RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05367
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050325

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

CI CONTENTION:  He was hospitalized a second time for a manic episode just prior to separation at Camp Lejeune Naval Hospital.  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 - 20050301	VARD - 20050902	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	Bipolar Disorder	9432	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Bipolar Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI reported to mental health (MH) in May 2004 with symptoms of fatigue, decreased sleep, mild-to-moderate anxiety and unexplained depression.  He was initially placed into an anxiety group, but was later admitted to inpatient psychiatry after taking excessive amounts of an over-the-counter cough medication (Coricidin).  Recent stressors included his parents’ divorce, deployment of his roommate, switching from dayshift to swing shift, and a high operational tempo at work.  

At the 20 July 2004 NARSUM examination hospital discharge, 8 months prior to separation, the CI reported using Coricidin to become intoxicated and admitted using this medication in the past, but he did not have symptoms of depression or mania.  He also reported feeling good and that he could sleep well. He had relief from some anxiety and was not having any significant side effects from Depakote (mood stabilizer).  There was a maternal and paternal family history of bipolar disorder.  While hospitalized the CI displayed frank manic behaviors of excessive energy with decreased need for sleep, impulsive behaviors, rapid speech, flight of ideas, grandiose delusions, pressured speech, increased distractibility and acting in odd ways.  He responded well to psychotropic medications.  A diagnosis of bipolar I, severe, with psychotic features, was rendered with a Global Assessment of Functioning (GAF) score of 50 - 55 (moderate impairment).  Discharge medications included Depakote and Zyprexa (mood stabilizer).  In September 2004 the Zyprexa was discontinued due to repeated remissions and he was removed from his job and assigned to maintenance of the base dormitories.  The September 2004 commander’s statement noted the CI had performed his duties in a satisfactory manner and the November 2004 Enlisted Performance Report indicated he was a good performer.  

During the 14 December 2004 psychiatric addendum to the MEB NARSUM, 3 months prior to separation, the CI reported feeling good since removal from a stressful work environment.  The CI also reported he had begun taking Coricidin again in an effort to sleep and due to anxiety from work.  He reported looking forward to returning to his family pending separation.  He was not having any significant side effects from Depakote and could sleep well.  During the mental status examination (MSE) the CI showed good eye contact and spontaneous and appropriate speech. There was no psychomotor agitation, retardation, or other abnormal psychomotor activity such as tics.  The CI described his mood as "good" and affect congruent with his stated mood.  He denied illusions, and did not appear to have any underlying delusional thoughts or paranoia.  He denied any history or current thoughts of suicide or harm to others.  His insight into his illness was good and his judgment was also good as evidenced by seeking appropriate MH treatment and continuing medications as recommended.  He was diagnosed with bipolar I disorder and anxiety disorder, not otherwise specified, with a GAF score of 70 (mild impairment).  On 14 January 2005 the MEB listed diagnoses of bipolar disorder, in remission, and anxiety disorder, not in remission, symptoms mild, and no impairment for civilian social and industrial adaptability.
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 MH disorder 10%, coded 9432 (bipolar disorder), citing “in remission with treatment and removal from stressors, Mild Social and Industrial Adaptability Impairment.”  The VA did not rate the MH disorder, but rather found it to be not service connected (NSC). The panel noted there was no traumatic event causing the unfitting mental health condition and therefore concluded that application of VASRD §4.129 was not appropriate in this case.  The panel then considered whether the evidence at the time of separation supported a rating higher than the 10% rating adjudicated by the PEB.  Two NARSUM examinations documented the CI’s symptoms and diagnosis of bipolar disorder; and the relief of symptoms with psychotropic medication; along with the abuse of Coricidin that preceded hospital admission.  The CI acknowledged during his last two clinic visits that he ingested multiple Coricidin pills (quantity and time of ingestion unclear) prior to the visits as well as on a regular basis for over a year, to “get high.”  The clinical notes at the end of January and beginning of February 2005 indicated the CI was seen as an emergency walk-in and denied the use of his psychotropic medication for 7 months.  Both examiners noted the continued use of Coricidin; a diagnosis of substance abuse was rendered and the CI was referred for detoxification.  Neither the MEB nor PEB documented a diagnosis of substance abuse, which is a non-ratable, non-compensable disability.  Both the performance report and the commander’s statement noted the CI performed his work in a satisfactory manner.  Panel members agreed the CI showed significant improvement of symptoms with treatment with continuous psychotropic medication and; therefore, 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 bipolar disorder.  

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. 

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05367.

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.