RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX  	CASE:  PD-2017-02171
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080807

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Combat Engineer, 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 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 – 20080613	VARD - 20090225	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	Bipolar Disorder	9432	10%	20081021	
Obstructive Sleep Apnea (OSA)	Not Unfitting	Obstructive Sleep Apnea	6847	50%	20081021	
Anxiety Disorder	Not Unfitting	Anxiety Disorder	9499-9400	NSC	20081021	
History of Alcohol Dependence	Not Compensable	 No VA Placement	
Personality Disorder NOS	Not Compensable	Personality Disorder NOS	9299-9201	NSC	20081021	
Upper Back Pain	Not Unfitting	Lumbar Spine Strain 	5243	0%	20081124	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Bipolar Disorder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had a childhood history of suicidal gestures that led to a 2-week psychiatric hospitalization.  While in the Army, he self-referred to behavioral health on 5 October 2006 due to stress, difficulty concentrating, marital problems (separation from his wife and child), mood swings, anxiety and work stress.  He was diagnosed with an adjustment disorder and referred to therapy.  He had one inpatient psychiatric admission that occurred in January 2008 after he threatened suicide.  He was discharged with the diagnosis of bipolar disorder, type II, and placed on mood stabilizing medication.  There were no additional inpatient treatments or emergency room (ER) visits. 

The 26 February 2008 mental health (MH) MEB NARSUM consultation, 5 months prior to separation, noted complaints of improved, but continued, mood instability and problems with attention and concentration.  The mental status examination (MSE) noted tense facial expressions, and an anxious, depressed and labile mood.  There was no suicidal or homicidal ideation and no evidence of psychosis.  
 
During the 19 May 2008 MEB NARSUM examination, 3 months prior to separation, the CI reported that he was unable to carry a weapon, had emotional instability, was overwhelmed by any sort of work stress and found it difficult to multitask.  It was noted that he took mood stabilizing medication, but the medication blood level was sub-therapeutic.  The commander stated that the CI was capable of performing his assigned tasks independently, but was not capable of maintaining appropriate relationships with peers and superiors due to his bipolar disorder.

At the 21 October 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported sleeping well on medication and CPAP machine, but was not always compliant with the CPAP.  He was living with friends and spent time with his girlfriend and other friends.  The CI had a job as a cook but quit the job because it was too painful for him to be on his feet all day.  He was a full-time student, enrolled in classes for automotive technician certification.  The CI stated that he took his severance pay of about $40,000 and bought a motorcycle, 4-wheel all-terrain vehicle and a bicycle for a friend.  There were no reports of suicidal or homicidal ideation, problems with memory or concentration, panic attacks or chronic insomnia.  The MSE was unremarkable with the exception of pressured speech.  Cognitive function was intact.  The psychologist opined that the bipolar disorder would probably affect stable employment, but was not significant enough to preclude employment.  

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 symptoms controlled with continuous medication.  The panel notes that the contended anxiety disorder was part and parcel of the unfitting bipolar disorder and any disability from that condition was properly subsumed in the rating for the bipolar disorder.  The VA also rated the bipolar disorder 10%, coded 9432, based on the C&P examination, citing 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.

Panel members first agreed that the provision of VASRD§ 4.129 (a mental disorder that develops in service as a result of a highly stressful event) were not applicable.  The panel next proceeded with the rating recommendation.  Panel members noted the absence of ER treatment or hospitalizations, and the apparent stability of symptoms during the 6 months prior to separation and 3 months after separation.  The MEB MH consult noted the complaint of continued mood instability and an anxious and labile mood, but no documented complaints of problems with memory or anxiety attacks.  The NARSUM noted that the CI’s medication blood level was sub-therapeutic, which likely explained his continued mood instability.  The C&P examination, most proximate to separation, noted the CI’s condition was stable in that he was not suicidal and had not required ER care or inpatient treatment.  He had no difficulty with sleep, mood instability, memory or anxiety attacks.  His medication had changed and appeared to have been beneficial in stabilizing his mood.  The commander noted the CI was able to perform his assigned tasks independently, but had problem with maintaining appropriate relationships with others including his superiors.  There was no mention of mood or anxiety symptoms interfering with duty performance.  Therefore, the panel agreed, the PEB’s 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; or symptoms controlled by continuous medication.”  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 bipolar disorder.

Contended PEB Conditions:  OSA, Personality Disorder, History of Alcohol Dependence and Upper Back Pain.  The panel first notes that IAW DoDI 1332.38, personality disorder and alcohol dependence are conditions not constituting physical disabilities.  Therefore, the panel has no basis for recommending them for additional disability ratings.  In regards to the OSA and back pain, the panel’s main charge is to assess the fairness of the PEB determination that the conditions were not unfitting.  The OSA was profiled, but neither the unit commander nor the WTU commander implicated OSA as a condition interfering with duty performance.  There was no performance-based evidence from the record that any of the contended conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the bipolar disorder and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  In the matter of the contended OSA and back condition, the panel recommends no change from the PEB determination as not unfitting.  In the matter of the contended personality disorder and alcohol dependence, the panel agrees it cannot recommend them for additional disability rating.  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 20170224, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

PD-2017-02171

AR20200000618, XXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      

Enclosure

PD-2017-02171