IN THE CASE OF:	  

		BOARD DATE:	  27 August 2015

		DOCKET NUMBER:  AR20150002462 


THE BOARD CONSIDERED THE FOLLOWING EVIDENCE:

1.  Application for correction of military records (with supporting documents provided, if any).

2.  Military Personnel Records and advisory opinions (if any).


THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE:

1.  The applicant requests reconsideration of his previous request to change the medical diagnosis on his physical evaluation board (PEB) proceedings from bipolar disorder to post-traumatic stress disorder (PTSD). 

2.  The applicant states that:

	a.  He was discharged for bipolar disorder.  He is not bipolar.  He went for treatment five times and three of the five were at PTSD clinics.  The other two were for self-safety checks.  He was sent to a military PTSD clinic in Colorado on two occasions. 

	b.  His medical evaluation board (MEB) was handled through Madigan Army Medical Center (MAMC) in early 2010.  During that time MAMC was found to have changed many diagnoses from PTSD to bipolar disorder.  He believes his diagnosis was one of those changed.

3.  The applicant provides copies of his medical records, DA Form 199 (PEB Proceedings), and a letter of support.

CONSIDERATION OF EVIDENCE:

1.  Incorporated herein by reference are military records which were summarized in the previous consideration of the applicant's case by the Army Board for Correction of Military Records (ABCMR) in Docket Number AR20130017939, on 9 July 2014.  
2.  The applicant has provided new evidence and argument that warrants consideration by the Board.  

3.  The applicant was retired due to permanent disability on 5 July 2011 in the rank of staff sergeant (SSG)/E-6.

4.  He served two tours in Iraq and one tour in Afghanistan.  He was awarded, in part, the Bronze Star Medal, Army Commendation Medal (5th Award), and the Army Achievement Medal (2nd Award).  A review of the award citations shows he was commended for his duty performance as a light wheeled vehicle mechanic.  For the Bronze Star Medal, he was commended for his leadership skills as the noncommissioned officer in charge (NCOIC) for the compound entry control point.  He was not awarded the Combat Action Badge or the Purple Heart. 

5.  On 28 December 2010, an MEB found that he failed to meet retention criteria in accordance with Army Regulation 40-501 (Standards of Medical Fitness) for the following medical conditions:  PTSD, bipolar disorder, major depressive disorder with psychosis, and chronic back pain.  He agreed with the MEB findings and recommendations.  

6.  On 16 March 2011 at Fort Leonard Wood, Missouri, a psychiatric MEB consultation report stated that he had classical bipolar II disorder with a past history of episodes of hypomania and periods of major depression.  As a result of his major depression with suicidal ideation, bipolar disorder and PTSD, he had been hospitalized four times.  His PTSD symptoms were minimal, were not impairing his functioning, and were considered in partial remission.  Of note, he met the retention standards for PSTD because this mental condition had been formally diagnosed, but the symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication.  The reviewing official stated the signs and symptoms of PTSD were not apparent in his medical records in the Armed Forces Health Longitudinal Technology Application (AHLTA) even though he had been hospitalized.  The applicant does give a history of symptoms of PTSD.  He self-reported that he was in a convoy that suffered an explosion; that he saw dead bodies, people shot and severely injured; that his compound was mortared by enemy fire; and that he led a raid into a village searching for combatants after the convoy was attacked.  The assessment showed:

           (1)  Axis I:  Bipolar II Disorder, Rapid Cycling.  As manifested by periods of hypomania and major depression with psychotic features and Obsessive-Compulsive Disorder

		(2)  Axis II:  No Diagnosis.    

		(3)  Axis III:  Per the primary MEB narrative summary.

		(4)  Axis IV:  Psychosocial stressor, medical occupational and social. 

		(5)  Axis V:  Global Assessment of Functioning (GAF):  70.

7.  A PEB was convened on 29 March 2011 at Fort Lewis, Washington.  The DA Form 199 shows the applicant was found unfit for continued military service by reason of bipolar disorder and degenerative arthritis listed as chronic back pain.  The board recommended a combined rating of 40 percent and permanent disability retirement.  The applicant concurred and waived a formal hearing of his case.  Of note, the PEB determined the VA Schedule for Rating Disabilities (VASRD) 4.129 did not apply as the applicant had not been exposed to a highly stressful event (emphasis added).  

8.  In support of his application, he provides copies of his voluminous medical records showing in pertinent part:

	a.  On 8 July 2010, he was seen at the Community Mental Health Clinic, Fort Leonard Wood, Missouri.  His complaint was that he had a "bad night"; he had not slept all night.  He had suicidal thoughts with plans of cutting his wrists.  The assessment showed:

		(1)  Axis I:  Major Depression; Anxiety Not Otherwise Specified (NOS).

		(2)  Axis II:  OCPD (Obsessive–compulsive personality disorder).

		(3)  Axis III:  Review medical record.

		(4)  Axis IV:  social; occupational. 

		(5)  Axis V:  Global Assessment of Functioning (GAF):  75-80.

	b.  On 8 July 2010, he agreed to hospitalization and was seen at the St. Mary's Health Center, Jefferson City, Missouri.  His chief complaint was: "I don't know what's wrong so I don't know how to fix it.  I need some help to figure this out."  The diagnostic impression showed:

		(1)  Axis I:  Major depressive disorder, single episode.  Rule out recurrent with anxiety.  Rule out underlying generalized anxiety disorder.  History of obsessive-compulsive disorder.
		(2) Axis II:  Obsessive compulsive traits versus personality traits versus disorder.                            

		(3)  Axis III:  History of glucose-6-phosphates dehydrogenase deficiency.

		(4)  Axis IV:  Psychological stressors include work and family stressors.

		(5)  Axis V:  GAF:  35.

	c.  A 4 May 2011 examination at the Columbia, Missouri, VA Medical Center, found that he met the DSM-IV (Psychiatric Disorders.  Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria for a diagnosis of PTSD.

		(1)  Axis I:  Major depressive disorder with psychotic features, PTSD.

		(2)  Axis II:  None.

		(3)  Axis III:  Chronic pain.

		(4)  Axis IV:  Occupational difficulties.

		(5)  Axis V:  GAF:  55.

     d.  He was seen on 25 August 2012 at the Haven Behavioral-Pueblo, St. Mary-Corwin Medical Center.  His chief complaint was "I was hearing voices."  The diagnosis showed:

		(1)  Axis I:  Major depressive disorder with psychotic features PTSD.

		(2)  Axis II:  No diagnosis.

		(3)  Axis III:  Status low back pain.

		(4)  Axis IV:  Problems with primary support system.

		(5)  Axis V:  GAF:  20. 

9.  He provides a Department of Veterans Affairs Rating Decision dated 6 January 2012 that shows he was rated 50 percent for PTSD effective 6 July 2011 based on occupational and social impairment with reduced reliability and productivity, disturbances of motivation and mood, flattened affect, anxiety, chronic sleep impairment, depressed mood, mild memory loss and a mental condition that has been formally diagnosed.  The rating decision does not list bipolar disorder as a service-connected disability.  He also was rated as service-connected for multiple physical ailments to include 40 percent for thoracolumbar spine degenerative joint and disc disease. 
	
10.  He provides a letter from the VA dated 1 May 2014 which shows he is being paid at the 100 percent rate because he is unemployable due to his service-connected disabilities.  

11.  An advisory opinion was obtained from the Behavioral Health Division of the Office of the Surgeon General (OTSG) in the processing of this case.  The advisory official stated: 

	a.  The applicant enlisted in the Regular Army as an 91B (wheeled vehicle mechanic) and served a total of 10 years.  He was deployed to Iraq from 1 April 2003 to 1 April 2004 and from 13 December 2004 to 1 May 2005.  He reported exposure to traumatic events while deployed and symptoms consistent with combat exposure:  sleep disturbances, nightmares, and avoidance symptoms.  However, he was not diagnosed with PTSD nor did he meet the diagnostic criteria while he was treated at Military Treatment Facilities (MTF).  He was diagnosed with bipolar II disorder.  

	b.  The VA diagnosed him with PTSD and he is currently receiving combined service-connected disability (50 percent for PTSD and the remainder percentage for other physical conditions).  He requested the diagnoses on his PEB be changed from bipolar disorder to PTSD. 

	c.  He was hospitalized at civilian psychiatric hospitals and residential treatment facilities where he was given a diagnosis of PTSD.  However, there was insufficient documentation in his Army medical records to support this diagnosis.  When he was returned to outpatient treatment at the MTF, his diagnosis was changed to bipolar II disorder and there was sufficient evidence in the medical records to support this diagnosis.  Furthermore, there was evidence that he responded to treatment for this diagnosis.  

     d.  He received a MEB for the diagnosis of bipolar II disorder among other unfitting conditions and was found unfit and ultimately medically retired from the Army with an honorable discharge.

     e.  A review of his military medical records shows there was insufficient evidence to conclude that he met the medical criteria for a PTSD diagnosis and that his PEB should be changed from bipolar II disorder to PTSD. 



12.  On 10 August 2015, he responded to the advisory opinion.  He stated:

     a.  After reviewing the results from OTSG he was unclear as to their opinion with his appeal.  There was an error in his VA disability rating pertaining to PTSD.  The VA had given him a 70 percent service-connected disability rating for PTSD and not 50 percent as stated in the advisory opinion.  The VA has never treated him for bipolar II disorder because his symptoms did not warrant that diagnosis.

     b.  The treatment he received when he was diagnosed with bipolar II disorder consisted of medication which turned off his emotions.  He was not able to express his feelings.  He disagreed that his "zombie like state” was considered positive treatment.

     c.  He realized that many mental disorders have similar symptoms.  He has researched both PTSD and bipolar II disorder.  He has never gone out on any compulsive spending sprees nor has he engaged in activities that led to harmful or painful consequences.  He did have trouble sleeping and was tired all the time.  This led to his being impatient, angry, anxious and depressed.  

     d.  He experiences anxiety when driving, in crowds, and around loud noises.  He cannot be around areas with planes and helicopters due to the loud noise.  He is not able to keep up to date with the newest terrorist attacks.

     e.  His life has changed from what it used to be.  He has good days and bad days.  He has been seeing mental health professionals for over 5 years and talks with different physiologists who told him to get used to his current life and stop avoiding it.  He has had treatments related to PTSD symptoms but the results were often short-lived.

     f.  It is difficult for him to open up and talk about his experiences.  Talking about his experiences makes him feel vulnerable to triggers.  He hates that he is unable to go into a store, mall, or on community outings because of his paranoia.  His wife has recently resigned from her job and together they were trying to live stress free.  They treated everyday as a new day and were constantly learning and improving themselves from different situations.                         

13.  Army Regulation 40-501 governs medical fitness standards for enlistment; induction; appointment, including officer procurement programs; retention; and separation, including retirement.  Once a determination of physical unfitness is made, the PEB rates all disabilities using the VASRD.  Ratings can range from 0 to 100 percent rising in increments of 10 percent.

14.  Army Regulation 635-40 establishes the Army Physical Disability Evaluation System (PDES) and sets forth policies, responsibilities, and procedures that apply in determining whether a Soldier is unfit because of physical disability to reasonably perform the duties of his or her office, grade, rank, or rating.  In each case, it is necessary to compare the nature and degree of physical disability present with the requirements of the duties the Soldier reasonably may be expected to perform because of his or her office, grade, rank, or rating.  Separation or retirement by reason of disability requires processing through the PDES.

15.  Army Regulation 635-40, chapter 4, contains guidance on processing through the PDES, which includes the convening of an MEB to document a Soldier's medical status and duty limitations insofar as duty is affected by the Soldier's status.  If the MEB determines a Soldier does not meet retention standards, the case will be referred to a PEB.  The PEB evaluates all cases of physical disability equitably for the Soldier and the Army.  The PEB investigates the nature, cause, degree of severity, and probable permanency of the disability of Soldiers whose cases are referred to the board.  It also evaluates the physical condition of the Soldier against the physical requirements of the Soldier's particular office, grade, rank, or rating.  Finally, it makes findings and recommendations required by law to establish the eligibility of a Soldier to be separated or retired because of physical disability.

16.  VASRD 4.129 states that when a mental disorder develops in service as a result of a highly stressful event and 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 6 month period following the veteran’s discharge to determine whether a change in evaluation is warranted.  The authority is Title 38, U.S. Code, section. 1155.

17.  Title 38, U.S. Code, sections 1110 and 1131, permits the VA to award compensation for a medical condition which was incurred in or aggravated by active military service.  The VA, however, is not required by law to determine medical unfitness for further military service.  The VA, in accordance with its own policies and regulations, awards compensation solely on the basis that a medical condition exists and that said medical condition reduces or impairs the social or industrial adaptability of the individual concerned.  Consequently, due to the two concepts involved, an individual's medical condition, although not considered medically unfitting for military service at the time of processing for separation, discharge or retirement, may be sufficient to qualify the individual for VA benefits based on an evaluation by that agency.



DISCUSSION AND CONCLUSIONS:

1.  The applicant contends the PEB medical diagnosis and rating decision should be changed from bipolar disorder to PTSD because the MEB originally had listed PTSD as a medically disqualifying condition.  He further states he was seen at the MAMC and that they were found to misdiagnosis Soldiers.  

2.  The applicant’s MEB does show he failed to meet retention standards for PTSD, bipolar disorder, major depressive disorder with psychosis and chronic back pain.  Prior to submitting the MEB to the PEB, a psychiatric MEB consultation found that he had classical bipolar II disorder with a past history of episodes of hypomania and periods of major depression and that his PTSD symptoms were minimal and did not impair his functioning nor warrant medical separation through the PDES.  

3.  The PEB considered all the medical evidence and determined that his PTSD was not an unfitting condition and did not rate it in accordance with the VASRD 4.129 rule due to his lack of exposure to a highly stressful event.  The applicant had self-reported incidents that he assumed were "highly stressful"; however, his records do not support his contentions.  He consistently was recognized for his service as a wheeled vehicle mechanic during his periods of deployment and in garrison.  

4.  Based on the diagnosis of classical bipolar II disorder and the advisory opinion from OTSG, it appears that there is insufficient evidence to conclude that he met the medical criteria for a PTSD diagnosis that was unfitting during his active military service.  Furthermore, he concurred with the modified diagnosis of bipolar disorder as determined by the PEB.  He had the opportunity at that time to object and request a formal hearing if he disagreed with the PEB.  

5.  The absence of bipolar disorder among his VA-rated service-connected disabilities is not a basis for questioning the medical opinions that were the basis for the diagnosis that led to his retirement with permanent disability.  The VA does not determine fitness for duty for Army Soldiers.  That is a function of the Army PDES and the Soldiers chain of command.  Notwithstanding the fact that he was originally diagnosed with PTSD that did not meet medical retention standards, the record shows that, after further examination and review, he was not found unfit for this condition while on active duty.  Therefore, there is insufficient evidence to grant him his requested relief. 



BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

___x____  ___x____  ___x____  DENY APPLICATION

BOARD DETERMINATION/RECOMMENDATION:

The evidence presented does not demonstrate the existence of a probable error or injustice.  Therefore, the Board determined that the overall merits of this case are insufficient as a basis to amend the decision of the ABCMR set forth in Docket Number AR20130017939, dated 9 July 2014.



      ___________x______________
                  CHAIRPERSON
      
I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case.

ABCMR Record of Proceedings (cont)                                         AR20150002462



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ABCMR Record of Proceedings (cont)                                         AR20150002462



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