohol abuse and personality traits do not constitute physical disabilities and are not ratable; therefore, the panel agreed the 20% deduction was not supported.

The panel then considered the rating at the time of separation.  As noted above, the PEB initially assigned a 30% rating.  The §4.130 criteria for a 30% rating is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks.”  The 50% rating criteria is “occupational and social impairment with reduced reliability and productivity” and the 70% rating criteria is “occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood.”  The MEB NARSUM psychiatric addendums documented impaired mental status with respect to thought process, mood, affect, appearance, judgment and insight.  The CI refused medication and denied his mental illness despite hospitalization and work issues.  The commander addressed the CI’s demotion and need for close supervision.  The CI was able to perform normal activities of daily living and lived with his family.  The panel agreed the CI’s mental health impairment most approximated a 50% disability at separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 50% for the bipolar disorder, coded 9432.

BOARD FINDINGS:  In the matter of the bipolar disorder, the panel recommends a disability rating of 50%, 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 Disorder, Single Manic Episode	9432	50%	

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

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Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-01937

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.