RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03518
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20060510

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Diagnostic Imaging Journeyman, medically separated for cognitive disorder secondary to Traumatic Brain Injury (TBI) rated at 10%. 

CI CONTENTION:  The applicant makes no specific contention in his application.

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 - 20060322	VARD - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cognitive Disorder	9424	10%	Cognitive Disorder	9304	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Cognitive Disorder.  The NARSUM documented the CI’s history of reported changes in his memory after he was involved in a motor vehicle accident (MVA) in June 2004.  The CI was traveling on a highway when he lost control and crossed the median, rolling the car several times.  He was wearing his seatbelt and does not recall the events that followed.  The CI suffered multiple traumas that required a 1 week admission to the hospital.  Since the accident, he has experienced intermittent headache pain “behind the right eye” which he has maybe once every other week at night if he is reading or watching television close-up.  The pain resolves when he stops reading and rest for a while.  The records demonstrate the CI participated in counseling from December 2004 until the end of October 2005.  In addition to his diagnosis of cognitive disorder, not otherwise specified (NOS); he was receiving counseling for the diagnosis of adjustment disorder with depressed mood.  He was not prescribed any psychotropic medications.  Additionally, he underwent neuropsychological testing twice, in December 2004 and October/November 2005 with the same psychologist, and was found to have deficits consistent with mild cognitive impairment secondary to the head trauma.  At the 2005 neuropsychological evaluation, approximately 7 months before separation, the CI reported his memory had continued to deteriorate.  He expressed frustration over not be able to play basketball or engage in some of the other leisure activities at his pre-morbid level.  He noted in the questionnaire that he had problems with attention, arousal/alertness, decreased activity level, slowed processing speed, memory gaps, nighttime confusion, and emotional lability.  The examiner noted that he had achieved driving without tickets, accidents, close calls, or getting lost.  He has managed his finances without difficulty in relations to paying bills, managing checkbook, spending responsibly.  The examiner noted that his situation had not changed since the 2004 evaluation; he continued to work and felt he had done a good job.  It was noted that he continued to demonstrate primary impairment with memory without any changes from previous testing in this area, and his language problem difficulties were in the area of confrontation naming.  He tested in the range of average intelligence.  The diagnoses of cognitive disorder secondary to MVA, and adjustment disorder with mixed features were documented on Axis I, and a Global Assessment of Functioning (GAF) score of 67 (mild impairment/symptoms) was recorded.  It was noted that his condition is relatively stable, and his job performance was expected not to change significantly.  The CI was also evaluated by neurology in October 2005, and that examiner assessed “subjective complaint of memory disturbance, subjective complaints of non-specific headaches probably muscle contraction type, and associated sleep disorder.”  His neurological examination was essentially unremarkable.  The neurologist noted that although he was involved in a car accident more than a year ago, his head injury was reportedly minor.  The examiner opined that his memory disturbance symptoms were more a reflection of an underlying depression.  The CI was prescribed Trazadone for sleep; however, in the follow-up neurology visit, it was noted that the prescription had not been filled.

At the narrative summary (NARSUM) dated 19 January 2006, the CI noted that he was preoccupied with his condition and has had headaches since the MVA.  He also noted that he was frequently becoming lost and had concerns about finding his way to appointments.  He also reported decreased concentrating ability; however, his grades in school classes were good.  Review of systems documented absence of confusion, or disorientation, and no loss of time, no speech difficulties, no difficulty writing, and no motor or sensory disturbance.  The examiner cited findings from the psychological evaluation as noted above, which included the opinion of the psychologist that he should continue his “periodic counseling” and an antidepressant could be considered, but his situation seemed to be relatively stable.  The examiner opined that the CI’s condition caused a “mild” degree of civilian social impairment and a “minimal” degree of military industrial impairment, “which is still consistent with military standards and bearing”.  The examiner also stated, “He is currently qualified and it is recommended that he continue to serve in the military.”  The commander’s statement was accomplished a week after the NARSUM.  It was noted that although the CI’s overall performance of his duties was “satisfactory” or “average,” the MVA had affected his motivation, enthusiasm, and his attention to detail.  His supervisor had spent a good deal of time helping him maintain his schedule, and he required substantial supervision.  The commander recommended not retaining the CI.  The CI was non-attendant to the VA Compensation and Pension (C&P) examination.

The Board directed its attention to its rating recommendation based on the above evidence.  As noted above, the PEB rated the condition at 10%, coded 9424 (somatoform, conversion disorder).  The VA used the service treatment records and granted a 0% evaluation under the 9304 code (dementia due to head trauma).  First, the Board noted there was no specific, highly stressful service related event to invoke §4.129 for a mental disorder due to traumatic stress.  All Board members agreed the provisions of §4.129 were not applicable.  The VA used the 9304 code to rate the CI’s condition.  The Board proceeded to rate under VASRD §4.130 and compared the NARSUM opinion of the CI’s employability and work function, and the commander’s statement of duty performance.  Deliberations focused on the 30% versus 10% rating levels.  The 30% rating requires evidence of “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.”  The NARSUM examiner opined that his industrial impairment was “minimal,” and attributed most of his reported cognitive difficulty to depressive and anxiety symptoms.  The CI had an S1 profile.  The examiner stated, “He is currently qualified” and recommended that he continue to serve in the military.  On the other hand, the commander noted loss of attention to detail and need for significant supervision, which suggested a decrease in work efficiency; however, there was no suggestion of intermittent periods of inability to perform occupational tasks due to memory loss, depression, or falling asleep on the job.  In fact, the commander stated that his performance was average or satisfactory; however, recommended separation.  There was no documentation of disorientation, or getting lost due to memory impairment, or that his symptoms required the use of electronic notepads or GPS.  All Board members agreed the 30% disability criteria were not met.  The Board reviewed the 2007 VA C&P examination that was accomplished 17 months after separation, and considered it was too remote from separation for consideration.  However, it was noted although the CI was not working, he reported he had done a good job, had received good evaluations, but left the job to be with his girlfriend in another city.  He indicated that he was currently on leave without pay.  The examiner noted that the CI held a good job was promoted and did well, and his job is still available to him.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), and the application of §4.130, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the cognitive disorder condition.  

BOARD FINDINGS:  In the matter of the cognitive disorder secondary to traumatic brain injury condition and IAW VASRD §4.130, 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 201340723, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03518.

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,

Attachment:
Record of Proceedings