RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04341
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20090420

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E7, Recruiting and Retention NCO, medically separated from the Temporary Disability Retired List (TDRL) for “bipolar disorder” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 – 20090410	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Bipolar Disorder.  According to the service treatment record and MEB narrative summary (NARSUM), the CI started outpatient mental health counseling in November 2005 for work and marital stress with an initial diagnosis of depressive disorder.  She was hospitalized in December 2005 with paranoid delusions and was diagnosed with bipolar I disorder.  The CI was separated and placed on TDRL on 24 May 2006.  

During the 1 August 2007 TDRL reevaluation, 21 months prior to TDRL removal (separation), the CI reported resistance to her diagnosis and continued treatment.  She had been hospitalized in December 2006 in the context of an acute manic episode with psychosis, and had restarted psychoactive medications.  She had recently started a full-time position that had been going well.  The mental status examination (MSE) was notable only for rapid, but not pressured, speech.  Mood was described as “pretty good,” with a full and appropriate affect.  There was no active suicidal ideation, delusional or hallucinatory symptoms or other symptoms suggestive of psychosis, speech disturbance, objective cognitive impairment or other abnormality.  The psychiatrist indicated the degree of impairment for social and industrial adaptability was considerable.  

At the 18 March 2009 TDRL reevaluation examination, 1 month prior to TDRL removal, the CI reported being nearly symptom free with a stable mood.  She related some mild depressive symptoms at times related to situations in her life, but nothing that had been persistent or interfered with her functioning.  She was sleeping well, maintained normal interest in activities, had a good energy level and a good appetite.  She stated she was able to concentrate well and had no difficulty at her full-time job.  The CI was not under treatment or taking and psychoactive medications.  The MSE was unremarkable; there was no active suicidal ideation, delusional or hallucinatory symptoms or other symptoms suggestive of psychosis, speech disturbance, objective cognitive impairment or other abnormality.  

The psychiatrist assessed that the CI was doing very well on no medications, working in a responsible full-time job as a Corrections Department classification officer.  His impression was that there was no problem with the CI’s employability, but given the cyclic nature of Bipolar Disorder there was likely to be a relapse “at some time in the future,” which was unpredictable.  Given a recurrence, she could resume medication and probably do well.  The diagnosis was bipolar disorder in full remission, and the global assessment of functioning was 80 (slight impairment).  There was no VA examination proximate to TDRL removal in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The CI was removed from the TDRL with a permanent disability disposition of separate with severance pay at 10% for bipolar disorder, coded 9432 (bipolar disorder).  The PEB cited occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress.  

The panel noted there was no traumatic event causing the unfitting mental health disorder and therefore concluded that application of VASRD §4.129 was not appropriate in this case.  The 10% rating criteria is for occupational and social impairment due to mild or transient symptoms which decrease work efficiency only during periods of significant stress, or; symptoms controlled by continuous medication.  The higher rating of 30% requires evidence of “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks” due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events.”  

At the time of the TDRL examination, 1 month before TDRL removal, the psychiatrist indicated the CI was functioning well at a higher level full-time job, had minimal to no symptoms and no significant occupational or social impairment.  All panel members agreed the CI’s condition at the time of removal from TDRL did not support the higher 30% disability rating.  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 disorder at the time of TDRL removal.  

BOARD FINDINGS:  In the matter of the bipolar disorder and IAW VASRD §4.130, 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:

AR20180016630, XXXXXXXXXXXXXXXXXX

Dear  XXXXXXXXXXXXXXXXXX

	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.