RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02729
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060703

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aircraft Armament Systems Journeyman, medically separated for “cyclothymic disorder” with a  disability rating of 10%.  

CI CONTENTION:  “The disability discharge was for cyclothymic disorder which was misdiagnosed.”  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 - 20060516	VARD - 20061206	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cyclothymic Disorder	9431	10%	Bipolar Disorder	9432	30%	20061003	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY: 

Cyclothymic Disorder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s cyclothymic disorder began in January 2005 after reporting that he was going through cycles where he had increased sleep patterns followed by decreased sleep patterns.  These episodes of increased sleep and decreased sleep cycled about one week at a time.  

The 20 April 2006 MEB NARSUM examination, 2 months prior to separation, noted episodes of increased sleep including disinterest in activities, irritability, slowed thoughts, poor concentration, difficulty finishing tasks and decreased appetite.  These episodes may or may not have involved depressed mood.  During the episodes, he slept 13-15 hours per night and awoke feeling tired.  He also had episodes of decreased sleep, which included 4-5 day episodes of no sleep but no fatigue.  These episodes were accompanied by poor focus, racing thoughts, rapid speech, driving fast and not finishing tasks at work.  His mood could become irritable when dealing with others.  He also had increased interest in sexual activity and increased appetite.  He reported a long history of difficulty controlling his anger regardless of the sleep cycle and a low tolerance for “stupid things.” He denied impaired duty performance and suicidal ideation/behaviors.  He did report self-mutilation in the form of tattoos, which he often revised as a way to create pain.  He also noted one episode of dissociation/lost time.  He was prescribed daily Lamictal, a mood stabilizing, anti-convulsion medication, resulting in significant mood stabilization, improved control of irritability and anger, and good sleep, interests, concentration and appetite.  He had been evaluated in the service due to panic attacks/hyperventilation and had received several letters of reprimand for disrespect to an officer, and infractions related to concentration difficulties.  Supervisors noted the CI was unable to perform his duties due to medication.  Physical examination showed a euthymic mood with appropriate affect and no suicidal/homicidal ideation.  An Axis I diagnosis of cyclothymic disorder and Axis II notation of narcissistic and borderline personality traits were rendered with a Global Assessment of Functioning (GAF) score of 71-80 (mild-transient symptoms, impairment.)  The examiner noted he could not perform duties while taking medication.  

At the 3 October 2006 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported feeling tired and lethargic with a resurgence of his moods since he ran out of his medicine.  He had symptoms every 3-4 days that lasted about 3-4 days.  He reported intermittent panic attacks once or twice a year with hyperventilation and palpitations.  He had obsessional rituals like checking on doors before sleep.  He had mild memory problems.  He was taking a mood stabilizing, anti-convulsion medication daily.  He had just found a job and was living with his girlfriend.  He reported he got along fairly well with coworkers and supervisors and did not have much of a social life partly due to financial reasons and partly due to his mood swings since he ran out of medication.  He had not lost any time from work.  Mental status examination showed appropriate appearance and behavior without suicidal ideation.  A diagnosis of bipolar disorder was rendered with a GAF score of 65 (mild symptoms, impairment.)

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the cyclothymic disorder 10%, coded 9431 (major depressive disorder), citing “social and industrial adaptability impairment, none to mild.”  The VA rated the condition 30%, coded 9432, (bipolar disorder) based on the C&P examination.  Panel members agreed that the ‘highly stressful event’ requisite for application of §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,” a 30% rating is assigned for “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while the criteria for a 50% rating requires evidence of “occupational and social impairment with reduced reliability and productivity.”

The NARSUM examiner noted the CI had made significant improvement in mood and affect and other symptoms with the introduction of medication.  The examiner noted the CI required medication to maintain control.  The mental status examination was unremarkable.  The subsequent C&P examination noted some resurgence of symptoms since he ran out of medicine.  However, he was scheduled to get his medication and was encouraged to stay with it in order to maintain control.  He was working and getting along well with his supervisors and peers.  The panel agreed the CI was essentially stable with continuous medication.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the cyclothymic disorder.  
BOARD FINDINGS: In the matter of the cyclothymic disorder and IAW VASRD §4.71a, 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 20170324, 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-2017-02729.

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,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings