RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX						            CASE:  PD-2014-04134
BRANCH OF SERVICE:  AIR FORCE 	SEPARATION DATE:  20050525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Aircraft Armament Specialist) medically separated for “chronic vertigo,” rated 10%.   

CI CONTENTION:  The applicant requests that all conditions be considered.  Her 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 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:  

FPEB - Dated 20050330	VA* - (~5 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Vertigo	6204	10%	Chronic Vertigo	6204	10%	20051028	
Other MEB/PEB Conditions x 0	Other x 8	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20060111 (most proximate to date of separation [DOS]).  

ANALYSIS SUMMARY:  

Chronic Vertigo.  The narrative summary (NARSUM) noted the CI had a history of intermittent vertigo (dizziness).  The CI experienced “dizzy spells” with head movement, associated with nausea, vomiting and ringing in her ears.  Comprehensive evaluation by cardiology was unremarkable and evaluation by neurology did not lead to a specific diagnosis.  The CI also reported a history of migraine headaches once a week (relieved by an over the counter anti-inflammatory medication) which the neurologist indicated were unrelated to the vertigo symptoms.  Serial neurological exams noted a normal gait and no abnormalities of coordination and balance; the CI reported no ringing in the ears.  Magnetic resonance imaging of the brain was normal except for evidence of sinusitis, which was treated, but the dizziness did not improve.  The vertigo symptoms were unresponsive to medications and a Medical Evaluation Board (MEB) was initiated.  At the MEB exam on 20 January 2005, 4 months before separation, the CI reported chronic vertigo.  The MEB physical exam noted a normal neurological evaluation, including a normal gait, and the remainder of a complete exam was normal.  

At the VA Compensation and Pension (C&P) Ear Disease exam on 28 October 2005, 5 months after separation, the CI reported vertigo several times per day lasting seconds to minutes with “falling more to the right,” intermittent ringing, and decreased hearing bilaterally; her symptoms had occurred since 2003.  A pertinent exam noted no abnormalities of the ears.  An audiology evaluation the same day recorded decreased hearing in the right ear since enlistment, but hearing and speech discrimination were normal in both ears.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the vertigo condition 10%, coded 6204 (peripheral vestibular disorders).  The VA also rated tinnitus 10%, coded 6260 (recurrent tinnitus).  The Board agreed that the evidence supports a 10% rating coded as 6204 IAW VASRD §4.87 (Diseases of the Ear).  The Board reviewed to see if the next higher evaluation of 30% was supported.  The CI reported difficulties with balance with the vertigo, but multiple neurological evaluations recorded normal gait and no abnormalities of balance or coordination were noted on exam.  Therefore, Board consensus was that the next higher rating of 30%, which specifies “occasional staggering,” was not sufficiently supported.  Meniere’s syndrome (episodes of vertigo, tinnitus, and intermittent hearing loss) was not diagnosed in record for a higher rating coded as 6205 (Meniere’s syndrome).  The vertigo episodes were associated with tinnitus and there was no evidence in the record that the tinnitus was associated with functional impairment that was separately unfitting and it is therefore not eligible for a separate rating.  Additionally, there was no evidence of a tumor or other ratable impairment of the ear or related structures (mastoid bone) for a higher rating.  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 vertigo condition.

BOARD FINDINGS:  In the matter of the vertigo condition, the Board unanimously recommends no change in the PEB adjudication IAW VASRD §4.87.  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 20141007, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear XXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-04134.

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.

Sincerely,

Attachment:
Record of Proceedings