RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00009
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20061031

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Field Artillery Fire Control Man, medically separated for “post-concussion syndrome,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based upon a review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB -  20060906	VARD - 20131104	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-concussion Syndrome	8045-9304	10%	Traumatic Brain Injury also Claimed as Post Concussion
Syndrome with Headaches	8045	NSC	20060713	
Post Recurrent Migraine Headaches	Cat II					
Grade III Concussion						
Posttraumatic Insomnia		Posttraumatic Stress Disorder with Major Depressive Disorder and Symptoms of Insomnia and Anxiety	9411	70%	20060614	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

Post-concussion Syndrome. According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s post-concussion syndrome began in November 2005 after he suffered a closed head injury as a result of a motor vehicle accident.   He lost consciousness for a few minutes and neuroimaging was normal.  He presented to the neurology clinic in December 2005 due to daily headaches, chronic neck pain, dizziness, poor sleep, diminished attention span, decreased appetite and blacking out during the day when engaged in low interest activities.  Examination was normal and a mini mental status examination was 29 out of 30.  Neurological examination was unremarkable.  He was referred to the concussion clinic, the dizziness clinic and to orthopedics.  Driving privileges were revoked due to mental lapses.  The concussion clinic assessment revealed a concussion score of 23 out of 30, significant for post-concussion syndrome.  The vestibular clinic examination noted cervical vertigo during head-body rotations.  Further neuroimaging was negative.  There was no evidence of intracranial pathology.  

He was admitted to the hospital on January 2006 after taking an excess of anti-convulsion medication and continues to be followed by mental health.  The NARSUM examiner rendered diagnoses that included Grade III concussion, post-concussion syndrome, chronic headaches and posttraumatic insomnia.  The post-concussion syndrome was noted to be refractory to treatment.  The non-medical assessment (NMA) by his commanding officer noted the CI was away from his current duties 8 hours per week.  

The May 2006 neuropsychological NARSUM addendum noted his appearance was remarkable because he looked like he had not slept in days and had dark circles under his eyes and was marginally groomed.  He reported depression, anxiety, apathy, insomnia and daytime sleepiness.  Affect was blunted.  Psychological testing showed low average intelligence.  He had taken a number of different medications for sleep and for migraine headaches and appeared to be suffering a post-concussive syndrome.  He did not appear able to continue on duty at the time.  A diagnosis of mood disorder due to head injury, mild TBI, migraine headaches and post-traumatic insomnia were rendered with a Global Assessment of Functioning (GAF) score of 60 (moderate bordering on mild symptoms, impairment.)

At the VA Compensation and Pension (C&P) examination performed 4 months before separation, the CI reported sleep problems, irritability, anxiety, and decreased memory and concentration.  He reported his main problem was an inability to adjust because of the accident.  He was taking two medications for sleep and last saw his psychologist May 2006.   

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the post-concussion syndrome condition 10% coded 8045-9304.  The PEB adjudicated post recurrent migraine headaches, grade III insomnia, and posttraumatic insomnia as Category II; conditions that were related to the Category I unfit condition of post-concussion syndrome.  The VA rated the traumatic brain injury condition (claimed as post-concussion syndrome) non-service connected coded 8045 based on the lack of evidence to show the disability had been clinically diagnoses.  

The PEB coding approach was consistent with the VASRD in effect at the time, which required that subjective symptoms of TBI be rated in this manner.  Regarding the appropriate coding option, it was agreed that the 8045-9304 code chosen by the PEB is technically accurate in this case.  The applicable 2002 VASRD for the 8045 code (TBI) states:  “Purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, will be rated 10 percent and no more under diagnostic code 9304.  This 10 percent rating will not be combined with any other rating for a disability due to brain trauma.  Ratings in excess of 10 percent for brain disease due to trauma under diagnostic code 9304 are not assignable in the absence of a diagnosis of multi-infarct dementia associated with brain trauma”. The Board determined the post recurrent migraine headaches, grade III insomnia, and posttraumatic insomnia as related Category II conditions were not separately unfitting but subsumed in the post-concussion syndrome condition, and therefore not recommended for an additional rating.  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 adjudication for the post-concussive condition.  

BOARD FINDINGS:  In the matter of the post-concussion condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the post recurrent migraine headaches, grade III insomnia, and post traumatic insomnia conditions, the Board unanimously agrees that it cannot recommend them for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 9 Aug 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC

						XXXXXXXXXXXXXXXXXXXX
	     					Assistant General Counsel
						  						(Manpower & Reserve Affairs)