RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03451
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060411

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Health Care Specialist, medically separated for “bipolar I disorder…” with a disability rating of 10%.   

CI CONTENTION:  Review of all conditions requested.  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 - 20060313	VARD - 20060927	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar I Disorder	9432	10%	Bipolar Disorder	9432	50%	20060621	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Bipolar I Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s mental health condition began in September 2005 when he was hospitalized after acting erratically at work.  The CI was loud, acting oddly, and had offended higher ranking members of his unit.  He made suicidal comments, appeared to have visual and auditory hallucinations, and was delusional.  The CI showed pressured speech, racing thoughts, and reported anxiety symptoms.  Labs were positive for marijuana and benzodiazepines (valium), which he was taking for back pain prior to admission.  The CI had a history of being a good soldier but agreed he had an alcohol problem.  However, he was never in withdrawal during his hospital course.  The CI had 4 years of prior service without incident until 2001.  He reported regular marijuana use after his discharge from the Marines in mid-2001.  He reported he had not used again until just prior to admission.  Mental status examination (MSE) showed mild psychomotor agitation, paranoia, and grandiosity.  Mood was elevated at times but controllable.  There was both thought insertion and broadcasting.  The 17 January 2006 MEB NARSUM examination, 3 months prior to separation, noted the CI was abstinent from substances, compliant with his outpatient treatment plan, and lacked insight into his illness of bipolar disorder.  Psychotropic medications included Depakote ER (mood stabilizer) and Seroquel (anti-psychosis).  Diagnosis of bipolar I was rendered.  The examiner noted symptoms persisted beyond the time of intoxication.  Prognosis was better if he remained abstinent from substances.  

At the 21 June 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported intermittent symptoms that included sleep problems, especially during a manic episode, mood swings, depression, and mania.  Medication was helping but he still had racing thoughts.  Feelings of grandiosity, auditory hallucinations and paranoia decreased with medication.  The CI reported that when he had a manic episode he could not function at all.  He reported he had been clean and sober for 9 months, preferred to be alone, and had last worked in the military.  He reported it was hard for him to work because he was overly stressed in a work atmosphere.  The CI had problems establishing and maintaining work relationships and problems with co-workers and supervisors and he had some difficulty with complex demands.  He denied emergency room (ER) visits.  The CI had received medals and citations during his military service as a medic.  MSE showed mild depression and anxiety.  Memory was mildly to moderately abnormal.  He had difficulty with retention of highly learned material and forgot to complete tasks.  He denied suicidal ideation.  A diagnosis of bipolar disorder was rendered with a Global Assessment of Functioning score of 65 (mild symptoms, impairment).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar disorder at 10%, coded 9432 (bipolar disorder), citing psychiatry opinion the CI should be able to function in the civilian sector.  The VA used the same code (9432), but rated the condition at 50%, based on the C&P examination, citing reduced reliability and productivity.  

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 the CI presented with severe psychiatric symptoms that required an initial hospitalization that exceeded 2 weeks versus the standard 3-4 day psychiatric hospitalization.  Despite high doses of medication the CI remained symptomatic, although he showed improvement with medication and was compliant with outpatient treatment.  The C&P examination, closer to separation, noted the CI was treatment-compliant but still having intermittent symptoms, including sleep difficulty, mild depression, anxiety, and some memory impairment.  There was no documentation of a work history within a year of separation.  The CI initially reported he had not been able to work due to his condition.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the bipolar I disorder, coded 9432.  

BOARD FINDINGS:  In the matter of the bipolar I disorder, the panel recommends a disability rating of 30%, coded 9432 IAW VASRD §4.130.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, 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 I Disorder	9432	30%	

AR20190008534, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiries concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO. Brower), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs.