RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

ideations. 

 
NAME:  XXXXXXXXXXXXXXX                                  BRANCH OF SERVICE:  ARMY 
CASE NUMBER:  PD1200711                                 DATE OF PLACEMENT ON TDRL:  20000519 
BOARD DATE:  20130125                                          DATE OF PERMANENT SEPARATION:  20030819 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty SGT/E-5 (02T/Guitar Player), medically separated for 
bipolar disorder.  The CI began exhibiting depressive symptoms in 1998 at Fort Bragg and was 
eventually  hospitalized  for  suicidal 
  Subsequently  he  was  diagnosed  with 
cyclothymia,  profiled  as  S2  and  was  treated  pharmacologically  and  with  psychotherapy.    His 
treatment continued with his transfer to Fort Benning in 1999; however, despite these efforts, 
the  CI’s  symptoms  continued  and  were  re-classified  as  Bipolar  I  disorder.    The  CI  did  not 
improve  adequately  with  treatment  to  meet  the  physical  requirements  of  his  Military 
Occupational  Specialty  or  satisfy  physical  fitness  standards.    In  2000,  he  was  issued  a 
permanent  S3  profile  and  was  referred  for  a  Medical  Evaluation  Board  (MEB).    The  MEB 
forwarded  bipolar  disorder,  Type  I  to  the  Physical  Evaluation  Board  (PEB)  as  medically 
unacceptable IAW AR 40-501.  Status post (s/p) intra-articular unicondylar fracture, left small 
finger, identified in the rating chart below, was also identified and forwarded by the MEB.  The 
PEB adjudicated the Bipolar I disorder condition as not sufficiently stable for final adjudication 
and  placed  him  on  the  Temporary  Disability  Retired  List  (TDRL)  in  2000,  rated  30%.    The 
remaining small finger condition was determined to be not unfitting.  He was continued on the 
TDRL  with  an  interim  reevaluation  in  2001,  and  then  underwent  a  final  evaluation  after 
approximately  3  years  on  the  TDRL.    At  that  time  the  PEB  adjudicated  bipolar  disorder  as 
permanently 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:    My  bipolar  disorder  has  drastically  worsened.    Please  review  my  VA  file 
regarding this. 
 
 
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 bipolar disorder condition requested 
for  consideration  meets  the  criteria  prescribed  in  DoDI  6040.44  for  Board  purview,  and  are 
accordingly addressed below.  The remaining condition (left small finger condition) rated by the 
VA at separation is 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. 
 

 

TDRL RATING COMPARISON: 
 

S/P Fracture, Left Little Finger 

5299-5227 

0% 

20000207 

Combined:  30% 

Code 
9432 

Rating 
30%** 

Exam 
20000126 

Rating 
Sep. 
TDRL 
10% 
30% 
Not Unfitting 

VA* – All Effective Date 20000519 
Condition 
Bipolar Disorder, Type I 

Service IPEB – Dated 20030804 
Code 
Condition 
 
On TDRL – 20000519 
Bipolar Disorder, Type I 
9432 
Status  Post  Fracture,  Left  Small 
Finger 
No Additional MEB/PEB Entries 
Combined:  10% 
* VA rating based on exam most proximate to date of permanent separation. 
**VA  rating  decisions  increased  to  50%  and  70%,  effective  20090204  and  20100930  respectively,  based  on  later  exams; 
combined 50% and 70%. 
 
 
ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application, 
that there should be additional disability assigned for conditions which worsen over time.  It is a 
fact, however, that the Disability Evaluation System (DES) has neither the role nor the authority 
to compensate members for anticipated future severity or potential complications of conditions 
resulting  in  medical  separation.    This  role  and  authority  is  granted  by  Congress  to  the 
Department of Veterans Affairs (DVA).  The Board utilizes DVA evidence proximal to separation 
in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special 
consideration to post-separation evidence.  The Board’s authority as defined in DoDI 6044.40, 
however, resides in evaluating the fairness of DES fitness determinations and rating decisions 
for disability at the time of separation.  Post-separation evidence therefore is probative only to 
the  extent  that  it  reasonably  reflects  the  disability  and  fitness  implications  at  the  time  of 
separation. 
 
Bipolar  Disorder  Condition.    The  Board  first  addressed  if  the  tenants  of  §4.129  (Mental 
disorders due to traumatic stress) were applicable.  The Board noted that there was no “highly 
stressful event” for which provisions of §4.129 would apply, and therefore concludes that its 
application is not appropriate to this case.  Consequently, the rating recommendation for the 
time  of  placement  on  the  TDRL  will  not  automatically  reflect  the  50%  minimum  as  required 
under §4.129.  At the time of entry onto TDRL, the CI’s symptoms could best be described as 
mild  to  moderate.    According  to  the  VA  Compensation  and  Pension  (C&P)  examiner  on 
26 January 2000 (4 months prior to placement on the TDRL), the CI lived with his fiancée, with 
whom  he  had  a  good  relationship.    Mental  status  exam  (MSE)  revealed  good  grooming  and 
normal orientation.  Mood was anxious, but not depressed.  Affect was appropriate.  Speech 
was  normal,  and  there  was  no  looseness  of  association  or  flights  of  ideas.    Immediate  and 
remote  memory  was  intact,  and  attention and  concentration  were  good.    The  diagnosis  was 
cyclothymia with moderate symptoms.  The Global Assessment of Functioning (GAF) was 75-80 
(connoting no more than slight symptoms or impairment).  The narrative summary psychiatrist 
on  25  February  2000  (3  months  prior  to  placement  on  the  TDRL)  indicated  that  since  his 
hospitalization in 1998 for a severe major depressive episode and active suicidal ideations, he 
benefitted  significantly  from  one  psychotropic  medication  and  outpatient  psychotherapy.  
However,  despite  excellent  compliance  with  treatment,  the  CI  continued  to  suffer  from 
recurrent  depressed  mood,  anhedonia,  decreased  energy  and  concentration,  poor  sleep  and 
suicidal ideations.  These symptoms alternated with manic or hypomanic episodes that included 
inflated  or  grandiose  mood,  racing  thoughts,  decreased  need  for  sleep  and  potentially 
dangerous  impulsivity.  The  examiner  was  also  concerned  about  the  possibility  of  delusions.  
MSE noted good grooming and normal orientation.  Mood was anxious, psychomotor agitation; 

pressured  speech  and  motor  restlessness  were  evident.    Affect  was  anxious  and  expansive.  
Thought processing was linear, although occasional tangential or circumferential thinking was 
noted.  There was no suicidal or homicidal ideation.  Although some grandiose and paranoid 
thinking  was  expressed,  it  was  not  of  a  clearly  delusional  severity.    Judgment,  insight  and 
memory were intact.  The diagnosis was Type I bipolar disorder.  A GAF score was not assigned.  
The  described  functional  status  was  definite  impairment  for  military  duty  and  for  social  and 
industrial  adaptability.    The  commander’s  letter  on  16  February  2000  noted  the  CI’s 
performance  on  a  recent  MOS  audition  was  substandard  and  that  he  displayed  inconsistent 
performance on daily, recurring tasks.  It also stated that the supervisory chain was hesitant to 
assign stressful tasks for fear of triggering a manic-depressive episode.  A VA outpatient follow-
up evaluation on 9 September 2000 (4 months after placement on the TDRL) indicated that the 
CI experienced no obsessions, compulsions or panic attacks.  He married 4 months previously 
and was expecting a child.  He was employed as a land surveyor and planned to attend college.  
The CI considered the two psychotropic medications he was taking to be helpful, and stated he 
had experienced no suicidal thoughts during the preceding year.  MSE revealed good grooming, 
normal  speech  and  no  psychomotor  agitation.    He  appeared  somewhat  anxious.    Mood  was 
“ok”  and  affect  appropriate.    Judgment  and  insight  were  good,  and  thought  processes  and 
content  were  normal.    Memory  and  orientation  were  intact.    Hallucinations,  delusions  and 
suicidal or homicidal ideations were absent.  The assessment was that he was functional, free of 
mania or depressive symptoms and doing well since release from the service.  The GAF was 72 
(no more than slight impairment).  At the time of the interim TDRL re-evaluation in 2001, VA 
psychiatric  notes  described  a  recent  episode  of  depression  that  responded  to  a  change  in 
medication.  He denied manic symptoms.  He was returning to school full time and was going to 
buy  a  house.    MSE  noted  good  personal  appearance  and  hygiene,  and  described  him  as 
pleasant  and  engaging.    Mood  was  “ok”  and  affect  was  appropriate.    There  was  no  suicidal 
ideation.  GAF was 80. 
 
At the time of removal from TDRL, the most proximate sources of comprehensive evidence on 
which to base the permanent rating recommendation in this case are VA outpatient notes.  On 
16 April 2003 (4 months prior to permanent separation), a VA psychiatric note indicated the 
condition was “very well maintained” on two psychotropic medications.  He was doing well in 
school.  He rated his mood severity as 1-2 on a 0-10 scale.  He was completing the process of 
adopting his step son.  MSE was identical to the most recent VA exam described above and GAF 
was 77.  The assessment was bipolar disorder in full remission.  However, a note on 17 July 
2003  stated  that  during  the  prior  week he had experienced  increased  energy  and decreased 
need  for  sleep.    Some  medication  dosage  adjustments  were  instituted  and  a  medication  for 
sleep was prescribed.  A C&P evaluation on 26 March 2009 stated that the CI had worked as a 
social worker at the VA for 5 years and that he had obtained a Master’s degree. 
 
The Board directs attention to its rating recommendation based on the above evidence.  At the 
time of entry on TDRL, the PEB and the VA both assigned a 30% rating.  All members agreed 
that the §4.130 criteria for a rating higher than 30% were not met at the time of placement on 
TDRL.  The VA re-evaluation examination at the time of removal from TDRL was consistent with 
the general description for a §4.130 rating of 10% “(occupational and social impairment due to 
mild  or  transient  symptoms;  or  symptoms  controlled  by  continuous  medication),”  but  the 
Board debated if sufficient criteria for a rating of 30% were present.  Social and occupational 
impairment  consistent  with  a  30%  evaluation  “(Occupational  and  social  impairment  with 
occasional  decrease  in  work  efficiency  and  intermittent  periods  of  inability  to  perform 
occupational  tasks…)”  could  be  suggested  by  the  slightly  depressed  mood.    However,  there 
were  no  panic  attacks,  suspiciousness,  sleep  impairment  or  memory  problems;  and  he  was 
attending school full time while adopting his step son.  The Board debated the significance of 

apparent  symptom  exacerbation  a  month  prior  to  separation.    Although  there  were  no 
available  proximal  follow-up  evaluations,  the  Board  considered  that  the  CI  began  a  job  as  a 
social worker soon thereafter.  On balance, the Board concluded that there was not adequate 
reasonable doubt favoring the next higher rating, and agreed that  at the time of permanent 
separation the condition more nearly approximated the criteria for the 10% rating.  After due 
deliberation,  considering  all  of  the  evidence  and  mindful  of  VASRD  §4.3  (Resolution  of 
reasonable  doubt),  the  Board  concluded  that  there  was  insufficient  cause  to  recommend  a 
change in the PEB adjudication for the bipolar disorder, type I 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 disorder, Type I condition and IAW VASRD §4.71a, 
the Board unanimously recommends no change in the PEB adjudication.  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: 
 

VASRD CODE  RATING 
9432 
COMBINED 

TDRL  PERMANENT 
30% 
30% 

10% 
10% 

UNFITTING CONDITION 
Bipolar Disorder, Type I 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120606, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 
 

 

           xxxxxxxxxxxxxxxxxxx, DAF 
           Director 
           Physical Disability Board of Review 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / xxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for xxxxxxxxxxxxxxxxxxx, AR20130002269 (PD201200711) 
 
 
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 
 
 
 

     xxxxxxxxxxxxxxxxxxxxxxx 
     Deputy Assistant Secretary 
         (Army Review Boards)