RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00078
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20060718

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve E-7 (Aerospace Ground Equipment Mechanic) medically separated for cerebrovascular accident (CVA-stroke) with mild residuals and hypertension.  These conditions could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS).  He was issued a P4E2 profile and referred for a Medical Evaluation Board (MEB).  “Cerebrovascular accident with mild residuals” and “hypertension, uncontrolled” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated “cerebrovascular accident with mild residuals” and “hypertension, uncontrolled” as unfitting, rated 10% and 10%, citing application of DoD Instructions and the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:  He was not evaluated for Sleep Apnea.  His complete submission is at Exhibit A.  

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 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/Naval 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 confined to review of medical records and all available evidence for application of the 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:  

IPEB - Dated 20060511	VA* - (~14 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cerebrovascular Accident with Mild Residuals	8008	10%	Left Sided Facial and Tongue Numbness, Residuals, Cerebrovascular Accident	8008-8207	10%	20070910	
			Left Upper Extremity Parenthesias and Mild Weakness, Residuals, Cerebrovascular Accident	8008-8515	10%		
Hypertension, Uncontrolled	7101	10%	Hypertension	7101	10%		
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 2	
COMBINED RATING:  20%	COMBINED RATING:  60%	
*Derived from VA Rating Decision (VARD) dated 20071001 (most proximate to date of separation [DOS]).  
ANALYSIS SUMMARY:  

Cerebrovascular Accident with Mild Residuals.  The CI was right handed based on his entry physical (MEPS).  The narrative summary (NARSUM) and treatment record noted the CI had a history of hypertension (HTN) and transient ischemic attack (TIA) prior to activation.  He had controlled HTN and no fixed neurologic deficits until activation and deployment.  While deployed he had poorly controlled blood pressure and a cerebrovascular accident (CVA-stroke).  The stroke residuals were left sided facial and tongue numbness and left arm weakness and paresthesias (abnormal sensations).  Multiple different types of imaging confirmed the CVA and the CI was on maintenance medication for prevention of recurrence.  

At the MEB exam, the CI complained of left sided facial numbness and tingling, with tingling in his left “index finger and left thumb, with slight weakness noted.”  The MEB physical exam and neurologist consultation, approximately 8 months prior to separation, noted numbness to the left face, tongue and palate (roof of mouth).  The left index finger had numbness.  Gait, reflexes and muscle tone were normal.  Motor exam was normal with “no focal paresis, drift or atrophy” in any extremity and with intact cranial nerves.  Neurologic exam was otherwise normal.  

At the VA Compensation and Pension (C&P) exam performed 14 months after separation, the CI reported a similar history with symptoms of “residual left arm paresthesia/hyperesthesia, left sided facial and left sided tongue numbness/sensitivity (with chewing problems), headaches and erectile dysfunction.”  There was no history of seizures, swallowing problems, impaired taste, or speech problems.  The CI had moved from an outside job to an inside office job.  Exam documented normal speech with normal mouth, and ENT (ear, nose and throat) exams.  There was 4/5 muscle strength in the left upper extremity with decreased sensation to light touch.  There was no decrease to hand dexterity.  Reflexes were normal.  The examiner’s summary indicated “residual left sided facial numbness, left sided tongue numbness, headaches, left arm paresthesias and mild weakness …”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the CVA with mild residuals as 8008 (brain, vessels, hemorrhage from), rated 10%.  The VA rated the CI for two residuals of CVA, coded 8008-8515, rated 10% for left upper extremity weakness and 8008-8207, rated 10% for facial weakness.  The Board deliberated if any of the CI’s residual conditions from the CVA (stroke) were independently unfitting and ratable.  The facial weakness and numbness did not have any abnormal findings with speech, vision, or eating that would interfere with performance of duties and the Board adjudged there was insufficient evidence for any unfitting cranial nerve disability.  The Board concluded therefore that this condition could not be recommended for additional disability rating.  The Board next addressed the left arm mild weakness and paresthesias.  The MEB findings of non-dominant hand index finger numbness without any hand or arm weakness could have potentially been unfitting given the CI’s AFS of aerospace ground equipment mechanic.  However, any rating for this condition would be no greater than 10% IAW VASRD §4.124a.  Since the CVA residual minimum 10% rating as awarded by the PEB cannot be combined with rating of any residual conditions, changing the coding would provide no benefit to the CI.  

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 CVA with mild residuals condition.  

Hypertension.  The NARSUM noted the CI had a history of hypertension (HTN) prior to activation.  While deployed he had poorly controlled blood pressure and a stroke (see above).  The CI was on four anti-hypertensive medications for HTN and his blood pressure remained uncontrolled.  An exercise treadmill test (sub-maximal due to medicines and fitness) indicated increased blood pressures, but was negative for evidence of cardiac ischemia or abnormal heart rhythm.  The CI did not have a diagnosis of hypertensive heart disease.  The Service and VA records noted diastolic pressure predominantly 100 or more, and systolic pressure predominantly 160 or more, and the requirement for continuous medication.  The Board directed attention to its rating recommendation based on the above evidence.  Diastolic pressure was not predominately 110 or more, and systolic pressure was not predominantly 200 or more to warrant a rating higher than 10%.  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 hypertension 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 CVA with mild residuals condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the hypertension condition and IAW VASRD §4.104, 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131226, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX
XXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00078.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied. 

Sincerely,

XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings