RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXX CASE: PD1201364 BRANCH OF SERVICE: ARMY BOARD DATE: 20130424 DATE OF PLACEMENT ON TDRL: 20000711 DATE OF PERMANENT SEPARATION: 20020627 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (11M/Infantry) medically separated for bipolar disorder. The original onset was in 1999 when brought to the hospital by his girlfriend due to depression and threats to harm himself. He was stabilized with medication but the condition was disqualifying for continued military service. He was issued a permanent S3 profile and referred for a Medical Evaluation Board (MEB). The bipolar disorder condition was forwarded to the Informal Physical Evaluation Board (IPEB) IAW AR 40-501. No other conditions were submitted by the MEB. The IPEB adjudicated bipolar disorder as unfitting, rated 30%, and placed the CI on the Temporary Disability Retired List (TDRL). He was reexamined in October 2001 with recommended removal from TDRL. The IPEB adjudicated the bipolar disorder, rated 10% and the CI appealed, requesting a formal hearing. The Formal PEB (FPEB) rated the bipolar disorder 0% IAW USAPDA policy and the CI was medically separated with that disability rating. CI CONTENTION: “A 0% disability is not congruent with a PEB decision of “unfit for service.” SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting bipolar condition is addressed below. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the respective Service Board for Correction of Military Records. RATING COMPARISON: Final Service FPEB - 20020411 VA 9 dys Prior to Adjudication Date*) - Effective 20000711 On TDRL - 20000711 Code Rating Condition Code Rating Exam Condition TDRL Sep. Bipolar Disorder 9432 30% 0% Bipolar Disorder 9432 30% 20000512 No Additional MEB/PEB Entries. Other x 4 20000512 Combined: 30% . 0% Combined: 30% *Reflects VA rating exam proximate to TDRL placement; no VA rating evidence proximate to permanent separation. ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service-connected by the Department of Veteran Affairs (DVA) but not determined to be unfitting by the PEB. However the DVA, operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service-connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should the degree of impairment vary over time. The Board’s role is confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to Veterans Affairs Schedule for Rating Disabilities (VASRD) standards, based on severity at the time of separation. Bipolar Disorder Condition. The CI started to experience mood disorder symptoms around September 1999, which gradually exacerbated to the point where inpatient psychiatric care was required in March 2000. The CI endorsed severe mood lability, alternating episodes of depression with suicidal thoughts and hypomanic/manic ones. His psychiatrist diagnosed bipolar disorder, most recent episode manic with psychotic features, confirmed by classic symptoms of increased energy, racing thoughts, impulsive behavior, paranoid delusions, irritability. No triggering traumatic event was identified. After initiation of antipsychotic and mood stabilizing medication, the CI‘s paranoia completely resolved and his insight and judgment improved considerably, however his physicians recommended initiation of MEB process. The VA Compensation and Pension (C&P) examination performed on 12 May 2000, a month prior to placement on TDRL and 3 weeks after discharge from the hospital, noted the CI was doing “fairly well.” He complained of impaired memory and concentration but acknowledged his mood was more stable and the delusions and paranoia remitted completely. At that time the CI was assigned to an office job which he found “not as bothersome.” He stated he had a good relationship with his girlfriend. Mental status exam (MSE) noted a well groomed and well kept male, with normal speech, thought processes and content. His mood was described as anxious while insight and judgment were intact. Memory and concentration were described as fair to good. As the CI condition was not sufficiently stable for final adjudication, the PEB placed the CI on the TDRL with a 30% disability rating. The TDRL psychiatric re-evaluation examination, narrative summary (NARSUM) 16 October 2001 (17 months after placement on TDRL), stated the CI continued mental health treatment at the VA clinic. He went regularly to follow up appointments every 3 months, continued daily mood stabilizing medication and he was able to maintain a stable mood, without any rebounding depression, mania or psychosis. He married and started a family with his new wife, and worked 10 months as a driver for a temporary agency. He started classes at a community college which he attended full time in 2011. He wanted to become a physical education instructor. MSE noted a cooperant male, with normal speech, full, stable affect, intact cognition and normal thought processes and content, without any psychomotor retardation or agitation. The examiner concluded the bipolar I disorder was in full remission and recommended continuing medication and therapy to prevent a possible destabilization with reoccurrence of psychiatric symptoms. The Board directs attention to its rating recommendation based on the above evidence. The Board first addressed if the tenant of §4.129 (Mental disorders due to traumatic stress) were applicable. The Board determined that the bipolar disorder was not due to a “highly stressful event” as used in the VASRD, and that §4.129 is not applicable in this case.” The Board next considered the rating at the time of placement on the TDRL. Both the PEB and the VA rated the CI’s bipolar disorder 30% based on the MEB NARSUM examination and C&P examination respectively that were proximate to the date of placement on TDRL. While the CI still had residual anxiety, diminished concentration and memory, he still had significant improvement of his condition evidenced by stable mood and complete remission of paranoia and delusional thinking. Symptoms present at the time justified placement on TDRL with 30% rating. All members agreed a rating higher than 30% at the time of placement on the TDRL was not supported by the evidence of those examinations. The Board finally considered the permanent rating at the time of removal from the TDRL. According to the TDRL psychiatry NARSUM October 2001, the CI continued regular outpatient treatment and medication regimen with further improvement. There were no other inpatient admissions, the CI was able to maintain his marriage, work and study full time. Psychiatric exam performed in October 2001 did not evidence any active or residual psychiatric symptoms and noted a completely normal MSE. The psychiatry examiner concluded the CI’s condition was in full remission on medication. The PEB rated the CI’s bipolar disorder condition after removal from TDRL at 0%, citing full remission, with symptoms well controlled by regular use of psychotropic medication and capable of full employment. The FPEB applied a USAPDA policy in its rating adjudication. Although the CI was considered in full remission, he was maintained on continuous medication meeting the §4.130 guidelines for a 10% rating. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends no change in the PEB adjudication at the time of placement on TDRL and a permanent disability rating of 10% at the time of removal from TDLR for the bipolar disorder condition. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. As discussed above, PEB reliance on USAPDA policy for rating the bipolar disorder condition at the time of removal from TDRL was operant in this case and the condition was adjudicated independently of that policy by the Board. In the matter of the bipolar disorder condition, the Board unanimously recommends no change in the PEB adjudication at the time of placement on TDRL and a disability rating of 10% coded 9432 IAW VASRD §4.130. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior permanent medical separation: UNFITTING CONDITION VASRD CODE RATING TDRL PERMANENT Bipolar Disorder 9432 30% 10% COMBINED 30% 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120718, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxxx, DAF Director of Operations Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130011063 (PD201201364) 1. I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation. This decision is final. 2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum. 3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures. BY ORDER OF THE SECRETARY OF THE ARMY: Encl xxxxxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)