RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03929 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050930

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E1, Aviation Ordnance Systems Technician, medically separated for the overall effect of “bipolar I disorder,” “chronic left knee pain,” and “bilateral pes planus” with a disability rating of 0%.

CI  CONTENTION:	The  CI  requested  a  reconsideration  for  a  higher  rating.	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 - 20050809	VARD - 20051012	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar I Disorder	
Overall Effect	
0%	Bipolar Disorder, Type I with Status Post Depression and Mania, Non-Psychotic	9432	10%	20050712	
Chronic Left Knee Pain			Left Knee Patellofemoral Syndrome	5099-
5019	0%	20050712	
Bilateral Pes Planus			Pes Planus	5276	NSC	20050712	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Overall Effect of Bipolar I Disorder, Chronic Left Knee Pain and Bilateral Pes Planus. The PEB combined the bipolar I disorder, chronic left knee pain and bilateral pes planus conditions under a single disability rating citing the overall effect of these conditions contributed to an unfit finding as permitted by DoDI 1332.38 (E3.P3.4.4). The combination of multiple conditions as a single disability reflects the PEB’s determination that each condition was not separately unfit, but the functional impairment resulting from the conditions when considered together was unfitting. The panel’s initial charge in this case was therefore directed at determining if the PEB’s single overall effect rating was justified in lieu of separate unfit determinations and ratings. If the panel judges that two or more separate ratings are warranted in such cases, however, it must satisfy the requirement that each “unbundled” condition was unfitting in and of itself as shown by a

preponderance of evidence. The panel’s recommendations may not produce a lower combined rating than that of the PEB. The evidence for each of the conditions is presented separately, with attendant recommendations regarding separate unfitness, and separate rating, if indicated.

Bipolar Disorder I. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was first seen for his mental health condition in December 2004. He reported that he had a history of “depressive episodes” that first appeared when he was 14-15 years old but he had never been diagnosed or treated. He reported having attempted suicide once by overdose but vomited. The CI reported two episodes of “craziness,” both since joining the USMC, one lasting at least a week and the second nearly 2 weeks, during which he felt “unstoppable.” During these times, he reported signs of mania. He also reported a history of alcohol abuse, which he had used to try and manage his depressions but more recently was used in the context of a manic episode. During his most recent manic episode over the 2004-2005 holiday, he incurred a driving under the influence (DUI) charge while driving over 90 miles per hour. The CI was evaluated in the emergency room 29 December 2004 due to depression and suicidal ideation. He stated he had no reason to live and had been drinking. The military entrance examination in 2003 revealed no evidence of a psychiatric illness. The February 2005 limited duty (LIMDU) form listed bipolar disorder.

The 27 June 2005 MEB NARSUM examination, 3 months prior to separation, noted treatment with a daily mood-stabilizer agent. Symptoms appeared well managed and there had been3 months of stability. Mental status examination (MSE) showed mild psychomotor retardation, mood “not great” and affect tired and depressed. He denied suicidal/homicidal ideation. Diagnoses of bipolar I disorder and alcohol abuse were rendered with a Global Assessment of Functioning (GAF) score of 55 (moderate symptoms, impairment.) The examiner noted the CI suffered from severe bipolar disorder, which responded satisfactorily to medication. He opined the CI required constant medication and recurring psychotherapy throughout his life, no stressful or hazardous duty, and evaluation every 3 months by a psychiatrist.

At the 12 July 2005 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported loss of energy and interest, some anxiety, and not wanting to do a lot. He reported that when manic, he would get reckless, drive his motorcycle fast, show poor judgment, and get into fights. He had been sober for 8 months. He wanted to go to school and major in civil engineering. The CI reported he could perform his activities of daily living, and liked to fish, work out, play video games, and enjoy other activities. He was not married but had a good friend. He reported he could socialize fairly well except when he was on a manic spell. Functional disorders included difficulties dealing with work stress, maintaining attention, and behaving in an emotionally stable manner. MSE showed mild depression, psychomotor retardation and anxiety. When manic, he showed pressured speech, flight of ideas, poor judgment, irritability, and poor impulse control. Diagnoses and GAF score were as reported in the NARSUM.

The 20 July 2005 non-medical assessment (NMA) noted the CI’s medical condition prevented him from accomplishing tasks that required handling explosives, a critical component of his military specialty. During the 1 August 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported he was seeing a psychologist for bipolar disorder and doing well with the medication. The examiner noted symptoms were improving.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bipolar I disorder/left knee pain/bilateral pes planus conditions 0%, noted to be due to the overall effect of the conditions combined. The VA rated the bipolar I condition 10%, coded 9432 (bipolar disorder), based on the C&P examination, citing that the condition was controlled with medication. 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 a history of undiagnosed and untreated depression, as well as the new occurrence of two episodes of mania since joining the military. He reported drinking excessively to manage his depression and also as part of his mania, resulting in a DUI prior to separation. The STR showed evidence of an emergency room visit due to depression and suicidal ideation. The CI appeared to achieve some stability with constant medication. The CI had manic episodes during which he engaged in reckless behaviors. The LIMDU cited bipolar disorder and the NMA did not endorse retention even in a permanent LIMDU status. Both the NARSUM and the C&P examinations noted mild depression symptoms despite mood stabilizing medications and functional abilities in the moderate (GAF 55) range. The panel agreed the preponderance of evidence noted the CI’s bipolar illness was unfitting and met criteria for 10% disability. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the bipolar condition, coded 9432.

Left Knee. According to the STR and MEB NARSUM, the CI’s left knee condition began in January 2004 and was unrelated to any known injury. At the C&P examination, the CI reported constant sharp pain behind his left knee cap when running or climbing but it was relieved with rest. There was limitation of the ability to run and climb stairs when the pain was present but there was no time lost from work. Physical examination of the knees showed both were within normal limits, without evidence of any abnormalities. There were no pain issues, fatigue, weakness, or lack of endurance with repetitive use. Gait was normal.

During the 1 August 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported left knee pain had started between February and March 2004 but it was fine unless he was walking up stairs or running long distances. Physical examination did not document pain, limited motion or other abnormalities. The examiner noted the CI was asymptomatic. The VA rated the left knee condition 0%, analogously coded 5099-5019 (bursitis), based on the C&P examination, citing no evidence or painful or limited motion.

The left knee condition was not profiled or implicated in the commander’s statement, and did not fail retention standards. The C&P examination noted left knee pain occurred when running or climbing and was relieved by rest. The CI lost no time from work. Neither the C&P examination nor the MEB H&P noted abnormalities of the left knee. The panel members concluded there was not a preponderance of evidence showing that the right knee condition standing alone would have caused the CI to be referred into the DES or be found unfit.

Bilateral Pes Planus. According to the STR and MEB NARSUM, the CI’s pes planus condition was present at birth and worsened in the military. X-rays showed mild bilateral pes planus. This was documented to the medical record in December 2004 and the CI was diagnosed with flat feet and prescribed shoe inserts which improved his ability to be on his feet. At the C&P examination, the CI described increased discomfort in the base of his feet bilaterally which limited his ability to perform long marches or running. There had been no time lost from work. The CI did not have the orthotic sole supports in his shoes at that point. Physical examination showed gait and posture were normal with slight tenderness in the plantar fascia bilaterally and mild pes planus. During the 1 August 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported foot pain had bothered him since around August to November 2004. Physical examination revealed a diagnosis of bilateral pes planus that improved with orthotics.

The PEB included bilateral pes planus in the overall effect rating of 0%. The VA determined that the pes planus condition was not service connected and did not rate it since there was no evidence of an acquired abnormality of the feet. The MEB noted the pes planus condition was

present since birth and worsened in the military. X-rays showed mild pes planus. The CI noted the use of orthotics improved his ability to stand. The C&P examination noted the CI lost no time from work, had normal gait and posture, slight tenderness of the plantar fascia, and the use of orthotics not in evidence. The panel members concluded there was not a preponderance of evidence showing that the bilateral pes planus condition standing alone would have caused the CI to be referred into the DES or be found unfit.

BOARD FINDINGS: In the matter of the bipolar I disorder, the panel recommends a disability rating of 10%, 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, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Bipolar I Disorder	9432	10%	

The following documentary evidence was considered:

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

IN REPLY REFER TO:
1850
CORB:003 12 Oct 20

From: To:

Subj:

Ref:

Director, Secretary of the Navy Council of Review Boards 

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
(a) DoDI 6040.44
(b)	PDBR ltr of 23 Dec 19
(b)	

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

2.	On 7 October 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) took action in your case by accepting the recommendation of the PDBR. Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Department of the Navy Physical Evaluation Board (PEB) from 0% to 10% without re-characterization of your discharge.

3.	For your information, since all disability ratings from 0% to 20% qualify for disability severance pay, the above stated increase will not result in your entitlement to additional compensation.

4.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, has been forwarded to the office of the Deputy Commandant, Manpower and Reserve Affairs, for appropriate changes to your personnel records and notification to you upon completion.