RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-01309
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20041013

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Light Wheel Vehicle Mechanic, medically separated for “post-concussive syndrome diagnosed as undifferentiated somatoform disorder” with a disability rating of 10%.

CI CONTENTION:  The CIs conditions continue to worsen and negatively affect daily activities.  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 - 20040720	VARD - 20050404	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Concussive Syndrome diagnosed as Undifferentiated Somatoform Disorder	8045-9423	10%	Post-Concussive Syndrome (Also Claimed as Migraines, Head Trauma, Dizzy Spells, Blackouts, Nausea and Vomiting)	8045	10%	20040818	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Post-Concussive Syndrome diagnosed as Undifferentiated Somatoform Disorder.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s post-concussive syndrome condition began in May 2003 after a head injury during physical training.  There was no loss of consciousness.  He had a history of two to three mild head injuries in the past but had not sought medical care.  After the 2003 injury, he developed nausea, vomiting, severe dizziness, blackout spells and multiple headaches.  Short term memory and speech were affected.  Electrical study of the brain and neuroimaging was normal.  Physical therapy, multiple different medications, acupuncture and chiropractor consultation to treat headaches and dizziness did not help.  Headaches occurred weekly and periods of blacking out occurred once a week, lasting a few seconds to several minutes.  

The CI reported he could not work more than 6 hours per day and was unable to perform his duties as a light wheel mechanic.  Fatigue aggravated his symptoms of headache, dizziness and nausea.  He was not able to drive or fire a weapon.  Heat or physical exertion exacerbated his dizziness, nausea and vomiting.  Examination was normal.  A diagnosis of post-concussion syndrome was rendered.  Neuropsychological examination in March 2004 noted the CI had depression that could compromise attention.  He had a high level of focus on his medical symptoms and evidenced impairments in memory and executive functioning.  However testing showed few cognitive impairments but they met criteria for a mild to moderate cognitive disorder.  He reported he was unable to work in any capacity.  A diagnosis of cognitive disorder NOS was rendered.  

A neurology consultation in May 2004 noted the CI was hospitalized June 2003 with hyperventilation and anxiety.  He reported uncontrollable body twitches somewhat responsive to medication.  He had headaches daily and at least twice per week the headaches required bedrest.  He was taking three medications.  Examination showed a grade 1/10 headache, normal cranial nerves, sensory and motor function.  Diagnoses of recurrent migraine and somatoform and/or anxiety disorder were rendered.  
 
At the VA Compensation and Pension (C&P) examination in November 2008, performed 2 months before separation, the CI reported he does vacuuming at home but had no hobbies and few friends.  Mental status examination (MSE) revealed a delusion that someone was trying to break into the house, diminished ability to concentrate and pay attention, and diminished speech.  Memory was intact.  A diagnosis of cognitive disorder was rendered with a Global Assessment of Functioning (GAF) score of 50 (moderate symptoms, impairment.)

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB initially assigned a 10% rating under the 8045-9304 code (post-traumatic encephalopathy.)  Code 8045, per the VA Schedule for Rating Disabilities (VASRD) in effect, stipulates, “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.”  The CI appealed and a Formal PEB was convened.  The Formal PEB re-adjudicated the case in response to specific inquiries and again assigned a 10% rating but under the 8045-9423 code (undifferentiated somatoform disorder due to residuals of traumatic brain injury), citing subjective symptoms, normal testing and mild impairments in memory and executive functioning.  

The VA also assigned a 10% rating for post-concussive syndrome using the 8045 code and assigned a 10% code for cognitive disorder using the 9304 code, based on the VA C&P examination 2 months before separation.  Members agreed, however, that a 10% rating is readily supported under the PEB code and, compliant with the rating language of the VASRD in effect for that code (see above).  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 syndrome due to brain trauma condition.  

BOARD FINDINGS:  In the matter of the post concussive condition and IAW VASRD §4.124, the Board unanimously recommends no change in the PEB adjudication.  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 20140304, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXXXXX AR20160011305 (PD201401309)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (000 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
( ) OVA