RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	      CASE:  PD-2014-01121
BRANCH OF SERVICE:  Army                                                                   SEPARATION DATE:  20060213

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Indirect Fire Infantryman, medically separated for episodic loss of consciousness with a disability rating of 0%.  

CI CONTENTION:  “VA found higher ratings after discharge.  VA also found other conditions.”  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 confined to 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 - 20051214	VARD - 20060830	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Episodic Loss of Consciousness	8999-8910	0%	Blackouts	8999-8045	10%	20060606	
Anxiety w/PTSD Symptoms	Not Unfitting	PTSD, Including Dysthymia	9411	30%	20060512	
		Anxiety	9413	NSC	20060512	
Acne	Not Unfitting	No VA Placement	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Episodic Loss of Consciousness.  Service treatment records (STR) noted the CI deployed to Iraq from September 2003 to October 2004.  He received shrapnel wounds to the upper right side of his body with tinnitus and momentary loss of hearing.  He thought he sustained a very brief loss of consciousness (LOC) but was aware he was “dazed.”  He was hospitalized for 2 weeks and shrapnel was removed.  He returned to duty December 2003 and 2 weeks afterward suddenly dropped down by his bed and was unconscious for 30 seconds.  This occurred four more times prior to completion of his deployment.   After redeployment, he had 4-5 more random brief episodes of LOC.  The episodes have not been preceded by a warning, nausea/vomiting, hearing or speech disturbances, light sensitivity, numbness/tingling, or loss of bladder or bowel control.  After the explosion the CI recalled the onset of irritable mood, sleep difficulty, nightmares of war, recollections of explosions, hypervigilance and exaggerated startle.  He had intermittent acute anxiety with racing heart rate and shortness of breath but was able to concentrate on operations and relate well to peers.  Psychological symptoms did not impair his performance of duties.  Brain imaging and electroencephalogram were normal.  Extensive cardiac and neurological exams were normal.  

The commander noted the CI had an episode while driving and went to the emergency room.  A medical board was initiated.  He remained well motivated, shared his experience with his peers and provided leadership when needed.  The narrative summary (NARSUM), dated 31 August 2005, noted the last LOC occurred 22 October 2005 and occurred at home.  Psychiatry had evaluated him and found him fit for duty.  He was single and lived in an apartment.  The Psychiatric addendum, dated November 2005, noted that after redeployment, he reported irritability, easy frustrations, occasional nightmares, hyper vigilance and sleep difficulty twice a week.  He was close to his family and friends.  Concentration was good and he did not take medications.  Neuropsychological testing suggested the CI had a mild concussion and full recovery to baseline was expected.  Mental status exam was normal.  A diagnosis of anxiety disorder not otherwise specified was rendered with a Global Assessment of Functioning (GAF) of 70 (mild symptoms, impairment.)  The examiner noted it was not medically disqualifying.  

At the VA Compensation and Pension (C&P) exam, performed 3 months after separation, the CI reported he had been diagnosed with posttraumatic stress disorder (PTSD) but could not relate to men in a PTSD therapy group.  He was not receiving counseling or medications.  The CI reported he believed the syncopal attacks were related to pain medication he took after his war wounds, citing similar experiences among his wounded buddies.  When the men stopped all pain medication, their syncopal attacks stopped.  He reported no LOC since his discharge.  He still took pain medication on occasion but avoided a medication he used to take in large amounts for a time.  He was taking classes at a community college and volunteering at an auto repair shop.  He was considering a return to Iraq as a “mercenary” and had applied to become a correctional officer.  A diagnosis of PTSD and dysthymia was rendered with a GAF of 60 (moderate bordering on mild symptoms.)

At the Neurological exam, dated June 2006, the CI reported he had headaches that began after the explosion.  He described a dull annoying ache that was present daily.  If his ears started ringing the headaches would get worse.  The sensory, cranial nerve and motor exams were normal.  The neurologist noted the initial neurological evaluation suggested the possibility of a somatoform disorder (e.g. conversion disorder) and noted further evaluation would be necessary if the episodes persisted.  Diagnoses of blackout spells, chronic daily headaches, and status/post shrapnel wound to the right arm were rendered.  He opined that the etiology remained clear but were less likely due to a seizure.  The headaches began after a concussion that occurred after the blast and were partially due to pain medicine rebound.  There was no shrapnel in the scalp area or scarring due to shrapnel on exam.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition 0%, coded 8999-8910 (grand mal seizure) while the VA rated the condition 10%, coded 8999-8045 (residuals of traumatic injury.)  The PEB noted the etiology of the LOC episodes was unknown and that all evaluations were normal.  His syncopal attacks were not explained by traumatic brain injury or post-concussive syndrome, therefore code 8045 is not appropriate.  The psychiatric addendum noted symptoms were mild and the C&P exam noted he had no further episodes since separation.  A higher rating of 10% requires a confirmed diagnosis of epilepsy with a history of seizures.  The Board agreed criteria for the 10% rating was not met.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the LOC condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that anxiety with PTSD symptoms and acne were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The anxiety with PTSD symptoms and acne were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed and considered by the Board.   There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the anxiety with PTSD symptoms or the acne conditions and so no additional disability ratings are recommended. 

BOARD FINDINGS:  In the matter of the LOC condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended anxiety with PTSD symptoms and acne conditions, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140307, 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 XXXXXXXXXXXXXXXXXXXX, AR20160007271 (PD201401121)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA