RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE: ARMY  
SEPARATION DATE:  20040928 

 
NAME:    
CASE NUMBER:  PD1101043 
BOARD DATE:  20121130 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SPC/E-4  (63W/Wheel  Vehicle  Repairer),  medically 
separated for bipolar disorder.  The condition began after returning from a deployment to Iraq 
in 2003.  She underwent a trial of medications and outpatient therapy, but failed to improve 
adequately to meet the operational requirements of her Military Occupational Specialty (MOS).  
She  was  issued  a  permanent  P2L2E2S4  profile  and  referred  for  a  Medical  Evaluation  Board 
(MEB).    The  MEB  forwarded  bipolar  disorder  and  panic  disorder  to  the  Informal  Physical 
Evaluation  Board  (IPEB)  as  medically  unacceptable  IAW  AR  40-501.    Eight  other  conditions, 
identified in the rating chart below, were also identified and forwarded by the MEB as meeting 
retention  standards.    The  IPEB  adjudicated  the  bipolar  disorder  condition  as  unfitting,  rated 
10%  with  likely  application  of  the  Department  of  Defense  Instruction  (DoDI)  1332.39.    The 
remaining conditions were determined to be not unfitting.  This finding was upheld by a Formal 
PEB (FPEB) and the CI was medically separated with a 10% disability rating. 
 
 
CI CONTENTION:  “I was given a 10% by the PEB for my bipolar disorder and the VA gave me 
50% when I was discharged.  Also the PEB found other conditions as Fit when the MEB listed 
them as unfitting.”  The CI attached a two page memorandum to her application from counsel 
which was reviewed by the Board and considered in its recommendations. 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.”  The ratings 
for  unfitting  conditions  will  be  reviewed  in  all  cases.    The  eight  conditions  requested  for 
consideration and the unfitting bipolar disorder condition meet the criteria prescribed in DoDI 
6040.44 for Board purview, and are accordingly 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 Army Board for Correction of Military Records. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

VA (7 Mo. After Separation) – All Effective Date 20040929 

Condition 

Post Traumatic Stress Disorder 
Left Ankle Sprains  
Residuals of Head Injury 
Pes Planus 

Code 
9411 
5271 
8045 
5276 

Rating 
50% 
0%* 
10%** 

0% 

NO VA ENTRY 

NSC 
NSC 
NSC 

Not Service Connected x 3 

Combined:  60% 

Exam 

20050422 

STR 
STR 
STR 

STR 
STR 
STR 
STR 

 

RATING COMPARISON:   
 

Service FPEB – Dated 20040811 
Condition 

Bipolar Disorder 
Residual Left Ankle Pain  
Migraine Headaches 
Benign Intention Tremor 
Pes Planus 
Left Fifth Finger Amputation 
Right Hand Frostbite Residuals 
Vision Defect 
Recurrent Low Back Pain 

Code 
9432 

Rating 
10% 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 
Not Unfitting 

↓No Additional MEB/PEB Entries↓ 

Combined:  10% 

*Increased to 10% by VA decision 20091230, effective 20090827 (based on new exam); combined 60% 
**Original VA decision rated 0%, increased to 10% by rating decision 20091230 (not based on new exam), effective 20040929; 
combined 60%  
 
 
ANALYSIS SUMMARY:  The Board acknowledges the CI’s contention that suggests ratings should 
have been conferred for other conditions documented at the time of separation.  The Board 
wishes to clarify that it is subject to the same laws for service disability entitlements as those 
under which the Disability Evaluation System (DES) operates.  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.  However the Department of Veterans Affairs, operating under a different set 
of  laws  (Title  38,  United  States  Code),  is  empowered  to  compensate  all  service-connected 
conditions  and  to  periodically  reevaluate  said  conditions  for  the  purpose  of  adjusting  the 
Veteran’s disability rating should the degree of impairment vary over time. 
 
Mental Health Condition.  Although the PEB rating preceded the promulgation of the National 
Defense  Authorization  Act  (NDAA)  2008  mandate  for  DoD  adherence  to  VASRD  §4.129,  IAW 
DoDI 6040.44 and DoD guidance the Board must apply §4.129 to all relevant Board cases.  The 
salient question before the Board is whether the CI’s psychiatric 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.”  In this 
case, the clinical record provides enough evidence the CI’s condition arose as a result of highly 
stressful events that the Board unanimously agrees §4.129 is applicable.  The Board is therefore 
obligated  to  recommend  a  minimum  50%  rating  for  a  retroactive  6-month  period  on  the 
Temporary Disability Retired List (TDRL).  The Board must then determine the most appropriate 
fit  with  VASRD  §4.130  criteria  at  the  end  of  the  TDRL  interval  for  its  permanent  rating 
recommendation.  The most proximate source of comprehensive evidence on which to base the 
permanent  rating  recommendation  in  this  case  is  the  VA  Compensation  and  Pension  (C&P) 
examination performed 7 months after separation.  There was no other relevant VA outpatient 
or  civilian  provider  evidence  providing  psychiatric  details  during  the  6-month  interval.  
Especially since the C&P examination also reflects the stress of transition to civilian life, which is 
a  core  intent  of  §4.129,  it  carries  the  preponderance  of  probative  value  in  the  Board’s 
assessment  of  a  fair  permanent  rating  recommendation.    The  MEB  evaluation  nevertheless 
serves as a useful reference point and retains relevant probative value.  The CI was medically 
evacuated from Iraq in July 2003 for an ankle problem, but within 6 weeks after return from 
this deployment she presented with psychiatric symptoms.  A diagnosis of bipolar disorder and 
panic disorder was made and she became stable on treatment.  However, inpatient treatment 
in  October  2003  for  worsening  depression  and  suicidal  ideation  was  required,  and  she  was 
discharged  in  November  2003  after  a  6 day  hospitalization.    In March  2004  she  experienced 
auditory hallucinations while on drug therapy, which responded to the addition of antipsychotic 

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medication.  The severity of the CI’s condition at the time of the MEB evaluation could best be 
described  as  moderate.    The  commander’s  statement  reflected  unpredictable  panic  attacks, 
poor concentration and the need for constant supervision and correction.  She was noted to 
frequently go into “near vegetative states,” but he opined that some of her symptoms were 
due  to  medications.    He  noted  that  while  working  in  her  MOS  in  Iraq,  she  was  exposed  to 
continuous danger that she did not effectively cope with.  The NARSUM examiner performed 4 
months  prior  to  separation  reported  that  her  symptoms  of  sleep  disturbance,  distractibility, 
auditory  hallucinations  and  increased  energy  were  intermittent.    She  also  experienced 
intermittent episodes of intense anxiety; for example she became tremulous and profoundly 
anxious when asked to drive a 5-ton vehicle.  She was taking three psychotropic medications.  A 
mental status exam (MSE) revealed no evidence of psychosis.  Mood was “okay” and there was 
no evidence of suicidal or homicidal ideation.  Global Assessment of Functioning (GAF) was 60, 
connoting moderate symptoms or impairment.  Two weeks after this exam however, the CI was 
re-admitted  for  inpatient  care  with  auditory  hallucinations,  sleeping  2-3  hours  per  night, 
pressured thoughts, low energy, depressed mood and suicidal ideation, likely as a consequence 
of  being  off  her  medications  for  3  weeks.    Symptoms  were  stabilized  with  resumption  of 
medication.    At  the  time  of  hospital  discharge  6  days  later,  she  was  sleeping  well,  had  no 
hallucinations and her GAF was 59 (moderate symptoms).  An outpatient note 2 weeks after 
hospital  discharge  indicated  significant  panic  attacks  twice  per  week  and  ongoing  sleep 
impairment.    Two  months  prior  to  separation,  a  narrative  summary  (NARSUM)  addendum 
stated that  new  information  about  experiences  in  Iraq  warranted the  additional  diagnosis  of 
posttraumatic stress disorder (PTSD), and referred to the fact that the CI had been a participant 
in  the  weekly  “Post  Traumatic  Stress  Disorder  Group”  since  20  November  2003.    Symptoms 
indicative  of  the  PTSD  diagnosis  included  recollection  and  re-experiencing  traumatic  events, 
avoidance,  hypervigilance,  nightmares,  sleep  disturbance  and  decreased  concentration.    She 
continued  to  avoid  crowded  places  for  fear  of  attack.    Her  GAF  at  that  time  was  62  (mild 
symptoms  or  impairment).    Although  her  overall  prognosis  was  considered  fair  to  good, 
impairment  for  social  and  industrial  adaptability  was  considered  definite.    At  the  VA 
examination on 22 April 2005 (7 months after separation and a month after the end of the 6 
month constructional TDRL period) symptoms were best described as mild to moderate.  She 
was a sophomore in college and worked 12 hour shifts as a paramedic.  She was being treated 
at  a  PTSD  program  and  was  taking  three  medications  for  PTSD.    She  reportedly  no  longer 
carried the diagnosis of bipolar disorder.  Panic attacks were occurring two to three times per 
week, and intrusive thoughts and flashbacks three to four times per week.  Sleeping problems, 
crying  spells,  anhedonia  (inability  to  enjoy  usually  enjoyable  activities)  and  nightmares  were 
also occurring.  She still reported auditory hallucinations and paranoia at times.  She stated that 
she was not as depressed now because she was working at a job she “truly enjoys” and because 
she was on her medication.  She indicated that she was fairly well adjusted and much better off 
compared  to  when  she  was  separated  from  the  military.    She  complained  of  some 
forgetfulness.  She was able to engage in a full range of normal activities of daily living and had 
some social contacts.  MSE revealed her to be very hyperactive with psychomotor agitation and 
restlessness.  There was no suicidal ideation.  She was oriented and appeared euphoric.  Speech 
was  normal,  thought  processes  were  logical  and  coherent,  and  abstract  thinking  was  intact.  
Concentration  was  fair  and  immediate  recall  appeared  intact,  however  formal  psychometric 
testing  revealed  her  concentration  and  immediate  memory  to  be  substantially  below  her 
expected  norms.    The  examiner’s  assessment  was  post traumatic  stress  disorder  and  bipolar 
disorder triggered by the PTSD.   The GAF was 50 (serious symptoms or impairment). 
 
The Board directs attention to its rating recommendation based on the above evidence.  In its 
deliberation,  the  Board  recognized  the  FPEB’s  acknowledgement  of  PTSD  features  when 
assigning a 10% rating under the 9432 code (bipolar disorder).  The Board first considered the 
rating  at  the  time  of  separation.    The  requirement  for  antipsychotic  medication,  the 
occupational impairment described by the commander and the need for hospitalization were 
considered to be indicators of the serious nature of the mental condition, and weighed heavily 

   3                                                           PD1101043 
 

in  the  Board’s  deliberation.    The  hospital  admission  after  the  first  NARSUM  examination 
likewise raised concern, although this was somewhat tempered by the fact that it occurred in 
the  context  of  stopping  her  medications;  after  resumption,  symptoms  improved,  suicidal 
ideation subsided and the GAF indicated moderate impairment.  The Board discussed whether 
these  factors  supported  a  §4.130  rating  of  70%  (occupational  and  social  impairment,  with 
deficiencies in most areas) or the minimum required 50% (occupational and social impairment 
with reduced reliability and productivity); ultimately the Board majority agreed that the 70% 
rating best depicted the clinical picture.  In determining the permanent rating, the Board relied 
heavily  on  the  VA  exam  which  described  a  positive  transition  to  civilian  life  as  evidenced  by 
occupational performance, school attendance and social interactions.  It was agreed that the 
criteria  for  a  70%  rating  were  not  met  and the criteria  for  a  10%  rating  were  exceeded;  the 
deliberation settled therefore on arguments for a 30% versus a 50% rating recommendation.  A 
50% rating IAW §4.130 would rely on an inference that the acuity of reported symptoms could 
reasonably  be  expected  to  result  in  impaired  occupational  reliability  and  productivity;  such 
impairment however did not appear to be the case.  The 30% description (“occupational and 
social  impairment  with  occasional  decrease  in  work  efficiency  and  intermittent  periods  of 
inability  to  perform  occupational  tasks”)  is  a  better  fit  with  the  occupational  functioning  in 
evidence and also well supported by the threshold symptoms present.  After due deliberation, 
considering  all  of  the  evidence  and  mindful  of  VASRD  §4.3  (reasonable  doubt),  the  Board 
recommends  a  TDRL  rating  of  70%  and  a  permanent  disability  rating  of  30%  for  the  bipolar 
disorder with PTSD condition, coded 9411-9432.    
 
Contended PEB Conditions.  The contended conditions adjudicated as not unfitting by the PEB 
were residual left ankle pain and stiffness, migraine headaches, pes planus, status post left fifth 
finger amputation prior to service, mild sensory neuropathy and cold intolerance of right hand 
status post frostbite prior to service, benign intention tremor, vision defect requiring E2 profile 
and recurrent low back pain.  The Board’s first charge with respect to these conditions is an 
assessment of the appropriateness of the PEB’s fitness adjudications.  The Board’s threshold for 
countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard 
used  for  its  rating  recommendations,  but  remains  adherent  to  the  DoDI  6040.44  “fair  and 
equitable” standard.  Left ankle pain and instability was surgically addressed in November 2003 
with a subsequent permanent L2 profile.  The mild sensory neuropathy and cold intolerance of 
the  right  hand  was  profiled  (P2)  to  allow  extra  cold  weather  gear  as  needed,  and  the  mild 
refractive error of the left eye was also profiled E2.  These three conditions were within the 
accession  profile  and  physical  demands  rating  for  the  CI’s  MOS.    None  of  the  remaining 
conditions  were  profiled;  none  of  the  conditions  were  implicated  in  the  commander’s 
statement; and, none were judged to fail retention standards.  The MEB submission specified 
that all the above conditions did meet retention standards.  The MEB physician stated: “She has 
no real physical difficulty in performing the MOS duties except when anxiety or panic attacks 
occur.”  All were reviewed by the action officer and considered by the Board.  There was no 
indication from the record that any of these conditions significantly interfered with satisfactory 
duty  performance.    After  due  deliberation  in  consideration  of  the  preponderance  of  the 
evidence, the Board concluded that there was insufficient cause to recommend a change in the 
PEB  fitness  determination  for  the  any  of  the  contended  conditions;  and,  therefore,  no 
additional disability ratings can be recommended. 
 
 
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 for rating bipolar disorder with PTSD condition was operant in this 
case and the condition was adjudicated independently of that instruction by the Board.  In the 
matter of the bipolar disorder PTSD condition, the Board by a vote of 2:1 recommends an initial 

   4                                                           PD1101043 
 

UNFITTING CONDITION 

Bipolar Disorder with Post Traumatic Stress Disorder 

VASRD CODE 
9411-9432 
COMBINED 

RATING 

TDRL  PERMANENT 
70% 
70% 

30% 
30% 

TDRL  rating  of  70%  in  retroactive  compliance  with  VASRD  §4.129  as  DOD  directed;  and 
unanimously recommends a permanent rating after removal from the TDRL of 30% IAW VASRD 
§4.130.  The single voter for dissent (who recommended a 50% initial TDRL rating) did not elect 
to  submit  a  minority  opinion.    In  the  matter  of  the  contended  residual  left  ankle  pain  and 
stiffness,  migraine  headaches,  pes  planus,  status  post  left  fifth  finger  amputation  prior  to 
service, mild sensory neuropathy and cold intolerance of right hand status post frostbite prior 
to service, benign intention tremor, vision defect and recurrent low back pain conditions, the 
Board  unanimously  recommends  no  change  from  the  PEB  determinations  as  not  unfitting.  
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;  and,  that the discharge  with  severance pay  be  recharacterized to  reflect  permanent 
disability retirement, effective as of the date of her prior medical separation: 
 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20111107, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

             
           President 
           Physical Disability Board of Review 

   5                                                           PD1101043 
 

 

 

 

SFMR-RB 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
 
1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed 
recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) 
pertaining to the individual named in the subject line above to  constructively place the 
individual on the Temporary Disability Retired List (TDRL) at  70% disability for six months 
effective the date of the individual’s original medical separation for disability with severance 
pay and then following this six month period recharacterize the individual’s separation as a 
permanent disability retirement with the combined disability rating of 30%. 
 
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: 
 
 
a.  Providing a correction to the individual’s separation document showing that the 
individual was separated by reason of temporary disability effective the date of the original 
medical separation for disability with severance pay. 
 
 
effective the day following the six month TDRL period. 
 
 
c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will 
account for recoupment of severance pay, provide 70% retired pay for the constructive 
temporary disability retired six month period effective the date of the individual’s original 
medical separation and then payment of permanent disability retired pay at 30% effective the 
day following the constructive six month TDRL period.   
 
 
medical TRICARE retiree options. 
 
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 
 
 

      
     Deputy Assistant Secretary 
         (Army Review Boards) 

b.  Providing orders showing that the individual was retired with permanent disability 

d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

   6                                                           PD1101043