DEPARTMENT  OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD DC 20374-5023

From: To:

Subj: Ref:

Director, Secretary of the Navy Council of Review Boards PD-2017-02634

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(b)	PDBR ltr of 28 Oct 19

IN REPLY REFER TO

1850
CORB:003
19 Feb 20

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

2.	On 12 February 2020, the Assistant Secretary of the Navy took action in your case by accepting the correct recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Physical Evaluation Board from 10 to 50 percent with assignment to the Permanent Disability Retired List.

3.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the Navy Personnel Command, for correction of your records as stated above.	You will be notified once those changes are complete.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXX	CASE: PD-2017-02634
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20050418

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was active duty E3, Electrical/Mechanical Equipment Repairman, medically separated for “bipolar disorder type 1” with a disability rating of 10%.

CI CONTENTION: VA gave a higher rating for the bipolar condition. 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 - 20050215	VARD - 20050922	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder Type 1	9432	10%	Bipolar Disorder	9432	70%	20050904	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Bipolar Disorder Type 1. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the  CI’s  first psychiatric evaluation and admission was  documented  as   1 November 2004 when he was referred to the ship psychologist by the ship’s chaplain for hyper- religiosity and pressured speech. He was medically evacuated to a naval hospital inpatient psychiatry unit where he was treated with anti-psychotic medication, various therapies, and stabilized over an 8-day period. The July 2001 military entrance processing station showed no evidence or history of psychiatric problems.

Admission mental status examination (MSE) showed copious and rapid but not pressured speech with normal tone and volume. Thought process was extremely tangential and thought content was remarkable for grandiosity and hyper religiosity. Memory and cognition were intact. There was an Axis I diagnosis of bipolar disorder I and an Axis II diagnosis of obsessive compulsive personality disorder with a Global Assessment of Functioning (GAF) score of 50 (serious symptoms, impairment). The examiner opined the degree of civilian and military impairment was moderate to severe.

The 9 November 2004 MEB NARSUM examination, (the hospital discharge summary), 5 months prior to separation, noted delusions, grandiosity, increased energy, tangential thought processes and increased goal-directed behaviors. The CI endorsed passive suicidality, based on his inability to change other people’s behavior. The CI reported he was “always like this” (manic), endorsed phases of depression and was treated with anti-psychosis medication. During the MEB examination (recorded on DD Forms 2807-1 and 2808), exactly one month later, physical examination referenced a diagnosis of schizoaffective disorder with obsessive-compulsive traits.

At the 4 September 2005 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported nightmares of falling, and very low self-esteem. He reported he lived with his mother, sister, and a friend. He hoped to become a priest and was currently unemployed as he was waiting until everything settled down. For enjoyment, the CI reported playing games in his head. He had no close friends but enjoyed sports, attended church once a week and taught children on religious topics. He did have some Vietnamese friends. He was capable of performing activities of daily living. MSE showed a slightly anxious mood, suspiciousness and vagueness. Insight was minimal due to a lack of education. He reported racing thoughts. A diagnosis of bipolar disorder with a GAF score of 38 (impairment in reality testing or communication or several areas, such as work or school, family relations, judgment, thinking, or mood) was rendered. The examiner noted the possible, unknowable impact of cultural differences on the CI’s presentation but acknowledged the CI had difficulty functioning with his challenges and needed a great deal of support to function successfully.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the mental health condition 10%, coded 9432 (bipolar disorder). The VA rated the bipolar disorder 70%, coded 9432, based on the C&P examination, citing occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment. The panel considered the provisions of VASRD §4.129 (mental disorders due to traumatic stress), and agreed there was no evidence of a traumatic event or stressor causing the unfitting mental health condition, and that application of VASRD §4.129 was not appropriate in this case.

The NARSUM examination noted symptoms of serious psychiatric impairment (delusions, abnormal thought process and content and passive suicidal ideation). The NMA noted serious impairment of behaviors. The panel agreed the CI’s condition most closely met criteria for 50% disability. After due deliberation, considering all 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 the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Bipolar Disorder Type 1	9432	50%	

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170322, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record