RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:XXXXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04517
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20091129

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

CI CONTENTION: The VA assigned 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’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 - 20090819	VARD - 20110518	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	Bipolar Disorder With History Of Psychosis And Panic Disorder With Agoraphobia	9432	10%	20100121	
Panic Disorder With Agoraphobia	9412	10%					
Alcohol Dependence	Cat IV	No VA Placement	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Bipolar Disorder/Panic Disorder with Agoraphobia. The evidence for the bipolar disorder and panic disorder are presented together since recommendation for separate ratings violates VASRD
§4.130 (general rating formula for mental disorders). According to the service treatment record and MEB narrative summary (NARSUM), the CI was diagnosed with bipolar disorder and panic disorder with agoraphobia in January 2009. There were no documented emergency room (ER) visits or hospitalizations related to his mental health (MH) conditions.

The 22 May 2009 MEB NARSUM examination, 6 months prior to separation, noted complaints of panic attacks 1-2 times a week which significantly improved with medication. He reported drinking excessive amounts of alcohol after boot camp and subsequent inpatient substance abuse treatment. When he stopped drinking, he “started feeling emotions again,” with his moods shifted erratically from minutes up to 2-4 days where he felt “happy for days and sad for days.” He also experienced grandiosity and participated in reckless behaviors. The conditions were controlled on a mood stabilizer for bipolar symptoms and an anti-anxiety medication for the panic attacks as needed. There was no record of a mental status examination (MSE), but the examiner recorded a Global Assessment of Functioning (GAF) score of 60 (borderline mild- moderate symptoms/impairment).

At the 22 January 2010 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported that he was doing better with no mood swings or panic attacks, and that current medications were working well. He had a good relationship with wife and their two children and worked a temporary job, but was supposed to start a new job laying carpet. There was no indication that his symptoms interfered with work performance and the examiner noted he was motivated to work. The MSE was unremarkable and the Axis I diagnosis was “history of psychosis, and panic disorder with agoraphobia” with a GAF score in the mild symptoms/impairment range.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bipolar disorder 10%, coded 9432 (bipolar disorder), and panic disorder with agoraphobia 10%, coded 9412 (panic disorder/agoraphobia). The VA rated the bipolar disorder with history of psychosis and panic disorder with agoraphobia 10%, coded 9432, based on the C&P examination, citing “evidence when reviewed as a whole more approximates a 10 percent evaluation.” As noted above, VASRD §4.130 rates degree of occupational or social impairment attributable to a mental disorder with a single rating given regardless of the number of MH diagnoses. Therefore, the panel is obliged to consider all symptoms and recommend a single rating. Panel members first agreed that the provisions of VASRD§ 4.129 for a “mental disorder that develops in service as a result of a highly stressful event” were not applicable.

The panel next proceeded with the rating recommendation, and considered the absence of ER treatment or hospitalization, and the apparent stability of symptoms during the 6 months prior to and 2 months after separation. The NARSUM noted the CI’s condition was stable and responded well to medication and that there were no reports of chronic insomnia or problems with concentration or memory. Panic attacks reportedly occurred 1-2 times a week, however, they were not severe enough to require ER treatment. The C&P examination, most proximate to separation, recorded reports of stable mood and did not mention panic attacks. The CI felt his medications were effective and he had good family relationships as well as plans to start a new job after temporary employment. Panel members agreed that a 10% rating was justified for “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; or symptoms controlled by continuous medication.” However, the panel may not lower a rating adjudicated by the PEB. 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 and panic disorder with agoraphobia.

BOARD FINDINGS: In the matter of the bipolar disorder and panic disorder with agoraphobia, and IAW VASRD §4.130, the panel recommends no change in the PEB adjudications. 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:

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

Ill REP LY REFER TO :
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.