RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03815
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20090101

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Infantry Rifleman, medically separated for “Central Disequilibrium” rated 10%, with a disability rating of 10%.  

CI CONTENTION:  “Please consider all 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 - 20081014	VARD - 20100301	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Central Disequilibrium	8045-6299-6204	10%	Vestibulopathy	8045-6204	0%	20100127	
Headache Syndrome	Category II	Traumatic Brain Injury (Head Injury, Concussion)	8045	40%	20091209	
PTSD, Chronic	Category III	PTSD with Alcohol Abuse	9411	50%	20090930	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Central Disequilibrium.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was exposed to numerous IED blast explosions and in November 2006, while passenger in a HUMVEE, an IED detonated underneath the vehicle destroying it.  He did not lose consciousness.  He was diagnosed with Grade II concussion, prescribed Motrin and Tylenol for headaches, and placed on light duty.  Due to continuing headaches and dizziness, he was referred to the concussion clinic.
In April 2007, the CI was evaluated at the concussion clinic where he denied LOC but noted he was disoriented for several minutes after the 2006 explosion.  The CI reported he was having headaches 2-3 times q week on a pain scale of 4/10 with dizziness and seeing spots with exertion.  The CI noted he took over the counter Tylenol which was not effective, and self-medicated with alcohol at times for sleep, which was also not effective since he was still fatigued.  

The CI underwent vestibular tests in May 2007.  He had complained of vertigo lasting seconds to minutes, accompanied by the sensation of tilting to the left.  He denied motion sickness and migraine headaches.  The diagnosis of vertigo was assessed.  

The record documented intermittent frequency of attacks of vertigo.  Treatment entry dated 31 July recorded 3 episodes of vertigo in 2 weeks.  Neurology consultation dated 7 August 2008 indicated the CI reported dizziness that occurs once every 2 weeks described as the room tilting to one side, that passes in 5-10 minutes if he holds still and holds onto something.  It was noted that Brain MRI in January 2008 was normal.  The neurologist assessed him with occasional disequilibrium and chronic daily headaches.

The NARSUM noted the CI underwent neuropsychological testing and was found to have relative cognitive strengths in a majority domain including: attention, working memory, and frontal systems functioning (executive functioning which includes judgment, impulse control, reasoning).

At the VA Compensation and Pension TBI examination dated 8 months after separation, the CI was administered a cognitive screen to assess for cognitive impairment due to TBI.  He reported mild memory problems and had no objective evidence of memory issue on testing.  His judgment was recorded as moderately impaired, and social interaction was assessed to be frequently inappropriate.  He reported daily headaches and he did not take medications, and had dizziness twice a week and nightly insomnia. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating with the application of analogous coding scheme of 8045-6299-6204 (peripheral vestibular disorder due to brain trauma) and opined that the condition of headache syndrome was a Category II condition (contributed to the primary condition).  The VA rated the condition at 40% under the 8045 code for traumatic brain injury.

While the CI had dizziness and vertigo events, episodes of staggering were not documented, and therefore, the higher rating of 30% under the 6204 code was not justified.  The Board next considered a rating under the 8045 code.  The CI suffered headaches, irritability, anger issues, and subjective memory loss, symptoms commonly associated with history of head trauma.

The VARSD in effect at the time of separation rated brain injuries under three main areas of dysfunction: cognitive, emotional/behavioral, and physical, each area represented by a set of important facet related to severity.

The VA assigns an evaluation based upon the highest level of severity for any facet (there are 10 facets with “3” as highest level of severity) of cognitive impairment and other residuals identified as associated with the condition.  The higher rating of 40% requires demonstration of impairment level corresponding to level 2.  The record supported only the 10% level of impairment for three or more subjective symptoms such as dizziness, insomnia and mild to moderate daily headaches; a complaint of mild loss of memory without objective findings; and one or more neurobehavioral effects that occasionally interfere with social interactions.  The Board noted the neuropsychological tests showed no evidence of impairment in judgment, communication, orientation, or motor/sensory, that would support a facet “2.”  

Therefore, Board members concluded the level “2” impairment was not met, and that his condition best reflected a facet “1” score.  Hence, applying the 8045 code was of no benefit to the CI.  

The Board opined that the headache syndrome Category II was accounted for under the 8045-6299-6204 coding scheme.  The CI had a history of headaches beginning after the 1st deployment that increased in frequency after the IED blast.  The treating neurologist, opined that the headaches were associated with the concussion. 

Therefore, the headache syndrome condition was an integral component of the IED blast pathology and could not be recommended for additional rating IAW VASRD 4.14 (avoidance of pyramiding).  

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 central disequilibrium condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that PTSD, chronic not unfitting.  The CI sustained a gunshot wound to his shoulder in 2004 during his Iraqi deployment.  The STR documented he had signs and symptoms of PTSD beginning in 2004.  He was diagnosed with PTSD in September 2005.  Treatment records were silent during the 3 months prior to his 2006-2007 deployment.  After his return from deployment in 2007, the CI underwent fitness for duty mental health evaluation and was found fit for full duty.  The CI noted despite having PTSD symptoms, he was able to serve as a vehicle commander in the COs personal security detachment for an entire year.  

The NARSUM, dated August 2008 was accomplished approximately 5 months before separation  The psychiatrist documented he had mild PTSD symptoms with mild social and civilian impairment.  The non-medical assessment (NMA) related that the CI was unable to perform within the physical requirements of his MOS due to medication side effects.  The NMA stated that the CI “gets dizzy during running due to medication.”  There was no mention of violence in the workplace or behavioral issues interfering with duty performance.  

The PTSD condition was not profiled in the 12 months prior to separation or implicated in the commander’s statement.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, and 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 contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the central disequilibrium condition and IAW VASRD §4.124a, the Board recommends no change in the PEB adjudication.  In the matter of the contended PTSD condition, the Board 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 20140820, 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 15 Nov 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:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC