RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXXX CASE: PD1201565 BRANCH OF SERVICE: ARMY BOARD DATE: 20130320 SEPARATION DATE: 20080527 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (68P/Radiology Technician) medically separated for bipolar disorder (BPD). She was initially diagnosed with premenstrual dysphoric disorder (PMDD). In 2007, her psychiatrist noted significant worsening of symptoms, and changed the diagnosis to BPD. She was treated, but did not improve adequately to fully perform her military duties. She was issued a permanent profile and referred for a Medical Evaluation Board (MEB). Bipolar disorder was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also forwarded four other conditions (patellofemoral syndrome, chronic right rotator cuff sprain, migraine headaches, and mild hypercholesterolemia), judged to meet retention standards. The Informal PEB (IPEB) adjudicated bipolar disorder as an unfitting condition not service incurred or permanently aggravated and therefore ineligible for disability compensation. The remaining conditions were determined to be not unfitting and therefore not ratable. The CI appealed to the Formal PEB (FPEB) stating that the board finding of existed prior to service (EPTS) was incorrect. Her appeal stated that she received no medical treatment for depression prior to November 2005 and outlined the stressors of the military as causing service aggravation. The FPEB changed the disability description to note she had no manic episodes or formal diagnosis with treatment until after service entry. She was then medically separated with a 10% disability rating. CI CONTENTION: “Physical Disability Evaluation Board combined rating and VA rating for the same condition are inconsistent for same condition (VDRS code 9432).” 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 disorder condition is addressed below and no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 Army Board for Correction of Military Records. RATING COMPARISON: Service FPEB – Dated 20080131 VA - (4 Mos. Post-Separation) Condition Code Rating Condition Code Rating Exam Bipolar Disorder 9432 10% Bipolar Disorder 9432 30% 20080922 Patellofemoral Syndrome Not Unfitting Chondromalacia Rt Knee 5260-5024 10% 20080922 Chronic Rt Rotator Cuff Sprain Not Unfitting Right Shoulder Pain 5201 20% 20080922 Migraine Headaches Not Unfitting Migraine Headaches 8100 30% 20080922 Mild Hypercholesterolemia Not Unfitting No VA Entry for Hypercholesterolemia No Additional MEB/PEB Entries Other x 1 20080922 Combined: 10% Combined: 70% Derived from VA Rating Decision (VARD) dated 20090202 (most proximate to date of separation [DOS]). ANALYSIS SUMMARY: Bipolar Disorder (BPD). The CI has a long history of psychiatric problems. During her teen years she suffered from depression, irritability, and self-mutilation. After joining the Army, she was diagnosed with PMDD, and was treated with anti-depressant medications. She then developed symptoms of paranoia, restlessness, racing thoughts, and insomnia; alternating with hyperphagia, memory loss, and crying spells. She was seen by psychiatry and was diagnosed with BPD. Due to her psychiatric illness, an MEB was initiated. At her October 2007 psychiatric visit, the CI appeared calm, had soft speech, and had mildly depressed mood. She denied suicidal/homicidal behavior, or psychotic symptoms. She was cognitively intact. Global Assessment of Functioning (GAF) was 60. As noted above, the CI was medically separated from the Army in May 2008. The Board carefully reviewed all evidentiary information available. The Board debated the applicability of the Veterans’ Administration Schedule for Rating Disabilities (VASRD) §4.129 in this case. The Board determined that the CI’s psychiatric symptoms did not result from a highly stressful event, and did not meet the implicit intent of VASRD §4.129. After much discussion, the Board unanimously agreed that VASRD §4.129 did not apply in this case. The Board then directed its attention to its rating recommendation, based on the evidence in the record. The best source of information on which to base the psychiatric rating recommendation is the September 2008 VA Compensation and Pension (C&P) exam performed just 4 months after separation. At that time, she was working full time as a receptionist at a hospital. She was married, and was raising three young children. Her medications included Zyprexa and Seroquel. On examination, she was groomed and dressed normally. She related to the examiner in a pleasant and cooperative manner. Speech was normal. She denied any flight of ideas or pressured speech. She denied hallucinations or delusions, and there was no grandiosity. Affect was appropriate, and she denied any suicidal or homicidal ideation. Her memory, fund of knowledge, calculations, spelling, insight, and judgment were all good. GAF score was 57. Were it not for her borderline personality disorder, her GAF would have been about five points higher. It was clear that her symptoms were fairly mild and that the CI was functioning reasonably well. This was evidenced by her good supportive employment, and her good family relations. She enjoyed reading novels, watching television, and surfing the internet. With regard to the psychiatric rating recommendation, all Board members agreed that 10% was appropriate. The Board determined that the CI’s mild symptoms would decrease work efficiency and ability to perform certain tasks, only during periods of significant stress. Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the BPD 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. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the BPD and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING Bipolar Disorder 9432 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120829, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxxx, AR20130007482 (PD201201565) 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 and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail. BY ORDER OF THE SECRETARY OF THE ARMY: Encl xxxxxxxxxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)