RECORD OF PROCEEDINGS
                     PHYSICAL DISABILITY BOARD OF REVIEW

NAME:                                                           BRANCH    OF
SERVICE:  navy
CASE NUMBER:   PD1100191                                          SEPARATION
DATE:  20060106
BOARD DATE:  20120228


SUMMARY OF CASE:  Data extracted  from  the  available  evidence  of  record
reflects that this covered  individual  (CI)  was  an  active  duty  HM3/E-4
(68086 / Hospital Corpsman), medically separated for  bipolar  II  disorder.
The CI injured  her  left  knee  during  basic  training  in  May  2002  and
developed bilateral knee pain.  Her symptoms did not  improve  with  limited
duty (LIMDU) and conservative  management  and  she  subsequently  underwent
left knee surgery  in  May  2005.   Despite  surgery,  her  left  knee  pain
persisted.  She did not respond adequately to treatment and  was  unable  to
perform within her rating or  meet  physical  fitness  standards.   She  was
continued on a second LIMDU and a third LIMDU was denied and  she  underwent
a Medical Evaluation Board (MEB).   During  the  MEB  time  period,  the  CI
sought  treatment  for  mood  swings,  depressive  symptoms   and   suicidal
ideation.  She was diagnosed with  bipolar  II  disorder  and  treated  with
therapy and medication.  The MEB forwarded chondromalacia of patella,  other
acquired deformities of the knee, and bipolar II disorder  to  the  Physical
Evaluation Board (PEB) as medically  unacceptable  IAW  SECNAVINST  1850.4E.
No other conditions appeared on  the  MEB’s  submission.   Other  conditions
included in the Disability Evaluation System (DES) packet will be  discussed
below.  The PEB adjudicated the bipolar II  condition  as  unfitting,  rated
10%,  with  application  of  the  SECNAVINST  1850.4E.    Additionally   the
conditions  of  left  knee  status  post-tibial  tubercle  realignment   and
bilateral chondromalacia of the patella (due to malalignment) were  adjudged
category III (cat III - not separately unfitting and do  not  contribute  to
the unfitting condition).   The  CI  made  no  appeals,  and  was  medically
separated with a 10% combined disability rating.


CI CONTENTION:  “After being medically  separated  from  the  United  States
Navy, I was evaluated by the Veterans Administration, and I was found to  be
70%  disabled  due  to  PTSD,  bipolar   disorder,   endometriosis,   lumbar
degenerative disc disease, and bilateral degenerative joint disease  due  to
chondromalacia.  Approximately two years later,  I  was  found  to  be  100%
disabled by the VA and was permanently disabled.”


RATING COMPARISON:

|Service IPEB – Dated 20051026  |VA (~12 Mo. After Separation) – All     |
|                               |Effective Date 20060107                 |
|Condition                      |Code                            |Rating |
|Combined:  10%                 |Combined:  70%                          |


*Bipolar Disorder and PTSD, 9432, increased to 100%, effective 20080307.


ANALYSIS SUMMARY:  The Board acknowledges the  sentiment  expressed  in  the
CI’s  application  regarding  the  significant  impairment  with  which  her
service-incurred condition continues to burden her.   The  Board  wishes  to
clarify that  it  is  subject  to  the  same  laws  for  service  disability
entitlements as those under which the DES operates.   The  DES  has  neither
the role nor the authority to compensate  service  members  for  anticipated
future severity  or  potential  complications  of  conditions  resulting  in
medical separation.  That role and authority is granted by Congress  to  the
Department of Veterans’ Affairs (DVA), operating under a  different  set  of
laws (Title 38, United States  Code).   The  Board  evaluates  DVA  evidence
proximal  to  separation  in  arriving  at  its  recommendations,  but   its
authority resides in evaluating the fairness of DES  fitness  decisions  and
rating determinations for disability at the time of separation.   The  Board
also acknowledges  the  CI's  contention  suggesting  that  service  ratings
should have been conferred for other conditions documented at  the  time  of
separation and for conditions not diagnosed while in the service (but  later
determined to be service-connected by the DVA).   While  the  DES  considers
all of the service member's medical conditions,  compensation  can  only  be
offered for those medical conditions  that  cut  short  a  service  member’s
career, and then only to the degree of  severity  present  at  the  time  of
final disposition.  The DVA, however, is empowered  to  compensate  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.

Bipolar II Disorder.  The psychiatric addendum to  the  MEB,  dated  October
2005 noted that the CI had self-referred one month  prior  for  symptoms  of
mood swings and depression.  She described her mood swings as  either  high,
or low.  The CI  endorsed  symptoms  of  distractibility,  insomnia  without
feeling tired, increased goal  directed  activity,  irritability,  pressured
speech, racing thoughts and  anxiety  occurring  during  the  “highs.”   She
noted that these symptoms  “do  not  cause  significant  problems,  but  the
patient  notes  them  as  significantly  out  of  the  norm  for   her   and
distressing.”  The “highs” would last from days to weeks, after  which  time
she would return to a normal mood.  This period of normal  mood  would  then
be followed by a “low” period of depressed mood which would last  for  three
to four weeks.  The CI’s low  periods  were  characterized  by  symptoms  of
hypersomnia, amotivation,  decreased  interest,  anhedonia,  crying  spells,
poor  appetitie,  guilt,   negative   self-talk   and   suicidal   ideation.
Additionally, the CI endorsed symptoms of  increasing  anxiety  as  well  as
increasing frequency and severity of her mood swings.   The  examiner  noted
that three weeks prior to the psychiatric narrative  summary  (NARSUM),  the
CI had experienced thoughts of wanting to harm her patients at work  in  the
setting of significant irritability and  depressed  mood.   She  denied  any
intent or plan and  she  did  recognize  the  thoughts  as  distressing  and
intrusive.  The CI was started on treatment with  Effexor  (anti-depressant)
at that time, but was later changed  to  Paxil  and  Lamictal  due  to  side
effect of insomnia.

At the time of the psychiatric NARSUM, the  examiner  noted  that  the  CI’s
symptoms had stabilized on medication; commenting that her mood and  anxiety
had improved and documenting that  she  was  no  longer  suicidal.   The  CI
continued to endorse symptoms of insomnia,  not  responsive  to  medication.
On mental status exam (MSE), she was mildly anxious with a mildly  depressed
mood and a mood-congruent, reactive affect.  The examiner documented  intact
attention and concentration as well as  good  insight  and  judgement.   The
CI’s speech was normal and there  were  no  psychotic  symptoms,  perceptual
disturbances or  abnormalities  of  memory.   The  examiner  commented  that
although the CI’s mood was responding to treatment, she  continued  to  have
prominent  depressive  symptoms,  “part  of  which  may  include  adjustment
difficulties  to  transition  out  of  the  military.”   Additionally,   the
examiner noted that the CI’s “low episodes are  more  dysfunctional  to  the
patient in regard to  both  work  and  social  functioning.”   The  examiner
assessed marked impairment for further military  duty  and  mild  impairment
for social and industrial  adaptability.   The  prognosis  was  “hopeful  to
return to a  pre-morbid  level  of  functioning  with  ongoing  therapy  and
psychopharmocologic optimization.”  The axis  I  diagnosis  was  bipolar  II
disorder, most  recent  episode  depressed  and  the  global  assessment  of
functioning (GAF) was assigned  at  55  –  60,  in  the  range  of  moderate
symptoms.  The CI’s mental health condition did not result in any LIMDU  and
the condition was not implicated in the non-medical assessment (NMA),  which
had been accomplished prior to the CI’s mental disorder diagnosis.  The  PEB
worksheet (JDETS) noted that “the impairment is  minimal,”  but  recommended
unfit due to concern that “bipolar often progresses.”

At the time of the VA Compensation and Pension (C&P) exam, approximately  12
months after separation, the CI continued to endorse bipolar symptoms.   She
also reported a history of a  suicide  attempt  by  overdose  that  was  not
treated by medical personnel.  She had not been in treatment for her  mental
health disorder since leaving the service.  The CI reported the  development
of symptoms of nightmares related to missile attacks during  deployment  and
her (pre-service) emergency care of victims of the September 2001  terrorist
attacks.  She also endorsed symptoms  of  avoidance,  emotional  detachment,
lack of trust, lack of friends, loss  of  interest  in  leisure  activities,
sleep disturbance, irritability, frequent arguments with her  boyfriend  and
others, exaggerated startle response and hypervigilance.   She  stated  that
she would only leave her home in order to go  to  work,  out  of  fear  that
something terrible might happen.  The CI also complained  of  being  tearful
and  having  suicidal  thoughts,  without  recent  intent.   Despite   these
symptoms, the CI reported that she had successfully  completed  a  paramedic
certification program and was currently employed  as  an  emergency  medical
technician.  The examiner noted that the CI was performing well on the  job,
without difficulties in her relationships  with  supervisors  or  coworkers.
On mental status exam, the CI’s mood was  described  as  depressed  with  an
incongruous affect.  The examiner commented  that  “she  frequently  laughed
and smiled when discussing her  experience  of  depression,  and  her  other
recent  difficulties  and  stressors.”   The  CI  reported  daily   suicidal
ideation  without  intent.   There  was  no  homicidal  ideation,  paranoia,
delusions or hallucinations.   Her  insight  and  judgment  were  good,  her
cognition was intact and  her  thought  processes  were  logical  and  goal-
oriented.  The axis  I  diagnoses  were  bipolar  I  disorder,  most  recent
episode depressed, and posttraumatic stress disorder (PTSD).   The  GAF  was
assigned at 50, in the range of serious symptoms, and indicated it  was  for
current functioning and the highest in the past  past  year.   The  examiner
concluded that her depressive symptoms were in the moderate to severe  range
and more debilitating to her daily functioning than her  episodic  hypomanic
and manic symptoms.   The  examiner  further  noted  that  although  the  CI
“continues to manage her daily work environment, which typically involved  a
good deal of stress, as well as difficult relationship  issues,  her  mental
state appears to be quite fragile.”  The VA assigned a  rating  of  50%  for
the  mental  health  conditions  based  upon  this  evaluation.   The  Board
concluded that the CI’s condition at the  time  of  the  VA  exam,  some  12
months  after  separation,  represented  post-separation  worsening  in  the
conditon and was not indicative of her condition at time of separation.

The Board directs its attention to its rating recommendations based  on  the
evidence just described.  It was first adjudged that PTSD was not  diagnosed
or apparent prior to separation and that this case of bipolar  disorder  did
not meet the requirements for application of a retroactive TDRL  rating  IAW
VASRD §4.129, or  as  directed  by  DoD  for  PTSD.   The  CI’s  psychiatric
condition was adjudged to be of an intrinsic nature, and not a result  of  a
“highly stressful event” (as per §4.129).  As regards the separation  rating
recommendation, all members agreed that  the  §4.130  threshold  for  a  50%
rating was not approached.  The Board acknowledged that the  VA  assigned  a
50% rating for the mental health conditions based  upon  their  exam  at  12
months after separation.  As discussed above, the Board considered that  the
VA exam represented some post-separation decline in the CI’s  condition  and
was not indicative of the CI’s level of functional  impairment  at  time  of
separation.   The  service  psychiatry  addendum  was  more   proximate   to
separation and was adjudged of greater probative  value.   The  deliberation
settled  on  arguments  for  a  10%   versus   a   30%   separation   rating
recommendation.  In support of the argument  for  a  10%  rating,  both  the
service exam and the C&P exam noted similar symptoms, but noted the  CI  was
functioning in her fulltime  employment.   Additionally,  the  service  exam
documented no social impairment  and  noted  that  the  CI’s  symptoms  were
responding to treatment and her prognosis was “hopeful;” although  this  was
within the first month of treatment.  The Board  noted,  however,  that  the
GAF assignment,  symptom  description  and  clinical  course  noted  at  the
service exam argue against a characterization of the  severity  as  mild  or
transient, and it is clear that symptoms were not completely  controlled  on
medication.  The Board considered the CI’s  prominent  depressive  symptoms,
sleep disturbance, decreased  energy,  decreased  motivation  and  increased
suicidal ideation, and deliberated if decreased efficiency  can  be  assumed
even though reliability and  productivity  were  not  affected.   The  Board
noted  that  the  severity  of  the  symptoms   supported   a   30%   rating
recommendation,  although  assessing  only  pre-separation  evidence  and  a
“hopeful prognosis” may support  a  10%  rating.   After  due  deliberation,
considering  the  totality  of  the  evidence  and  mindful  of  VASRD  §4.3
(reasonable doubt), the Board majority recommends  a  permanent  bipolar  II
disorder disability rating of 30% in this case.

Other PEB Conditions.   The  other  conditions  forwarded  by  the  MEB  and
adjudicated as not unfitting by the PEB were left  knee  status  post-tibial
tubercle realignment and bilateral chondromalacia  of  the  patella  due  to
malalignment.  The CI had a lengthy history of left knee pain that was  well
documented in the service  treatment  records  (STR).   Prior  to  entry  on
active  duty,  the  CI  had  undergone  diagnostic  arthroscopy  and   joint
debridement of the left knee in  1997,  and  of  the  right  knee  in  1998.
Following the surgeries, she had complete resolution  of  symptoms  and  was
cleared to enter onto active duty without restrictions or limitations.   The
CI injured her left knee while in basic  training  in  May  2002.   After  a
lengthy trial of  conservative  management,  to  include  LIMDU,  left  knee
injections and physical therapy,  she  underwent  arthroscopic  exploration,
followed by an open tibial tubercle realignment  and  open  lateral  release
procedure on the left knee in May 2005.  The CI displayed  some  improvement
in her left knee pain symptoms following surgery, however  at  the  time  of
her third LIMDU Board, in          July 2005, the  narrative  summary  noted
that  she  would  require  a  significant  period  of  additional  time   to
completely rehabilitate the left knee.  That summary also noted that the  CI
was having similar symptoms in the  right  knee  which  might  also  require
surgery  and  further  extension  of  her  LIMDU.   The   narrative   listed
limitations of no participating in impact activities  and  no  running,  but
added that “she is  more  than  capable  to  provide  the  service  that  is
necessary from her in her daily activities and current  work  space.”   This
request for a third  limited  duty  period  was  denied  by  Navy  Personnel
Command, which cited, “mbr has  exhausted  all  LIMDU.   Further  LIMDU  for
another surgery is not in the best interest of the service.”  The NMA  noted
that the CI was performing adequately within  her  specialty  and  commented
that she had good potential for continued service in her present  condition.
 However, the NMA also commented that she was not  wordwide  assignable  and
recommended against retention on active duty in a  permanent  LIMDU  status.
The (final, September  2005)  MEB  noted  that  the  CI  continued  to  have
significant bilateral knee pain with walking up and down stairs as  well  as
riding the bike, and stated that her symptoms were not  likely  to  improve.
The MEB concluded that her bilateral knee pain with  running,  climbing  and
daily activities  “would  interfere  with  her  ability  to  carry  out  her
assigned duties on active duty.”  Despite the findings of the  MEB  and  the
NMA, the PEB stated (JDETS notes) “knees not unfitting as HM3.”

The Board considered  the  considerable  documentation  of  duty  impairment
related to the left knee condition and referral into the  DES  was  for  the
left knee condition.  All evidence considered, the Board cannot find  enough
strength in the PEB position to overcome the sound  arguments  favoring  the
CI’s position regarding the left  knee  fitness  adjudication.   The  Board,
therefore,  recommends  that  the  left  knee  condition  be  rated  as   an
additionally unfitting condition.

Left  Knee  Status  Post  Tibial  Tubercle   Realignment   and   Left   Knee
Chondromalacia  Patella.   There  were  three  left  knee   evaluations   in
evidence, one with goniometric  range-of-motion  (ROM)  measurements,  which
the Board weighed in arriving at its rating recommendation.

|Goniometric ROM |Ortho ~6 Mo.    |MEB Info. ~2 Mo.  |VA C&P ~14 Mo.      |
|–               |Pre-Sep         |Pre-Sep           |After-Sep           |
|Left Knee       |(20050719)      |(20051107)        |(20070302)          |
|Flexion (140⁰   |“Full range of  |                  |0-85⁰               |
|normal)         |motion of the   |                  |                    |
|                |knee”           |                  |                    |
|Extension (0⁰   |                |                  |5⁰                  |
|normal)         |                |                  |                    |
|Comment         |Pain elicited by|More normal       |Antalgic gait; walks|
|                |motion of the   |Q-angle; regained |w/ cane, crutch and |
|                |knee; normal    |biceps strength;  |uses hinged brace;  |
|                |Q-angle         |full ROM;         |painful motion; pain|
|                |                |documented painful|with squatting;     |
|                |                |use with running, |flexion further     |
|                |                |climbing and daily|limited to 80⁰ with |
|                |                |activities        |repetitive use.     |
|§4.71a Rating   |10%*            |10%*              |10%*                |


      *With application of §4.59, painful motion or §4.40 functional loss.

The MEB narrative summary did not include an examination  of  the  knee.   A
post-operative orthopedic exam done six months  prior  to  separation  noted
full ROM with painful motion.  The VA C&P exam, which took place  14  months
after separation, documented complaints of  left  knee  pain,  weakness  and
giving out.  The CI stated that she had to quit her job  with  an  ambulance
company because her knee pain prevented her from climbing in and out of  the
ambulance.  The examiner noted tenderness over the area  of  pin  placement,
but did not find evidence of  effusion,  redness  or  heat.   There  was  no
instability on Lachman’s, McMurray’s, anterior drawer  or  posterior  drawer
testing, however, the examiner documented “+valgus  in  neutral  and  in  30
degrees of  flexion.”   The  exam  also  documented  painful  limitation  of
motion,  with  additional  limitation  of  flexion  due  to  pain  following
repetitive use.  Plain films of the left knee  noted  post-surgical  changes
without malalignment.  The films also documented a  transverse  nondisplaced
lucency which may have been due to remodeling.  A 2002 MRI of the left  knee
was interpreted as normal.  The VA utilized coding analgous to  osteomalacia
(5014) and rated at  10%  based  upon  evidence  of  painful  limitation  of
motion.  The degree of limitation of flexion  and  limitation  of  extension
documented at the VA exam was not compensable under the knee joint  specific
coding.  There was no evidence of frequent  locking  or  joint  effusion  to
warrant  a  higher  rating  under  alternate  coding  of  5258,   cartilage,
semilunar,  dislocated.   The  service  exams  did  not  comment  on   joint
stability and the “+valgus”  noted  at  the  VA  exam  would  not  meet  the
criteria for the higher 20% rating under  coding  for  lateral  instability.
After due deliberation, the Board  agreed  that  the  preponderance  of  the
evidence with regard to the functional impairment  of  left  knee  condition
favors  its  recommendation  as  an  additionally  unfitting  condition  for
separation rating.  It is appropriately coded 5099-5014 and meets the  VASRD
§4.71a criteria for a 10% rating.

Right  Knee  Patellofemoral  Syndrome  Condition.   The   documentation   of
functional impairment attributed to the right knee  condition  was  somewhat
limited  and,  absent  the  duty  limitations  imposed  by  the  left   knee
condition, there was insufficient evidence that  the  right  knee  condition
was separately unfitting.  All  evidence  considered,  the  Board  concluded
that there was insufficient cause to recommend a change in the  PEB  fitness
adjudication for the right knee condition.

Other Contended Conditions.  The CI’s application asserts  that  compensable
ratings should be considered for lumbar  degenerative  disc  disease  (DDD),
endometriosis, and PTSD.  The lumbar DDD did not result  in  any  LIMDU  and
was not implicated in the NMA.  This condition was reviewed  by  the  action
officer and considered by the Board.  There was no evidence  for  concluding
that the lumbar DDD condition interfered with duty performance to  a  degree
that could be argued as unfitting.  The Board determined therefore that  the
lumbar DDD condition was not subject  to  service  disability  rating.   The
conditions of endometriosis and PTSD were not documented in  the  DES  file.
The Board does not have the authority under DoDI 6040.44 to  render  fitness
or rating recommendations for any conditions not considered by the DES.

Remaining Conditions.  Several additional non-acute  conditions  or  medical
complaints  were  also  documented.    None   of   these   conditions   were
significantly clinically or occupationally active  during  the  MEB  period,
none carried attached duty limitations, and  none  were  implicated  in  the
NMA.  These conditions were reviewed by the action  officer  and  considered
by the Board.  It was determined that none could be argued as unfitting  and
subject to separation rating.  The Board therefore has no  reasonable  basis
for recommending any additional unfitting conditions for separation rating.


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 II disorder  condition,  the  Board
by a vote of 2:1 recommends a permanent service disability  rating  of  30%,
coded 9432 IAW VASRD §4.130.  The single voter for dissent (who  recommended
no change in the PEB 10%  adjudication  for  9432)  submitted  the  addended
minority opinion.  In the matter of  the  left  knee  chondromalacia  status
post-tibial  tubercle   realignment   condition,   the   Board   unanimously
recommends that it be added  as  an  additionally  unfitting  condition  for
separation rating, coded 5099-5014 and rated 10% IAW VASRD §4.71a.   In  the
matter of the right knee chondromalacia  condition,  the  Board  unanimously
recommends no change from the PEB adjudication as  not  unfitting.   In  the
matter of the lumbar DDD condition or any other medical conditions  eligible
for Board  consideration,  the  Board  unanimously  agrees  that  it  cannot
recommend any findings of unfit for additional rating at separation.


RECOMMENDATION:  The Board recommends that the CI’s prior  determination  be
modified  as  follows  and  that  the  discharge  with  severance   pay   be
recharacterized to reflect permanent disability retirement, effective as  of
the date of her prior medical separation.

|UNFITTING CONDITION                             |VASRD CODE  |RATING  |
|Bipolar II Disorder                             |9432        |30%     |
|Left Knee Chondromalacia S/P Tibial Tubercle    |5099-5014   |10%     |
|Realignment                                     |            |        |
|COMBINED    |40%     |


The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20110321, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record





                 President
                 Physical Disability Board of Review
MINORITY OPINION:

The CI was found unfit for Bipolar II Disorder by the PEB and rated 10%  and
was separated January 6, 2006.
The CI self-referred for evaluation on September 7, 2005, four months  prior
to separation with complaints of depression with anxiety.  The  CI  reported
her symptoms had been going on for about a year to a year and a  half.   The
service treatment  record  has  minimal  treatment  notes.  Her  psychiatric
addendum was completed for the MEB  on  October  7,  2005.   At  this  time,
treatment  notes  indicate  she  was  responding  well  to  treatment.   Her
symptoms had stabilized on medication and her mood and anxiety had  improved
and she was no  longer  suicidal,  but  continued  to  endorse  symptoms  of
insomnia.

Although the CI reports she had symptoms for  over  a  year,  there  was  no
indication that any of these symptoms were apparent to her chain of  command
or interfering with her duty performance.  She  continued  to  work  in  her
specialty and her Non Medical Assessment (NMA)  stated  “has  performed  her
duties adequately to support the mission of Naval Health Care New England.”

The VA C&P exam completed approximately 12  months  after  separation  noted
the CI continued to endorse bipolar symptoms. Despite her symptoms,  the  CI
reported she successfully completed a paramedic  certification  program  and
was employed as an emergency medical  technician,  performing  well  on  her
job,  without  difficulties  in  her  relationships  with   supervisors   or
coworkers and reported no significant time missed from work. She also was  a
scuba instructor.

The members of the Board deliberated between 10% and 30%.

 30%- Occupational and social impairment with occasional  decrease  in  work
efficiency and intermittent periods of  inability  to  perform  occupational
tasks  (although  generally   functioning   satisfactorily,   with   routine
behavior, self-care, and conversation  normal)  due  to  such  symptoms  as:
depressed mood, anxiety,  suspiciousness,  panic  attacks  (weekly  or  less
often) chronic sleep impairment,   mild  memory  loss  (such  as  forgetting
names, directions, recent events)

10%- 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.  Despite her  symptoms,  there  was  no  evidence  of
decrease in work efficiency or any  intermittent  periods  of  inability  to
perform occupational tasks.

I believe a final rating of 10% more closely approximates  the  elements  of
the CIs Bipolar condition at the time of separation.  The Board  unanimously
agreed the  left  knee  be  added  as  an  additional  unfitting  condition,
appropriately rated at 10%.

As the  minority  member,  I  recommend  the  CI’s  prior  determination  be
modified to reflect a combined rating of 20%.
MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION

Ref:   (a) DoDI 6040.44
       (b) PDBR ltr dtd 15 Mar 12

1.  Pursuant to reference (a) I have reviewed the recommendation of the
PDBR set forth in reference (b), and direct correction of the subject
member’s Naval records as follows:

    a.  Effective 6 January 2006, disability separation with a rating of 20
percent (increased from 10 percent), with entitlement to disability
severance pay.

2.  Please ensure all necessary actions are taken to implement these
decisions, including the recoupment of disability severance pay if
warranted, and notification to the subject member once those actions are
completed.




      Principal Deputy
      Assistant Secretary of the Navy
        (Manpower & Reserve Affairs)