RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201508 SEPARATION DATE: 20050427 

BOARD DATE: 20130409 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty Soldier, SPC/E-4(91W/Medic), medically separated 
for bipolar disorder, in partial remission, associated with anxiety symptoms similar to those of 
posttraumatic stress disorder (PTSD). The CI was evacuated from theater for possible PTSD and 
hospitalized for approximately 11 days in the psychiatric ward of Walter Reed Army Hospital 
(WRAMC). He did not improve adequately with treatment to meet the physical requirements 
of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a 
permanent S4 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded 
two Axis I diagnosis: PTSD, chronic, treated and improved; and bipolar I disorder, as medically 
unacceptable IAW AR 40-501. The MEB forwarded no other conditions for Physical Evaluation 
Board (PEB) adjudication. The PEB combined the two Axis I diagnoses and adjudicated bipolar 
disorder, in partial remission, associated with anxiety symptoms similar to those of PTSD as 
unfitting, rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities 
(VASRD). The CI made no appeals and was medically separated with a 10% disability rating. 

 

 

CI CONTENTION: The CI states: “Awarded ten percent evaluation for PTSD (chronic) and bipolar 
disorder (manic/moderate). Both incurring while deployed in OIF (Samaria 1st/4th CAV).” [sic] 

 

 

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. 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 Admin PEB – Dated 20050301 

VA – All Effective Date 20050428 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bipolar Disorder, in partial 
remission, associated with 
anxiety symptoms similar 
to those of PTSD 

9432 

10% 

Bipolar Disorder w/PTSD 

9432-9411 

10%* 

STRs 

 

.No Additional MEB/PEB Entries. 

 

0% X 0 / Not Service-Connected x 0 

STRs 

Combined: 10% 

Combined: 10% 



*Increased to 50%, effective 20080915, increasing combined to 50%, see VARD of 20081210. 

 

 

ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit 
and vital fighting force. 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 member’s 
career, and then only to the degree of severity present at the time of final disposition. The DES 
has neither the role nor the authority to compensate members for anticipated future severity 
or potential complications of conditions resulting in medical separation nor for conditions 
determined to be service-connected by the Department of Veterans Affairs (DVA), but not 
determined to be unfitting by the PEB. However the DVA, operating under a different set of 
laws (Title 38, United States Code), is empowered to compensate all 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. The Board’s role is 
confined to the review of medical records and all evidence at hand to assess the fairness of PEB 
rating determinations, compared to VASRD standards, based on severity at the time of 
separation. 

 

Bipolar Disorder. The MEB narrative summary (NARSUM), dictated 13 October 2004, noted 
that the CI started having difficulty during his Operation Iraqi Freedom (OIF) deployment. The 
CI reported that he experienced several episodes of shortness of breath (SOB), palpitations, 
tremulousness, diaphoresis, and lightheadedness, starting in March 2004, following a mass 
casualty involving Iraqi civilians. He first came to the attention of his command when he 
showed up for duty wearing a soiled uniform that he had been wearing the day before while 
caring for a soldier with a head injury. The CI was instructed to take a 3 day rest period. 
However, on his first day, the CI learned of the death of two of his friends. They had been on a 
mission he had not been able to attend. He then had another episode of anxiety symptoms and 
was evaluated by mental health. Soon afterwards, he was sent to Landstuhl for admission to 
the psychiatric unit. The CI was reportedly tangential and displaying symptoms felt to be 
consistent with an acute manic episode prior to his evacuation to Landstuhl Regional Medical 
Center although the air evacuation card noted that he was showing signs of PTSD. During his 
admission, he was reported as having elated mood, racing thoughts, difficulty concentrating, 
pressured speech, mild agitation, and pacing. He was treated with Risperdal which resulted in a 
significant reduction of his symptoms. He reported having difficulty sleeping (about two 
hours/night) during June and July of 2004. He was smoking up to three packs of cigarettes a 
day. The CI endorsed recurrent nightmares, flashbacks of the events experienced in March 
2004, increased startle response, avoidance of certain situations, and depressed mood. He also 
experienced anhedonia, feelings of guilt, and decreased appetite. The CI was admitted to 
WRAMC on 6 September 2004, following his evacuation from Iraq via Landstuhl. He was given 
a trial off the Risperdal to further assess the diagnosis of PTSD. This resulted in increased 
anxiety, irritability, and tremulousness which responded positively to treatment with Clonidine. 
The CI was given a weekend pass which resulted in increased irritability and anxiousness. The 
CI came close to several physical confrontations on that pass. He remained in the hospital. He 
then failed a discharge attempt on 13 September 2004. The CI had mood lability (excessive 
crying), paranoia, agitation, and restlessness. He remained in the hospital and was started on 
Lithium which was effective. At the time of discharge, the CI was calm and cooperative, with 
occasion irritability and angry outbursts. His thoughts were linear, logical, and goal directed. 
There was no evidence of delusions, hallucinations, homicidal ideation, or suicidal ideation. He 
reported improvement in his mood. He had normal speech, full range of emotion, and 
appropriate behavior. His judgment and insight was fair. His cognition was intact. The CI was 
discharged on 16 September 2004 with a diagnosis of PTSD and bipolar disorder. He was felt to 
be competent to handle all financial affairs and to participate in MEB proceedings. The CI did 
not show for the mental health Compensation and Pension (C&P) examination in August 2005. 
The VA Rating Decision on 15 September 2005, the closest to separation, was based on the 
service and VA treatment records and awarded the CI a 10% rating. It noted that he had failed 
to show up for his initial examination, but that the VA treatment records indicated that he had 
stopped taking his medication, and was working in construction 50-60 hours per week. At the 
time, the CI denied having any symptoms of mania, hypomania, depression, or panic attacks. 
He reported that he had occasional generalized anxiety, increased irritability, and occasional 


feelings of depression, some of which were controlled by the use of cannabis. The CI was given 
an offer to schedule an examination should he want to appeal the decision, but it appears that 
there was not a C&P examination performed until 15 November 2008, almost 3 years following 
separation. This examination had little probative value regarding the decision made by the PEB; 
however, it recorded some record of the social and occupation functioning of the CI following 
his discharge from military service. The CI reported that he had had several jobs following his 
discharge from the military and met his girlfriend in December 2005. The CI reported that he 
worked in construction, but was unable to hold any job for longer than 6 months and would 
often quit out of frustration with coworkers. He also reported that he was fired a few times for 
not showing up or not getting along with coworkers. The CI reported that he lived with and 
supported his girlfriend and her daughter with the income from his various jobs. His girlfriend 
was a stay at home mom. He reported the relationship was rocky due to mood swings and 
alcohol use and ended in July 2008. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
Board first considered if VASRD §4.129 was applicable. The PEB rating, as described above, was 
derived from DoDI 1332.39 and preceded the promulgation of the National Defense 
Authorization Act (NDAA) 2008 mandate for DoD adherence to Veterans Affairs Schedule for 
Rating Disabilities (VASRD) §4.129. While the primary diagnosis was bipolar disorder, which has 
a strong genetic component to it, the evidence is clear that this condition had its onset shortly 
after exposure to a series of traumatic events while in a combat zone. IAW DoDI 6040.44 and 
DoD guidance (which applies current VASRD §4.129 to all Board cases), the Board is obligated 
to recommend a minimum 50% mental disorder as a result of a highly stressful event rating for 
a retroactive 6-month period on the Temporary Disability Retired List (TDRL) for those mental 
health cases in which the condition is secondary to a traumatic event. All members agreed that 
the §4.130 criteria for a TDRL rating higher than 50% at the time of placement on TDRL were 
not met. After due deliberation and consideration of all of the evidence, and mindful of the 
VASRD §4.3 (reasonable doubt), the Board unanimously recommends a 6 month TDRL rating of 
50% for the bipolar with anxiety symptoms similar to PTSD condition. The Board then 
considered the rating at the 6 month point. The Board noted that the PEB and VA both rated 
the condition at 10% based on the service treatment records (STRs) and that the VA, which 
rated the condition near the 6 month point after separation, also had access to VA records for 
treatment after separation. The PEB adjudged the Bipolar I Disorder, in partial remission, 
associated with anxiety symptoms similar to those of PTSD condition to be unfitting and used 
the VASRD diagnostic code 9432. The VA rated the condition using combined codes 9432-9411 
for bipolar disorder with PTSD. The Board noted the considerable overlap of symptoms and 
that the same symptoms cannot be used to support multiple conditions IAW VASRD §4.14 
(avoidance of pyramiding). 

 

The Board then directed its attention to its permanent rating recommendation following the 6 
month TDRL. All members agreed that the VASRD §4.130 threshold for a 50% rating was not 
met. The deliberation settled on arguments for a 10% vs. 30% permanent rating. The 10% 
rating description in VASRD §4.130 (occupational and social impairment due to mild or 
transient symptoms which decrease work efficiency, during periods of significant stress) was 
clearly a better fit than the 30% description (occupational and social impairment with 
occasional decrease in work efficiency, and intermittent periods of inability to perform 
occupational tasks). The CI was not under psychiatric care and was requiring no medications. 
While the CI may have had symptoms during that period of time, he was working and provided 
all the support for his girlfriend and her daughter. After due deliberation and consideration of 
all the evidence, and mindful of VASRD §4.3 (Reasonable doubt), the Board unanimously 
recommends a permanent rating of 10% for the PTSD 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 for rating for the bipolar condition was operant in this case and the 
condition was adjudicated independently of that instruction by the Board. In the matter of the 
bipolar condition the Board unanimously recommends an initial TDRL rating of 50% and a 
permanent rating of 10% at 6 months, coded 9432, IAW VASRD §4.71a. 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: A 50% rating for the period of TDRL directed by the service (IAW §4.129 and DoD 
direction); followed by permanent disability separation with severance pay by reason of 
physical disability, with a final 10% rating as indicated above. 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

TDRL 

PERMANENT 

Bipolar I Disorder, in partial remission, associated 
with anxiety symptoms similar to those of PTSD 

9432 

50% 

10% 

COMBINED 

50% 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120413, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Director of Operations 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxxx, AR20130009520 (PD201201508) 

 

 

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 

50% 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 no recharacterization 
of the individual’s separation or modification of the permanent disability rating of 10%. 

 

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 as follows: 

 

 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. 

 

 b. Providing orders showing that the individual was separated with a permanent 
combined rating of 10% effective the day following the six month TDRL period with no 
recharacterization of the individual’s separation. 

 

 c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will 
provide 50% retired pay for the constructive temporary disability retired six month period 
effective the date of the individual’s original medical separation and adjusting severance pay as 
necessary to account for the additional TDRL time in service. 

 

 

 

 

 

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 xxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards) 


 

SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxxxx, AR20130009520 (PD201201508) 

 

 

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 

50% 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 no recharacterization 
of the individual’s separation or modification of the permanent disability rating of 10%. 

 

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 as follows: 

 

 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. 

 

 b. Providing orders showing that the individual was separated with a permanent 
combined rating of 10% effective the day following the six month TDRL period with no 
recharacterization of the individual’s separation. 

 

 c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will 
provide 50% retired pay for the constructive temporary disability retired six month period 
effective the date of the individual’s original medical separation and adjusting severance pay as 
necessary to account for the additional TDRL time in service. 

 

 

 

 

 

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 xxxxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)