RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-02511
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20051004

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Operations Intelligence Instructor, medically separated for “bipolar I disorder without psychotic features” with a disability rating of 10%.   

CI CONTENTION:  No specific contention was made.  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 - 20050805	VARD - 20060303	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder without Psychotic Feature	9432	10%	Bipolar Disorder	9434	50%	20051215	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Bipolar Disorder without Psychotic Features.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bipolar condition began during a period of 13 years of active duty service.  The CI reported mood fluctuation in 1998.  He first reported to Life Skills in July 2004 with a report of mood instability and depression.  He described periods of expansive mood, high energy, decreased sleep, grandiosity, increased talking, racing thoughts, and significant irritability, and risk-taking behaviors alternating with depression.  He began treatment with mood stabilizing medication in September 2004.  He had a good response but was not always compliant and had side effects from the medication.  He reported olfactory hallucinations in January 2005 and denied psychiatric hospitalizations.  

The 22 June 2005 MEB NARSUM examination, 3 months prior to separation, noted no currently significant manic or depressive symptoms.  When he was “hyper” he had significant interpersonal problems at work due to severe irritability but was very productive.  When depressed, he functioned poorly at work.  He stopped his medication twice.  A diagnosis of bipolar disorder I was rendered with marked military impairment and definite impairment for social and industrial adaptability.  A Global Assessment of Functioning (GAF) score was 85 (absent or minimal symptoms).  Medications included a mood stabilizer twice daily.  A mental status examination (MSE) found no hallucinations or suicidal ideation.  The NARSUM addendum one month later noted the CI was compliant with recommendations.  A sleep aid was added due to recent problems with insomnia.  He reported some decreased activity and low energy and at his last appointment he reported recent thoughts of suicide.  

At the 15 December 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported he was beginning to become depressed, was difficult to awaken and had trouble with focus and fatigue.  His illness exacerbated and remitted every 6 months.  He had panic attacks once per quarter.  He was isolative, unemployed, lived with his sister, and was preparing to attend college.  His moods had stabilized since beginning the medication in December 2004.  MSE showed lethargy, blunted affect, hopeless and depressed mood, rambling thought process and suicidal ideation.  He slept all the time while in his depressed phase, but when manic, he slept very little.  A diagnosis of bipolar disorder-mixed was rendered with a GAF score of 50 (moderate symptoms, impairment.)  The examiner opined the CI was somewhat depressed but in no way incapacitated.  The examiner noted his condition would stabilize with medication, which he had begun. The effect on social and occupational functioning was mild/transient.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar I disorder without psychotic features condition 10%, coded 9432 (bipolar disorder).  The VA rated the bipolar disorder condition 50%, coded 9434 (major depressive disorder), based on the C&P examination, citing occupational and social impairment with reduced reliability and productivity.  Application of VASRD §4.129 is considered by the panel for all cases of service-connected psychiatric conditions resulting in separation; but, all members agreed that the ‘highly stressful event’ requisite for §4.129 was not satisfied in this case.  

The panel then considered if there was evidence for a §4.130 rating higher than the 10% assigned by the PEB.  The §4.130 criteria for a 10% rating is “symptoms controlled by continuous medication,” and for a 30% rating it is “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  Both the NARSUM and C&P examinations noted the CI had an illness associated with an episodic presentation and he had difficulty with compliance as he occasionally discontinued the medicine, which was associated with exacerbation of symptoms.  He did not require hospitalizations and frequent emergency room visits.  He did have occasional, transient suicidal ideation but no plans and no attempts.  His moods stabilized with medication.  He had no known legal problems.  The panel agreed the CI most closely met criteria for 10% disability.  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 condition. 

BOARD FINDINGS:  In the matter of the bipolar disorder condition 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 20170302, 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-2017-02511.

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,

		

Attachment:
Record of Proceedings