RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05359
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20091028

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve O4, Physician, medically separated for “bipolar disorder type 1” with a disability rating of 10%. 

CI CONTENTION:  In addition to the bipolar disorder, the CI requested review of an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20090713	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder Type 1	9432	10%	 No VA Examination 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’s mental health (MH) disorder was diagnosed in 1976 during an inpatient psychiatric hospitalization that occurred after the sudden death of her father.  She was treated with Depakote (an anti-convulsion medication that acts as a mood stabilizer) and did well until she required a second hospitalization in 1989 for an acute manic episode due to mood instability precipitated by discontinuing her medication regimen.  She had since maintained her medication regimen.  Although the CI was a physician, she had various evaluations related to military fitness and compatibility.    

The 11 January 2009 MEB NARSUM examination, 10 months prior to separation, referenced the January 2004 letter above which suggested the CI was world-wide deployable without any serious signs or symptoms of a psychiatric disorder, and recommended no further psychotropic medications.  The 9 April 2009 MEB NARSUM examination, 7 months prior to separation, noted complaints of agitation and sleep difficulties about two to three times per month; this was treated with Depakote.  The medication was prescribed twice daily.  The CI worked in various part-time positions since quitting the medical profession in 2007.  She reported her medical license was “suspended” because she did not renew it.  She stated she did not have friends nor did she want friendship or community/social interaction and did not participate in social clubs or community activities.  Her mother and sister were her support.  She had been separated from her second husband for 3 years without contact.  The mental status examination (MSE) showed a restricted affect with underlying depression but the CI denied suicidal or homicidal ideation.  The remainder of the examination was unremarkable.  A diagnosis of bipolar disorder, type I, was rendered with a Global Assessment of Functioning (GAF) score of 80 (slight impairment.)  The examiner opined the social/industrial impairment was considerable and cited the 26 February 2007 Memorandum of Policy guidance on Deployment-Limiting Psychiatric Conditions and Medications, which noted that both her diagnosis as well as the Depakote she was prescribed were unwaiverable contraindications to an Air Force deployment.  There was no VA examination proximate to separation in evidence. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar disorder 10%, coded 9432 (bipolar disorder), citing, “The Board notes you are prescribed Depakote and you stated you take it only 2-3 times per month when you start to feel agitated and experience sleep difficulties. You have had two hospitalizations (in 1976 and 1989) which were preceded by severe stress.” Panel members 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 MH disorder.  Therefore, application of VASRD §4.129 was not appropriate in this case.  The panel next considered the §4.130 rating at the time of separation.  The CI reported minimal symptoms of agitation and sleep difficulties that occurred about 2-3 times per month and were successfully treated with mood-stabilizing medication.  Although the MSE noted a restricted affect with underlying depression, a GAF score of 80, indicating transient symptoms and slight impairment, was rendered.  The CI had lost her medical license but was able to work in part-time positions.  The panel agreed the CI’s MH disorder met the criteria for a 10% disability.  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 type I bipolar disorder.  

BOARD FINDINGS:  In the matter of the type I 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.  

SAF/MRB

Dear XXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05359.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.