RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201075 SEPARATION DATE: 20060622 

BOARD DATE: 20130313 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SPC/E-4 (92A10/Automated Logistical Specialist), 
medically separated for bipolar disorder. The CI’s condition could not be adequately 
rehabilitated and did not improve adequately with treatment to meet the physical 
requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. 
He was issued a permanent S3 profile and referred for a Medical Evaluation Board (MEB). 
Posttraumatic stress disorder (PTSD) and alcoholism conditions, identified in the rating chart 
below, were also identified and forwarded by the MEB. The Physical Evaluation Board (PEB) 
adjudicated the bipolar disorder condition as unfitting, rated 10%. The remaining condition(s) 
were determined to be not unfitting. The CI made no appeals and was medically separated 
with a 10% disability rating. 

 

 

CI CONTENTION: “It is requested that my records be retroactively amended to reflect that on 
my date of separation, I was placed on the Temporary Disability Retirement List (TDRL) for 6 
months, with a rating of 50% for Bipolar Disorder and PTSD in compliance with 38 CFR 4.129 
and that my records also be retroactively amended to show that, following 6 months on TDRL I 
was placed on Permanent Disability Retirement (PDR) with a Bipolar and PTSD rating equal to 
my first VA Bipolar and PTSD rating that was the result of a medical exam. I was separated from 
active duty with a rating of 10% and was not initially placed on TDRL, and therefore did not 
receive the requisite follow-up medical exam, It is requested that the initial (first) VA 
evaluations and ratings be used as the best replacement for that evaluation. Additionally, the 
narrative evaluation for the MEB clearly cites Bipolar disorder and PTSD (both as Axis I) as 
primary causes for disability separation. Both MEB records and VA findings indicate that neither 
Bipolar disorder or PTSD existed prior to military service and that the physician's diagnostic 
impression was that BOTH occurred during the line of duty and are service connected. The MEB 
diagnostic impression states that the degree of impairment for further military service and 
occupational/social impairment are severe. Original VA findings determined that both Bipolar 
disorder and Post Traumatic Stress Disorder were related to military service and granted service 
connection at the 100% rating. They do not separate the two. They also indicate the 
impairments are severe. Ratings for degenerative joint disease, tinnitus, and hypertension were 
also awarded. Current VA rating continues at present time to be 100%. Additionally, I dispute 
discharge orders dated 07 June 2006 which does not indicate LOD. Years of service is also 
inaccurate at 7 years, 3 months, and 1 day. It does not reflect years of service in the Army 
Reserve dating back to 28 May 1993. Total years should reflect 13 years of service. Thank you 
for your time and attention to this matter. You are appreciated.” 

 

 

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 conditions “identified but not determined to be unfitting by the PEB.” The ratings for 
unfitting conditions will be reviewed in all cases. The conditions bipolar disorder and PTSD, as 
requested for consideration, meet the criteria prescribed in DoDI 6040.44 for Board purview 
and are addressed below. The remaining conditions rated by the VA at separation and listed on 


the DD Form 294 are not within the Board’s purview. 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 IPEB – Dated 20060418 

VA (# Mos. Pre/Post-Separation) – All Effective Date 20060623 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Bipolar Disorder 

9432 

10% 

PTSD, Bipolar Disorder w/ Depression, 
Anxiety, and Alcohol/Substance Abuse 
(competent) 

9411 

100% 

20070921 

Posttraumatic Disorder 

Not Unfitting 

Alcoholism 

Not Unfitting 

.No Additional MEB/PEB Entries. 

Degenerative Changes Lumbar Spine 

5242 

10% 

20070821 

Tinnitus 

6260 

10% 

20071204 

Hypertension 

7101 

10% 

20071204 

Not Service-Connected x 11 

20070821 

Combined: 10% 

Combined: 100% 



 

 

ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit 
and vital fighting force. 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. 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 With Associated Post Traumatic Stress Disorder Condition. The Board noted 
that PTSD was an associated diagnosis that the PEB determined to be not separately unfitting. 
Service treatment records (STR) confirm that the predominant mental health condition was the 
bipolar disorder and the MEB narrative summary (NARSUM) in rendering a PTSD diagnosis, 
noted CI report of a traumatic stressor while deployed and that “at times he has experienced 
symptoms consistent with PTSD.” In accordance with DoDI 6040.44 and DoD guidance the 
Board is obligated to apply current VASRD §4.129 to Board cases with PTSD where appropriate, 
and recommend a minimum 50% PTSD 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 6 months for its permanent rating recommendation. Regardless 
of final PEB diagnosis, §4.129 does not specify a diagnosis of PTSD, rather it states “mental 
disorder due to a highly stressful event,” and its application is not restricted to PTSD. The 
Board also noted that relative contribution to impairment from bipolar disorder and PTSD could 
not be separated, therefore the Board considered the mental health conditions together in its 
deliberations. According to the MEB psychiatry NARSUM dated 13 March 2006, the CI reported 
symptoms consistent with bipolar disorder for the prior 5 years predating his deployment to 
Iraq by 2 years including depressive periods interspersed with distinct periods of increased 
energy with irritability, grandiosity, decreased need for sleep, increased involvement in 
projects, impulsive purchases, increased talkativeness, increased creativity, decreased 
concentration, and racing thoughts occurring two to three times per year. A VA treatment 
record from 4 October 2005 noted the CI reported periods of depression and anxiety since he 


was age 12 or 13. A VA treatment record from 5 October 2005 noted CI report of difficulty 
concentrating on a single task which previously caused significant difficulty in elementary and 
high school. A VA treatment record from 18 June 2007 recorded report of a long history of 
anger mismanagement problems and numerous fights as child and while in Army. The CI 
entered active duty in August 1999 at age 32 and served as an automated logistical technician. 
The first STR entry relating to psychological symptoms was 31 March 2003 when the CI sought 
care for feeling tense and anxious related to work stress. At the time of the pre-deployment 
health assessment, 20 August 2003, the CI indicated he had not sought care or counseling for 
mental health concerns in the preceding year. The CI deployed to Iraq at the end of August 
2003 arriving in theater 11 September 2003. According to the post deployment health 
assessment completed by the CI on 22 January 2004, he was assigned to Mosul and Qayyarah 
Air Base (near Mosul). During the deployment his health stayed the same, and he had no sick 
call visits. He checked “no” in response to question 7 regarding seeing anyone wounded, killed 
or dead during the deployment (coalition enemy or civilian). He checked “no” in response to 
question 8 regarding being in direct combat. The CI checked “yes” to question 9, feeling in 
great danger while deployed. The CI checked “no” to question 17 regarding whether he was in 
or entered or closely inspected any destroyed military vehicles. He checked “yes” to question 
11 for experiencing little interest and feeling down, and “no” to thoughts of self harm. The CI 
checked “no” to question 12 regarding whether he had any experience that was so frightening, 
horrible, or upsetting, that in the prior month he had had nightmares, unwanted thoughts 
about it, avoidance of reminders, was hypervigilant, experienced an exaggerated startle 
response, felt numb or felt detached from others, activities, or surroundings. He checked “no” 
to the question regarding concerns about losing control. He checked “unsure” to the question 
regarding concerns about having serious conflicts with spouse family or friends. Subsequent 
treatment records recorded the CI’s wife asked for a divorce while he was deployed. The CI 
returned from deployment in February 2004. A clinic encounter on 21 July 2004 noted the CI 
was still depressed related to the break up with his spouse and the CI was referred to the 
mental health clinic. No related records are available but the MEB NARSUM indicates he was 
treated with medications. The next STR entry is nearly a year later on 21 March 2005 which 
states the CI was undergoing separation and divorce from his wife but was “Doing well on 
meds…Resolving depression.” The CI had been in marital counseling from January to July2005 
(according to later VA records). A clinic encounter on 8 July 2005 noted use of an 
antidepressant medication without mention of complaint of depression or psychological 
symptoms. In the fall of 2005, the CI sought care for alcohol abuse and entered into a VA 
alcohol rehabilitation program at the end of September 2005. Increased alcohol use was 
related to marital discord and deployment. A long history of alcohol abuse was noted in VA 
treatment records and the longest period of sobriety was while the CI was at his first duty 
station in approximately 2002. Diagnoses of alcohol dependence and bipolar disorder were 
rendered. Symptoms suggestive of PTSD were noted and the CI reported experiencing combat 
while deployed without any detail. The commander’s letter dated 6 February 2006 reported 
good duty performance since the CI returned from alcohol rehabilitation treatment, and noted 
his supervisors recommended retention if possible. According to the MEB NARSUM, the CI was 
hospitalized for 3 days in February 2006 (25-28 February) due to worsening mood control with 
mixed depressive and manic symptoms with racing thoughts. The MEB psychiatry NARSUM 
dated 13 March 2006 recorded improved symptoms but with continued problems with anxiety, 
irritability, and energy bursts. The CI noted some obsessive compulsive behaviors (“some 
difficulties with the inability to see anything get dirty, for instance, before preparing a meal, he 
will clean his kitchen or when pulling out his tool box, if it is in disarray, he feels very anxious 
unless it is arranged He has noted this has been going on for a few months”). On mental status 
examination (MSE), the CI was well groomed, cooperative, and conversant with normal speech 
(normal rate, rhythm and volume). Mood was “better” with congruent affect. Thought 
processes were normal (linear, logical and goal directed), without evidence of hallucinations, 
delusions, paranoid thoughts, or suicidal ideation. Insight and judgment were considered good 
and there were no cognitive deficits evident. The MEB NARSUM recorded a diagnosis of bipolar 


 

The Board considered whether VASRD §4.129, mental disorders due to traumatic stress, was 
applicable. This paragraph states “When a mental disorder that develops in service as a result 
of a highly stressful event is severe enough to bring about the veteran’s release from active 
military service, the rating agency shall assign an evaluation of not less than 50 percent and 
schedule an examination within the six month period following the veteran’s discharge to 
determine whether a change in evaluation is warranted.” While examiners may have readily 
accepted an account of a stressor given in the setting of an evaluation, the actual existence of a 
stressor is a factual determination that must be based on a review of the entire record. 
Clinicians routinely accept and report statements of history given by patients, ordinarily 
without efforts at independent verification, and with scant ability by the examiner to 
objectively confirm events. Thus the clinician is in the role of a conduit of information that does 
not involve the application of actual medical expertise. Unless the clinician was present at that 
time, he or she cannot assume the role of witness to past events advanced as stressors, or 
validate symptoms and severity. The Board noted that the stresses of deployment to a combat 
zone, although considerable under the best of circumstances, do not automatically equate to 
the §4.129 standard of “a highly stressful event” or to Criterion A stressors for PTSD – a typical 
mental disorder for which the provisions of §4.129 would apply. The MEB NARSUM recorded 
“He states that while he was deployed, he experienced mortar fire, witnessed dead Iraqis and 
has noted some guilt about acting on anger towards Iraqis while deployed there. While he was 
deployed, his wife asked him for a divorce which was very upsetting to him.” The Board 
considered the post deployment health assessment form completed by the CI detailed above 
which did not corroborate this history related 2 years later. Treatment records documented 
problems with symptoms of bipolar disorder and alcohol abuse predating his deployment to 
Iraq. The Board also noted worsening of symptoms after return from Iraq but also noted the 
predominant stressor was the ongoing marital discord leading to divorce and separation from 


his child. The Board concluded that the application of §4.129 was not appropriate or warranted 
in this case. 

 

The Board next considered its recommendation for a rating for the unfitting mental condition 
based on the most appropriate fit with VASRD §4.130 criteria at separation. All members 
agreed that the §4.130 threshold for a 70% rating (“occupational and social impairment, with 
deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood”) 
was not supported by the evidence and that the criteria for a 10% rating were exceeded. The 
deliberation then settled on arguments for a 30% vs. a 50% permanent rating recommendation. 
With regard to a 30% evaluation, “occupational and social impairment with reduced reliability 
and productivity,” reduced reliability and productivity could be surmised from some of the 
documented symptoms at the time of the NARSUM examination and the hospital discharge 
summary from June 2006 including the CI’s disturbance of mood, irritability and anger. The 
potential confounder of the increased transient significant stresses involved with imminent 
separation from the military following the PEB, and his divorce were considered. The Board 
also noted the commander’s letter indicating satisfactory duty performance when not using 
alcohol and taking his medications. The Board noted the absence of other symptoms that 
would otherwise support a 50% evaluation such as flattened affect; circumstantial, 
circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in 
understanding complex commands; impairment of memory; impaired judgment; or impaired 
abstract thinking. The Board noted the recurrent symptoms in November 2006 associated with 
cessation of medications and subsequent increased problems with substance abuse and bipolar 
disorder following the death of his girlfriend. The Board noted the VA 100% rating was based 
on an examination over a year after separation when worsening of symptoms were related to 
the death of the CI’s girlfriend, and recurrent substance abuse. After due deliberation, 
considering the totality of the evidence, the Board concluded that the CI’s mental condition at 
the time of separation more nearly approximated the 30% evaluation for occupational and 
social impairment with reduced reliability and productivity. 

 

 

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. In the matter of the 
bipolar disorder with PTSD condition the Board unanimously recommends that application of 
VASRD 4.129 is not appropriate. In the matter of the bipolar disorder associated with PTSD 
condition, the Board unanimously recommends a disability rating of 30% coded 9432 IAW 
VASRD §4.130. 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 his prior medical separation: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Bipolar Disorder Associated with Posttraumatic Stress Disorder 

9432 

30% 

COMBINED 

30% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120621, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

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

 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 

for xxxxxxxxxxxxxxxxxxxx, AR20130007735 (PD201201075) 

 

 

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 
recharacterize the individual’s separation as a permanent disability retirement with the 
combined disability rating of 30% effective the date of the individual’s original medical 
separation for disability with severance pay. 

 

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 permanent disability retirement effective the 
date of the original medical separation for disability with severance pay. 

 

 b. Providing orders showing that the individual was retired with permanent 
disability effective the date of the original medical separation for disability with 
severance pay. 

 

 c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will 
account for recoupment of severance pay, and payment of permanent retired pay at 
30% effective the date of the original medical separation for disability with severance 
pay. 

 

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

 Deputy Assistant Secretary 

 (Army Review Boards)