RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-02162
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150106
SEPARATION DATE:  20060512

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (2W051/Munitions Specialist) medically separated for a bipolar II disorder condition.  He underwent a trial of medications, but failed to improve adequately to meet the operational requirements of his Air Force Specialty.  He was issued a U2S4 profile and referred for a Medical Evaluation Board (MEB).  The bipolar disorder condition was forwarded to the Physical Evaluation Board (PEB) for adjudication IAW AFI 48-123.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “bipolar II disorder, in partial to full remission, social and industrial adaptability impairment, mild,” as unfitting, rated 10%, citing criteria of Department of Defense and the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “The CI elaborated no specific contention in his application.”

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 II disorder condition is addressed below; 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 Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20060405 | VA - (4 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Bipolar II Disorder | 9432 | 10% | Bipolar Disorder | 9432 | 30% | 20060926
No Other MEB/PEB Conditions | Other x1 (Not in Scope) | 20060926
Combined:  10% | Combined:  40%
Derived from VA Rating Decision (VARD) dated 20061120 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using the VASRD, based on ratable severity at the time of separation.

Bipolar II Disorder Condition.  The CI presented to the Life Skills Support Center on 27 September 2004 for symptoms of irritability at work, depressed mood, spending too much money and increased suicidal thoughts among others.  He was diagnosed with bipolar II disorder and prescribed anti-depressant medication.  Over the ensuing 17 months, the CI’s bipolar II disorder alternated between being in partial to full remission due to periods of medication non-compliance and a change in medication due to adverse side-effects.  The commander’s statement contained the following statement:

Although he had proven to be a satisfactory performer, this debilitating illness has begun to hamper his ability to perform his duties in the same admirable manner.  Given the sensitive nature of our duties, his medical condition is not conducive for continued service in the Air Force.

The narrative summary (NARSUM) prepared 2 months prior to separation noted his symptoms never prohibited him from completing his assigned work, nor had they caused him to engage in behaviors with potential for legal problems.  With the initiation of medication, the CI expressed his belief that the medication combination was effective.  He had received feedback from his wife and coworkers that his mood was significantly better.  When the CI was informed that the medication would likely make him unable to deploy or be world-wide qualified, he expressed the desire to continue it because of the positive improvements he noticed in his interpersonal relationships, particularly with his wife.  His most recent appointment was 3 months prior to separation at which time the medication continued to work well.  His mental status exam (MSE) revealed that his speech and psychomotor activity were within normal limits.  His thoughts were goal directed and logical with normal thought content.  He denied suicidal thoughts with no evidence of psychotic beliefs.  The diagnosis was bipolar II, most recent episode depressed, in partial remission and he was assigned a Global Assessment of Function (GAF) of 75-80, if symptoms are present they are transient and expectable reactions to psychosocial stressors; no more than slight impairment in social, occupational, or school functioning.

At the VA Compensation and Pension (C&P) exam performed 4 months after separation, the CI reported the medications were helpful, but they made him sleepy.  He had not worked since leaving the Air Force and helped around the house with chores and his four young children.  He had no suicidal ideation and he felt depressed at times, “I don't feel like doing anything except lying in bed all day.  Other days, I do everything I possibly can.”  He was irritable, his concentration was unimpaired, and he described his decision making as good.  His sleep was unimpaired when he took his medications.  He noted that his symptoms returned when he did not take his medications.  His MSE was normal.  He was diagnosed with bipolar II disorder and assigned a GAF of 50-55 (moderate symptoms or moderate difficulty in social, occupational, or school functioning in social, occupational, or school functioning).

The Board directed attention to its rating recommendation based on the above evidence.  The PEB applied VASRD code 9432 (bipolar disorder) and rated it 10% citing “partial to full remission, social and industrial adaptability impairment, mild.”  The VA applied the same VASRD code yet rated it 30% based on the C&P examination.  The evidence supports that the correct diagnosis was bipolar II disorder and that application of VASRD §4.129 was not warranted.  The commander’s statement and the NARSUM both supports that the CI never had intermittent periods of inability to perform occupational tasks as required for the 30% rating.  Additionally, he did not manifest the panic attacks, memory impairment, suspiciousness or anxiety also consistent with the 30% rating.  All evidence supports that the CI’s symptoms were essentially controlled when he took his medications and both examinations documented that his mental status was normal.  When he took his medications, he got along with his wife and young children, and had no sleep impairment.  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 II 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 DoDI 1332.39 and the VASRD for rating the bipolar II disorder condition was operant in this case and the condition was adjudicated independently of the DoDI by the Board.  In the matter of the bipolar II disorder 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 20131031, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

				
XXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXX

Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-02162.

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 re-characterization or modification 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 re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

XXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

PD-2013-02162