RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXX		CASE: PD-2020-00200 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20071009

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Storekeeper, medically separated for “bipolar II disorder” with a disability rating of 10%.

CI CONTENTION: He should receive a higher mental health disability rating, as well as ratings for asthma and GERD [gastroesophageal reflux disease]. 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 - 20070625	VARD - 20080108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar II Disorder	9432	10%	Bipolar Affective Disorder	9432	50%	20070725	
GERD	Cat III	GERD	7399-7346	10%	20070725	
Asthma	Cat III	Asthma	6602	30%	20070725	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 80%	

ANALYSIS SUMMARY:

Bipolar II Disorder. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was diagnosed with an adjustment disorder with depressed mood in 2000. In 2001, he was hospitalized for a suicidal ideation and was discharged with adjustment disorder and a severe personality disorder. In February 2007, he was diagnosed and began mental health (MH) medication treatment for bipolar disorder, not otherwise specified.

The MEB NARSUM psychiatric examination was accomplished on 16 April 2007 and signed on 20 April 2007, 6 months prior to separation. The NARSUM noted the CI’s history of sleep disturbance, concentration difficulties, feelings of guilt, and complaints of auditory and visual hallucinations since 2003. A February 2007 initial comprehensive MH evaluation 2007 was referenced and noted that he had experienced hallucinations since 2003 and had only just recently mentioned these events to his providers. He further reported that he could go weeks or months at a time without a visual (seeing shadows) or audio (hearing a male voice say hello or

his name) hallucination. On 13 April 2007, the CI was voluntarily admitted to a psychiatric inpatient unit, and during the admission interview, he denied suicidal/homicidal ideation, hallucinations, or symptoms of mania or depression. The initial mental status examination (MSE) was unremarkable with the exception of mood and affect fluctuating between normal and anger/irritability. During the hospitalization, the CI did not report hallucinations, suicidal thoughts or display aggressive behaviors. He slept well and his mood stabilizing medication was adjusted. Upon discharge on 16 April 2007, the MSE showed intact memory, cognition and impulse control, “nervous” mood, normal affect, and no evidence of hypomania, psychosis, or suicidal/homicidal ideation. Insight and judgement were not impaired. The discharge summary documented that while the CI had a recent history of hypomanic episodes with periods of racing thoughts, little need of sleep, and feelings of grandiosity and indiscretion, his symptoms had responded to his mood stabilizing medication; he was also prescribed a sleep aid in the form of an antipsychotic medication. He was in a stable marriage and well-liked by his chain of command. The examiner documented a Global Assessment of Functioning score (GAF) of 65, denoting mild impairment. There were no other MH STRs prior to separation, but a pulmonary medicine visit in May 2007 documented a euthymic (normal) mood.

During the 25 July 2007 VA C&P MH examination, 3 months before separation, the CI reported that despite continuing his MH medication and receiving outpatient treatment, he was irritable and had poor interactions with people. The MSE noted the CI was pleasant but with flat affect and a mild to moderately anxious mood. There was no evidence of impaired thinking, judgment or cognition. The non-MH examiner rendered a GAF score of 52 indicative of a serious impairment. At a VA MH visit on 13 November 2007, one month after separation, the provider recorded that the CI was evaluated with a 10% bipolar disorder, but was currently receiving a 50% rating. During a VA primary care appointment on 1 December 2007, the examiner stated that his MH medications helped stabilize the mood disorder.

The 20 February 2008 VA MH outpatient treatment notes, 4 months after separation, documented that the CI sometimes forgot to take his mood stabilizing medication. Although he was attending school, he found it frustrating at times, and no longer attempted to work. His wife of 3 years had a difficult time understanding his MH diagnosis and its impact on their life.

The 2 June 2008 VA MH outpatient visit, 8 months after separation, noted the CI had only attended three face-to-face MH therapist visits since separation. He occasionally took his MH medication, and his wife, who also attended the appointment, stated she wished he would take his MH medication “more appropriately.” The CI was attending college, but with some difficulty. The MSE documented irritability but the remainder of the examination was normal. There were no documented MH hospitalizations or ER visits since separation.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the bipolar disorder 10%, coded 9432 (bipolar affective disorder). The VA rated the bipolar disorder 50%, also coded 9432, based on the C&P MH examination, citing 50% MH criteria. 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 then proceeded with the rating recommendation, and considered the absence of MH hospitalizations and ER visits, and the apparent stability of symptoms during the 4 months prior to separation and 18 months after separation. There were no complaints in the STR of psychosis, clinically significant mood instability, or suicidal ideation/attempts in the 6 months prior to separation, and there was no evidence of chronic insomnia leading to impairment, problems with memory, panic attacks, or signs of impairing psychosis at the time of separation; there was no report of domestic violence or aggression. While the July 2007 C&P MH examination indicated a serious impairment with the GAF score, the objective evidence did not substantiate this as the MSE results suggested the CI’s condition was stable. Thus, panel members concluded that a 10% rating and no higher 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.” 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 II disorder.

Contended PEB Conditions: GERD and Asthma. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. These conditions were not noted on limited duty forms or implicated in the 14 May 2007 non-medical assessment. Neither condition failed retention standards, nor was there any performance-based evidence from the record that either 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 any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the bipolar disorder and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication. In the matter of the contended asthma and GERD, the panel recommends no change from the PEB determinations as not unfitting. 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:

Exhibit A. DD Form 294, dated 20201111, w/atchs Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Record

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

IN REPLY REFER TO
6040
CORB:  001
7 March 2022

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

Subj:	Physical Disability Board of Review Determination Ref:	(a) 6040.44(Series)
1.	The Physical Disability Board of Review (PBDR) reviewed your case in accordance with reference
(a) and forwarded their recommendation for action.

2.	

On 3 March 2022, the Assistant Secretary of the Navy (Manpower and Reserve Affairs) accepted the of no change to your characterization of separation or disability rating
assigned.

3.	The PDBR determination is final and not subject to appeal or review.