RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2013-02021
BRANCH OF SERVICE:  Army	BOARD DATE:  20150505
SEPARATION DATE:  20051220

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Indirect Fire Infantry) medically separated for a mental health (MH) condition.  The MH condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty.  He was issued a permanent S3 profile and referred for a Medical Evaluation Board (MEB).  Bipolar I disorder was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated Bipolar I disorder as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “I was not treated properly.  They gave me a wrong diagnosis.  I was rushed out the service.  I was a good soldier, my company commander said “If not I was one of the best soldier in my troop.”  I’m now receiving care for PTSD.  It does not say so in my record but psychiatrist X gives me medication for it.  Please award me a new decision.  I have been through so much since I came out the service and still going through it.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation. 

RATING COMPARISON:

Service IPEB – Dated 20051129 | VA* - (~2 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Bipolar I Disorder | 9432 | 10% | Bipolar I Disorder | 9432 | 10% | 20060215
Other x 0 (Not in Scope) | Other x 3
Combined:  10% | Combined:  20%
*Derived from VA Rating Decision (VARD) dated 20060412 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Bipolar I Disorder.  The records documented that while hospitalized, on 27 August 2005, the CI was diagnosed with bipolar not otherwise specified (NOS), and at the time of admission he had a Global Assessment of Functioning (GAF) score of 21-30 (severe).  The MEB behavioral health consult dated 19 September 2005 documented no abnormalities in the brief mental status examination (MSE).  He was assessed with bipolar I disorder, severe with psychotic features; his GAF was assessed at 45 without medication and 51-60 with medication.  Although there were no recorded abnormalities in the MSE, the presence or absence of delusions or psychotic symptoms were not recorded.  The examiner opined that the CI’s condition was unfitting for military duty, that social and industrial adaptability was “definite,” and recommended continued outpatient treatment.  The MEB narrative summary (NARSUM), dated 1 November 2005, approximately 7 weeks prior to separation, documented the history of illness, noting that the CI in August 2005, made unusual, and bizarre comments.  The CI reportedly stated, “Before going to the box (field training) I was reading my Bible and asking God to open my eyes to everything, to see clearer.  When I was returning from the box, I felt threatened by my command.  I felt God was answering my prayers and that now I could see the evil inside people and I was fearful, and that is why I ran.”  The CI was charged with desertion and transported to the hospital where he spent one day.  While briefly hospitalized he reportedly stated that he was Jesus Christ, “the Son of God, in the flesh to save people from darkness.”  The CI was then transferred to the psychiatric unit of a different hospital where he spent 10 days and was diagnosed with bipolar I disorder.  The CI was treated with Lithium and an antipsychotic medication (Zyprexa) and recommended for a MEB.  He received outpatient treatment while awaiting the MEB and remained on the same medication without adverse effects.  However, the NARSUM examiner noted he remained with the belief that he was “Jesus Christ in the flesh.”  The CI indicated that he had never been suicidal or homicidal, and that he was feeling fine.  A formal MSE was not documented.  

At the VA Compensation and Pension (C&P) mental examination dated 15 February 2006, approximately 2 months after separation, the CI indicated he had no additional psychiatric hospitalizations.  He was planning to begin work with a security company and was living with his father.  He reported that he had continued with medication management treatment at the local VA; however the general C&P (dated the same date of the psych C&P) examiner documented that the CI stated he had discontinued his medications because he felt he no longer needed them.  The CI apparently reported that he had begun working at the security company and provided the name of the company as well as his salary.  The examiner for the MH C&P opined that the CI’s “Acute psychiatric symptoms appear currently to be in remission, secondary to psychiatric medication management.”  The examiner documented that his current symptoms “are minimal.”  The MSE was unremarkable and the examiner diagnosed bipolar disorder NOS with a GAF of 55 (moderate).

The Board directed its attention to the rating recommendation based on the evidence as described.  Both the VA and PEB rated the condition at 10%, coded 9432 (bipolar disorder).  The first question that came before the Board is whether this condition meets the §4.129 definition of “a mental disorder that develops in service as a result of a highly stressful event [that] is severe enough to bring about the veteran’s release from active military service.”  All Board members agreed that the provisions of §4.129 were not applicable in this case. The Board next proceeded to the rating recommendation based on §4.130 criteria.  Both the NARSUM and the C&P examinations reported similar mental status examinations in relations to stability with medication, and similar GAF scores.  The NARSUM examination did not describe impairment in social or occupational functioning, and assigned a GAF of 51-60 (borderline moderate to mild) with medication and 45 (serious) without medication, 3 months prior to separation.  The VA assigned a GAF of 55 (moderate), two months after separation; recorded a normal MSE, and suggested that the CI’s condition was in full remission.  The Board noted there were no additional hospitalizations, no visits to the emergency room for MH concerns, no report of panic attacks, and no recorded evidence of impairment in thinking or judgment at the time of separation.  Psychotic symptoms were not documented at the NARSUM or C&P examinations, and the CI denied ever experiencing suicidal or homicidal ideations.  The CI had either started a job or was about to begin a job, and appeared to have good support at home.  There was no record of a legal history or a history of violence.  The higher rating of 30% requires “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.”  All Board members agreed that the 30% rating was not supported by the evidence at hand.  The 10% description, “occupational and social impairment due to mild or transient symptoms which decrease work efficiency only during periods of significant stress, or; symptoms controlled by continuous medication,” more accurately reflects the CI’s condition at separation.  All evidence considered there is not reasonable doubt in the CI’s favor supporting a change from the PEB’s rating decision for the Bipolar I condition.  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 bipolar I 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 bipolar I disorder with psychotic features condition 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131030, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President 
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150011183 (PD201302021)

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		     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)

PD-2013-02021