RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD1301236
BRANCH OF SERVICE:  Army	BOARD DATE:  20140415
SEPARATION DATE:  20040828

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SPC/E-4 (63B10/Light Wheel Vehicle Mechanic) medically separated for recurrent transient ischemic attacks (TIAs) associated with left-sided weakness.  The TIA condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The stroke-like conditions, characterized as “right subcortical TIA manifested by left LE weakness” and “left UE numbness, dysarthria, and diaphoresis, all of which lasting 30 minutes,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The informal PEB adjudicated “recurrent TIAs, involving right subcortical white matter manifested by left arm or left leg weakness, occurring once per month, lasting approximately 30 minutes” as unfitting, rated 10%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Disability became more severe, cannot walk a long time, pain in right inner leg, was denied, need reevaluate.  PTSD was denied, reevaluated.  Became a diabetic in Army, when I was deployed.  2004 See V.A. medical record.”

SCOPE OF REVIEW:  The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  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 TIA condition is addressed below; the requested posttraumatic stress disorder and diabetes conditions were not identified by the PEB and thus are not 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, may be eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service IPEB – Dated 20040721	VA - (2 Days Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Transient Ischemic Attacks	8099-8008	10%	Hemiparesis of Left Lower Extremity, Residual of Stroke	8099-8520	20%	20040830	
			Hemiparesis of Left Upper Extremity, Residual of Stroke	8099-8212	10%	20040830	
			Hyperhidrosis, Residual of Stroke	8099-7832	0%	20040830	
			Memory Loss, Residual of Stroke	9399-9326	0%	20040830	
No Additional MEB/PEB Entries	Other x 8	20040830	
Combined:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20050207 (within 6 months of separation); VARD 20041005 (most proximate to date of separation [DOS]) reflects entitlement to vocational rehabilitation.

ANALYSIS SUMMARY:

Transient Ischemic Attacks (TIA) Associated with Left-Sided Weakness.  The CI’s initial medical work-up for an acute onset of left sided weakness and numbness lasting 30 minutes began in January 2004; however, records indicate a prior episode of similar symptoms occurred in April 2003 that lasted for an hour.  There were no clinical documents in evidence of the reported April event.  An initial cardiac evaluation that included trans-esophageal echocardiography failed to identify a cardiac source of embolic events (clots that travel to the brain) that could cause a stroke or stroke-like symptoms.  Neuro-diagnostic studies revealed no clinically relevant abnormality.  Carotid ultrasound was normal.  Extensive evaluation revealed no clear cause of the CI’s condition, although a brain bleed, clot, or mass was ruled out.  The MEB narrative summary (NARSUM) examination in April 2004 performed 4 months prior to separation, summarized the CI’s past history of symptoms and treatment; noting, no further episodic symptoms since original onset in January 2004.  The physical and mental status examination were normal except for a bilateral UE slight “intention tremor” (shakiness of hands/arms when initiating and action of some sort).  Cranial nerves 2-12 were intact.  There were no neurological deficits; gait was normal.  The diagnosis was right subcortical (brain) TIA manifested by left lower extremity weakness.  There was no comment in regards to the CI’s functional ability.  Three months later (July 2004), a NARSUM addendum noted that the CI endorsed “…continued occasional subtle left UE or left LE weakness, occurring once per month, each episode lasting approximately 30 minutes.”  A statement letter from the CI dated 17 June 2004 indicated that since April 2004, his symptoms were weakness, numbness and tingling in his left arm and left leg occurring 2-3 times per week.  His examination remained unchanged, but his diagnosis was changed to recurrent TIAs involving [an area of the brain] secondary to hypertension (elevated blood pressure) and hyperlipidemia (elevated cholesterol/fats).  The examiner specifically noted, “…this [CI] is continuing to have TIAs.”  Again, there was no comment on his functional ability; however, the permanent profile of 9 April 2004 limited only assignment or deployments to areas with definitive medical care, but that his activities were otherwise unrestricted.  At a follow-up neurology note of 16 June 2004, the CI endorsed occasional subtle numbness of both the left upper and lower extremities for 30 minutes once a month.  The examination was normal and the diagnosis was “recurrent TIAs.”  At the VA (neurology) Compensation and Pension examination in September 2004 performed 3 weeks after separation, the CI reported symptoms as described above (from his statement) with the addition of worsening memory loss.  The physical and mental examination was grossly normal with the examiner stating, “…but I cannot exclude that he indeed is different from baseline.”  His gait was normal.  The diagnosis remained as TIAs.  There was no comment in regards to social or occupational impairment.

The Board directs attention to its rating recommendation based on the above evidence.   The PEB’s determination of a single encompassing diagnosis of TIAs left room for elucidation of the unfitting condition in regards to any associated residuals.  Conversely, the VA rated according to residuals of the general TIA condition.  The DA Form 199 listed residuals associated with the TIA condition but its rationale found the CI unfit primarily due to the recurrence of his symptoms at once a month for 30 minutes.  This explanation is supported by the evidence described above, which revealed infrequent symptom exacerbations with virtually no resulting functional impairment.  In light of normal sensory, motor, and strength findings on examination, it was apparent that the occasional residual left-sided extremity weakness was not severe enough to be found independently unfitting; and, the level of impairment could best be described as “mild.”  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’s 10% adjudication for the TIA 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 TIA 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130911, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20140019506 (PD201301236)

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						     
						         
CF: 
(  ) DoD PDBR
(  ) DVA