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AF | PDBR | CY2012 | PD2012 00445
Original file (PD2012 00445.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:   CASE: PD1200445
BRANCH OF SERVICE: Army         BOARD DATE: 20130322
DATE OF PLACEMENT ON TDRL: 20001110
Date of Permanent SEPARATION: 20020905


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3(11C/Indirect Fire Infantryman) medically separated for bipolar I disorder. The condition developed after an airborne operation in April 2000 in which the CI began praising God in the day room on his return from a bible study. The CI was hospitalized after remaining up until 0430 reading his Bible and writing down scriptures. On the day of his admission, he was found to be wearing his class A belt with his BDUs, talking rapidly and speaking only of religion. The bipolar condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent S4 profile and referred for a Medical Evaluation Board (MEB). The bipolar condition, characterized as bipolar disorder, Type I was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The PEB adjudicated bipolar disorder as unfitting, rated 30%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD), and placed the CI on the TDRL. After 24 months on TDRL, a PEB adjudicated bipolar I disorder as unfitting, rating it 10% with application of the VASRD. The CI made no appeals, and was medically separated with a 10% disability rating.


CI CONTENTION: The CI writes: “When I was discharged and put on TDRL my rating was 30%. When the examination took place I was just as unstable.”


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 condition is addressed below; and, 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 respective Board for Correction of Military Records.


RATING COMPARISON:

Final Service PEB - 20020802
 VA (13 Mo. Prior to Adjudication Date) - Effective 20001110
On TDRL - 20001110
 Code Rating Condition Code Rating Exam
Condition
 TDRL Sep.
BIPOLAR I DISORDER
 9432 30% 10% BIPOLAR DISORDER 9432 10% 20010731
No Additional MEB/PEB Entries.
 Other x 0 20010330
Combined: 30% → 10%
 Combined: 10%





ANALYSIS SUMMARY:

Bipolar I Disorder. The CI developed symptoms of bipolar I after an airborne operation in April 2000 that led to hospitalization. The psychiatric narrative summary (NARSUM), 20 June 2000, was conducted while the CI was an inpatient (26 April-15 May 2000). The CI’s symptoms at the time of the NARSUM included racing thoughts, impaired concentration, pressured speech, euphoric mood and delusions. Insight and judgment were fair. The Global Assessment of Functioning (GAF) score was 40 (impairment in reality testing). Based on this examination the PEB placed the CI on temporary retirement disability list (TDRL) and assigned a disability rating of 30% with reevaluation at six months IAW 4.129. On 31 July 2001, approximately 8 months after being placed on TDRL, and 14 months prior to separation, he presented to the VA for a Compensation & Pension (C&P) mental examination. The CI reported he was single, living with his mother, and working full time as a customer representative. He indicated he had not been compliant with his medication but reported a normal appetite, had not engaged in suicidal thoughts, no longer had bizarre thoughts, no manic or depressed mood, and was sleeping for 8 hours nightly. The CI also stated he became depressed after breaking up with his girlfriend and had thought of kidnapping a random young girl at one point. On mental status examination (MSE), the CI was neatly dressed, cooperative, normal speech, no suicidal thoughts, no evidence of psychosis, and judgment was “adequate.” The examiner diagnosed bipolar affective disorder, type 1, last phase depression in January 2001, and assigned a GAF of 55, (moderate), reported by examiner as “average.” Based on this examination the VA rated at 10% code 9432. At a TDRL Evaluation, 27 February 2002, approximately 7 months prior to separation, the CI reported he had been living in his own apartment since October 2000, and was working more than 40 hours a week as a fraud investigator since June 2000. He had left his mother’s home and living in his own apartment. He enjoyed his work and was in a relationship for several months and had made several friends at church. During the evaluation, the CI denied having experienced depressed or elevated moods, manic symptoms, disturbed sleep, change in appetite, auditory or visual hallucination, paranoia, suicidality, or violent ideations against others, since being placed on TDRL. He indicated he had discontinued the use of his antipsychotic medication. On MSE, he was polite, engage able, with normal speech. Affect was full range and stable, without evidence of disturbed perception; thinking was clear. The examiner opined, “Insight regarding his illness was impaired, as evidenced by his noncompliance with treatment, despite apparent breakthrough symptoms. Judgment was fair, as he currently refrains from alcohol use. Impulse control was intact. Although he has not been treated with therapeutic doses of a mood stabilizer or an antipsychotic for several months, he has demonstrated reasonable social and occupational functioning.” The examining psychiatrist assigned a GAF of 90, and reported the CI had good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns. The examiner opined, however, given the severity of the initial manic episode and the CI’s genetic predisposition for bipolar illness, and his partial compliance with medications, he should remain on TDRL. However, on 2 August 2002, the PEB removed the CI from TDRL and assigned a permanent disability rating of 10%.

The Board directed its attention to its rating recommendation, based on the evidence just described. The Board first unanimously agreed that VASRD §4.129 was inapplicable in this case, in the absence of a highly stressful combat related causative event but that placement on TDRL for stabilization of the mental health condition was appropriate. All members agreed that at the time of placement of the TDRL, the VASRD §4.130 threshold for a 50% rating was not met. The CI had been discharged from acute care, was stable on medication and symptoms were determined to be consistent with mild mood elevation, and likely would have a mild-moderate effect on his job performance. The deliberation settled on discussions or a 10% vs. 30% TDRL. A 30% rating requires occasional decrease in work efficiency or intermittent periods of inability to perform occupational tasks; and a 10% rating (occupational and social impairment due to mild or transient symptoms which decrease work efficiency, during periods of significant stress). The Board agreed that the 30% rating best captured the CI’s condition at the time of the TDRL. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends a 30% TRDL rating for the bipolar 1 condition.

The Board directs attention to the permanent rating recommendation based on the evidence described. The PEB rated the condition 10% under code 9432 based on the TDRL psychiatric evaluation 7 months prior to separation. The VA also rated 10% code 9432 using a VA mental examination 31 July 2001, 14 months prior to separation. The Board agreed that the CI was having no major symptoms and no occupational or social impairment, in spite of not being fully compliant with prescribed treatment. The Board unanimously agreed that the 10% rating more accurately reflected the CI’s condition at time of separation. 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 permanent adjudication for the major depression 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. 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 I condition and IAW VASRD §4.130, the Board unanimously recommends no change in the PEB adjudications. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
TDRL PERMANENT
Bipolar Type I
9432 30% 10%
COMBINED
 30% 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120522, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for AR20130008373 (PD201200445)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application.
This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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