RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-04746 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060404

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Airman, medically separated for “bipolar disorder, not otherwise specified [NOS]” with a disability rating of 10%.

CI CONTENTION:   “VA  rated me 100% for bipolar disorder service connected.”	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 - 20051220	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder (NOS)	9432	10%	No VA Examination in Evidence Proximate to Separation	
Borderline Personality Disorder, Narcissistic Traits	Cat II		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Bipolar Disorder, NOS. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s bipolar disorder began early in his career, and he was evaluated by a mental health (MH) professional and referred to family services. He reported one attempted suicide by overdose as an adolescent (no hospitalization), and a history of self-mutilation and chronic suicidal ideation. The 8 November 2005 MEB NARSUM noted that on 22 August 2005, the CI was picked up by ambulance and taken to the emergency room (ER) after “waking up with intense thoughts of cutting his wrist to suicide.” He was admitted for a psychiatric evaluation the same day, and was reportedly wearing white clothing to “check in” to the hospital. At the time of admission, he believed that his worsening depressive symptoms and difficulty with sleep stemmed from his separation from his wife. The provider noted a previous diagnosis of borderline personality disorder and use of antidepressant medication. The mental status examination (MSE) noted dysphoric mood and affect, but no signs of agitation, psychosis, or impairment in memory or cognition. However, suicidal thoughts persisted. During the course of

inpatient treatment, the CI developed mania that was sufficiently addressed with mood stabilizing medication. At the time of discharge, he was not suicidal, homicidal, or psychotic, and insight and judgement had improved. The Axis I diagnosis was bipolar disorder, NOS with an Axis II diagnosis of “borderline personality disorder, narcissistic traits.”

There was no VA Compensation and Pension examination in evidence proximate to separation. However, a VA MH evaluation on 31 May 2006 noted that the CI was living in his car and seeking shelter placement after recently moving. The MSE revealed continued depressed mood, no suicidal or homicidal thoughts, and good impulse control and judgment. A follow-up visit in June 2006 showed that he was stable with depressed mood and affect. At an MH appointment in August 2006, 4 months after separation, the provider noted that he was doing fair and still stable, but not getting along with his father after moving in to live with him and his wife. He stated that his father did not pay much attention to him or tell him that he loved him. The examiner did not document information on other relationships or social activity, but noted that the CI was easily agitated and had lost his job.

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 listed borderline “personality disorder, narcissistic traits,” as a condition related to the primary unfitting bipolar disorder but not separately ratable. Panel members noted that VASRD §4.130 (general rating formula for mental disorders) rates degree of occupational or social impairment attributable to a diagnosed mental disorder, regardless of diagnosis, and therefore, all symptoms must be considered for a single rating recommendation. The panel 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. Upon deliberating over a rating recommendation, panel members considered the apparent stability of symptoms, albeit, chronic, during the 6 months prior to separation, and 4 months after separation. There was no report of clinical decompensation that required urgent psychiatric care, and the STR in the months after hospitalization was silent until the month of separation. At that time, there was indication that the CI was inconsistently taking psychotropic medication reportedly due to secondary effects; however, there was no documentation of additional emergency room or inpatient treatment in the absence of medication. There was no report of chronic insomnia, panic attacks, memory problems, or suicidal ideation in the 6 months prior to separation, and while there was no clear evidence of impairment in social or occupational functioning as a result of the bipolar condition, the CI was marginally stable and unable to maintain employment or housing. Thus, panel members adjudged that the totality of evidence supported a rating higher than 10%, and based on VASRD
§4.3 (reasonable doubt), concluded that a 30% rating best approximated the MH condition at separation for “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.” After due deliberation, considering all the evidence and mindful of VASRD §4.3, the panel recommends a disability rating of 30% for the bipolar disorder, coded 9432.

BOARD FINDINGS: In the matter of bipolar 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.

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 Disorder, NOS	9432	30%	

DEPARTMENT OF THE NAVY
SECRETARY OF TIIE NAVY com,CIL  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:	Director, Secretary of the Navy Council of Review Boards To:	

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr of 6 Dec 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy for appropriate action.
2.	On s October 2020, the Assistant Secretary of the Navy took action in your case by accepting the correct recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Physical Evaluation Board from 10 to 30 percent with assignment to the Permanent Disability Retired List.

3.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the Navy Personnel Command, for correction of your records as stated above.	You will be notified once those changes are complete.