RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03861
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050707

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Infantryman, medically separated for “post concussive headaches” with a disability rating of 10%.

CI CONTENTION:  The CI requests consideration of 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 - 20050401	VARD - 20060209	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Concussive Headaches	8045- 9304	10%	Head Trauma, Status Post-Concussion with Residual Tension Type Headaches	8045	10%	20050914	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:  

Post Concussive Headaches.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s post concussive headache condition began in August 2005 after the second of two concussions received from improvised explosive device (IED) detonations while deployed to Iraq.  After the second IED blast, the CI was unconscious for approximately 8 minutes and subsequently evacuated for additional evaluation.  A brain MRI scan was essentially normal and neuropsychological testing demonstrated performance in the normal-low normal range.  The preliminary summary of the neuropsychological tests in August 2004 noted that the CI demonstrated “some mild difficulties on tests of attention which could be more related to his lifelong problems with attention (likely past ADHD diagnosis.”  He scored within normal limits in areas of learning, memory, problem solving, processing speed, language, visuospatial skills and motor skills.  

At the MEB NARSUM dated January 2005, approximately 5 months prior to separation, the CI reported since the concussion, he has had headaches that occurs daily at an intensity of 2-4/10.  The headaches were not described as migrainous.  He did not have incapacitating headaches but once every 2 weeks he had to lie down, and he often would leave work early and go lie down in his room at the barracks.  The CI reported that because of his concussions his chain of command had allowed him to leave work early about every day.  The NARSUM noted that the CI had a history of seven concussions in his life; two before prior to service entrance and two that were combat-related, the rest were related to non-combat situations.  Other than the headaches, the CI reported memory loss, and dizziness when he ran more than a mile.  He was not taking any prescribed medication for headaches.  The physical examination was essentially normal.  The examiner opined that the CI had mild headaches which did not interfere with his ability to perform duties; however, once or twice every 1-2 weeks he “may need to lie down or take medication.”  It was also noted that he could take simple analgesics for his headaches.  At the VA Compensation and Pension (C&P) examination in September 2005, performed 3 months after separation, the CI reported he had headaches almost daily at an intensity of 3-5/10.  Alleviating factors included rest and alcohol before bed.  The examiner noted that the headaches were not debilitating.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under an analogous 8045 code (Residuals of traumatic brain injury), citing normal imaging and neurological psychometric examinations.  The VA also assigned a 10% rating using the 8045 code (Residuals of traumatic brain injury) based on the VA C&P examination 3 months after separation, citing the subjective nature of the headaches.  The VARSD in effect at the time of separation captured brain injuries under the generic category of brain disease due to trauma (8045).  There are two different scenarios for rating under this code; analogously with purely neurological deficits, or purely subjective symptoms.  In the absence of associated neurological disabilities (seizures, nerve paralysis, etc.), rating of this condition under 8045-9304 is limited to 10%, and cannot be combined with any other rating for a disability due to brain trauma.  The Board found absence of evidence that would support any neurological disability, and therefore, only 10% was supported. The Board considered the 8100 code; however, the Board concluded the use of this code provided no additional benefits to the CI.  The Board agreed that a 10% rating, but no higher, was justified for the headache condition under the code 8045, and there was no justification for a higher rating under the 8100 code since prostrating attacks were not present.  There were no additional applicable codes to consider for rating the condition.  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 headaches condition.  

BOARD FINDINGS:  In the matter of the post concussive headaches condition and IAW VASRD §4.124a, 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 20140530, with attachments
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

07 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
 (PD201403861)

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