[AR Number], XXXXXXXXXX

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

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.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO),.

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

Sincerely,					      

Enclosure

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04841
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091224

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, UH-60 Helicopter Repairer, medically separated for “bipolar disorder” with a disability rating of 10%.  

CI CONTENTION:  “The injury from post surgery while in the Army at Tripler in Hawaii should carry some 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 - 20091002	VARD - 20100804	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	Bipolar Disorder	9432	70%	20100527	
Iliotibial Band Friction Syndrome	Not Unfitting	Status Post Left Inguinal Hernia 	7338-7802	0%	20100616	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Bipolar Disorder: According to the service treatment record and MEB narrative summary (NARSUM), the CI’s mental health (MH) disorder began during basic training in the summer of 2008.  He felt stressed, became depressed and tried to hang himself.  He completed basic training and went to advanced training (AIT) but became angrier and aggressive.  After completing AIT he “snapped” during an encounter with a sergeant, and threatened to kill him with a screwdriver.  The CI had not been eating or sleeping and was struggling with depression and anxiety.  He appeared to be in a bipolar mixed episode with symptoms of depression and mania.  He was admitted to inpatient psychiatry on 7 February 2009 and treated with medication and intensive outpatient treatment upon discharge.  He developed suicidal ideation and was hospitalized again on 17 March 2009.  Since that time, he faced multiple stressors including his wife leaving him and financial issues.  There was a family history of bipolar illness.  The CI reported depressive and manic episodes from adolescence and a history of attention deficit hyperactivity disorder, treated during childhood.

The 5 August 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of poor sleep and anger but partial remission of symptoms.  He reported panic attacks and episodes of violence, but no suicidal ideation.  His sergeant reported he did a fair job in the tool room, but was always under supervision.  He functioned fairly well so long as he took his medication, although he continued to show symptoms of depression, irritability and anger.  His pre-military life was not marked by instability or trauma.  The mental status examination (MSE) showed a mildly depressed mood but no suicidal ideation.  A diagnosis of bipolar disorder was rendered with a Global Assessment of Functioning (GAF) of 65 (mild impairment).  The examiner noted occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.    

At the 27 May 2010 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported mania two to three times per month, with 3-5 days of no sleep, and agitation.  Sometimes he would spend a “lot of money.”  He reported a history of alcohol abuse and “20 something” associated blackouts.”  He reported no medical treatment.  He had been unemployed for 1-2 years, stating he could not get hired due to bipolar issues.  He was separated, and his friends from the military were in Iraq.  The MSE showed rapid speech, suspicion, anxiety, a rambling thought process and poor insight.  Diagnoses of bipolar disorder and alcohol dependence were rendered with a GAF score of 65.  The examiner noted occasional decrease in work efficiency and intermittent periods of inability to perform tasks.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the MH disorder 10%, coded 9432 (bipolar) citing mild or transient symptoms which decreased work efficiency and ability to perform tasks only during periods of significant stress.  The VA rated the MH disorder 70%, coded 9432 based on the C&P examination, citing symptoms with deficiencies in most areas.  Application of VASRD §4.129 was considered by the panel, but all members agreed the requirement of a “highly stressful event” was not satisfied in this case.

The panel then considered if the evidence supported a rating higher than 10%.  A 30% rating under §4.130 requires “occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks,” while criteria for a 50% rating requires “occupational and social impairment with reduced reliability and productivity.”  The panel noted the CI showed a partial response to medication, but continued to have depression, anger, irritability and panic attacks.  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 MH disorder, coded 9432.  

Contended PEB Condition:  Iliotibial Band Friction Syndrome.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the MH disorder, the panel recommends a disability rating of 30%, coded 9432 IAW VASRD §4.130.  In the matter of the contended iliotibial band friction syndrome, the panel recommends no change from the PEB determination as not unfitting.  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 	9432	30%