RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX  	CASE:  PD-2017-03023
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cavalry Scout, medically separated for “bipolar II disorder” and “low back pain,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  The VA rated the bipolar condition 50% and the CI requested review for accuracy and fairness.  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 - 20080520	VARD - 20081001	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar II Disorder	9432	10%	Bipolar Disorder	9432	50%	20080822	
Low Back Pain without Neurologic Abnormality	5242	10%	Lumbar Spine Degenerative Disc Disease and Recurrent Muscle Strain	5243	10%	20080911	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Bipolar II Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s bipolar disorder began in August 2007 when, 11 months into his tour, he was medically evacuated from theater for suicidal ideation with hypomanic symptoms.  The CI reported significant stress being outside the wire but denied combat-related incidents.  He was treated with mood stabilizing medication and symptoms became more manageable.  His psychiatrists recommended an MEB due to his profile and an inability to tolerate sleep deprivation.  The CI did not report post-traumatic stress disorder (PTSD) symptoms.  

The 21 November 2007 MEB NARSUM psychiatry examination, 9 months prior to separation, noted the CI’s symptoms were well controlled on Paxil (depression) and Seroquel (mood stabilizer).  He was asymptomatic.  The examiner opined that given his family history of bipolar disorder, he had an underlying mood disorder that worsened with sleep deprivation and the stress of deployment.  There was no evidence the disorder existed prior to enlistment or deployment.  Mental status examination (MSE) was essentially unremarkable.  A diagnosis of bipolar II disorder with a Global Assessment of Functioning (GAF) score of 65 (mild symptoms, impairment) was rendered.  

At the 22 August 2008 VA Compensation and Pension (C&P) examination, one week before separation, the CI reported an occasional acute depression but was stable, for the most part, due to his medications as described above.  He slept poorly without medication.  At times, the CI reported a problem with overspending.  He had been employed part-time for the past year at Sears but the CI reported back pain issues had interfered with his ability to obtain full-time work.  MSE showed a mildly depressed mood.  The CI reported panic attacks at social events when he talked to a group.  Immediate memory was mildly impaired.  A diagnosis of bipolar disorder in remission was rendered with a GAF score of 69.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar II disorder 10%, coded 9432, citing mild or transient symptoms.  The VA rated the bipolar disorder 50%, also coded 9432, based on the C&P examination, citing traumatic stress resulting in release from military service.  

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 panel next considered the §4.130 rating at the time of separation.  The NARSUM examination noted there was no evidence of combat exposures during deployment to Iraq and the CI reported no PTSD symptoms.  Both the NARSUM and the C&P examiners reported he was stabilized with medication and noted the CI was asymptomatic with mild impairment and seeking full time work.  Panel members agreed symptoms 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 condition.  

Low Back Pain (LBP).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s LBP began in September 2006 after he lifted a weapons rack and felt a sharp pain in his low back region.  He was treated conservatively and symptoms resolved.  He deployed to Iraq in October 2006 and worked on a security detail.  After about 2 months, he complained of increasing back pain.  He was treated with multiple medications, manipulation and a trigger injection with no significant improvement.  Physical therapy did not relieve symptoms.  Due to his bipolar illness he was evacuated and followed as an outpatient for his LBP.  The CI reported pain had worsened since deployment.  

The 11 January 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, showed pain occurred with flexion and extension, there was no limitation of movement, and gait and straight leg raising were normal.  The February 2008 MRI showed slight desiccation of L4 and L5 disks and mild central stenosis at L3-L4 and L4-L5 due to disk protrusions.  The 20 March 2008 MEB NARSUM examination, 5 months prior to separation, noted complaints of non-radiating LBP, worse with activity.  He reported no decrease in range of motion (ROM) with exacerbations.  Time and stretching exercises improved his pain.  Pain and fatigue increased with prolonged activity.  The focused physical on his back showed tenderness over the left greater than the right para lumbar muscles, mostly around L3-L4, tenderness around the right para lumbar muscles, primarily in L4-L5, and lower extremity showed 5 /5 motor strength. Sensation, reflexes and gait were normal.  The 16 May 2008 physical therapy (PT) examination showed thoracolumbar flexion of 90 degrees (normal) and extension of 30 degrees (normal).  

At the 11 September 2008 C&P examination, 2 weeks after separation, the CI reported constant pain in the middle of his low back, usually moderate, occasionally severe, with periodic sharp severe pain radiating into the buttocks.  He did not use a cane, crutch or walker but used a back brace daily to decrease discomfort.  He could walk a maximum of one mile before the back pain increased and he had to stop and rest.  As a sales associate at Sears, he experienced increased pain after about 3 hours into his 8-hour workday.  Back pain prevented some recreational activities.  Physical examination showed a normal gait and no assistive devices used for walking.  Lower extremity strength was full and there was no muscle atrophy.  Thoracolumbar ROM after repetition showed flexion of 75 degrees and combined ROM of 215 degrees (normal 240) with painful motion noted.  He was tender in the L4-L5 region but there was no muscle spasm.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the LBP 10%, coded 5242 (degenerative arthritis) citing tenderness of the spine.  The VA rated the LBP 10%, coded 5243 (intervertebral disc syndrome [IVDS]) based on the C&P examination, citing limited flexion to 75 degrees on repetitive motion.  The panel agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) and combined ROM (greater than 120 degrees but not greater than 235 degrees), as reported on the C&P examination proximate to separation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of IVDS which resulted in incapacitating episodes requiring physician-prescribed bed rest to warrant consideration of rating under the alternate VASRD formula for that condition.  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 LBP.  

BOARD FINDINGS:   In the matter of the bipolar II condition and IAW VASRD §4.130 the panel recommends no change in the PEB adjudication.  In the matter of the low back pain condition and IAW VASRD §4.71 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:  

PD-2017-03023

[AR NUMBER], XXXXXXXXXXXXXX 

Dear XXXXXXXXXXXX

	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.

,					      

Enclosure

PD-2017-03023