RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04186
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20081215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Aviation Structural Mechanic Airman, medically separated for “right tentorial fibrous and transitional meningioma, resected,” with a disability rating of 10%.

CI CONTENTION:  The CI contends his unfitting condition was declared pre-existing by the PEB which was not consistent with medical evidence.  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 - 20081001	VARD - 20090402	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Tentorial Fibrous and Transitional Meningioma, Resected	8003	10%	Residuals of Brain Tumor Surgery	8003	0%**	STR*	
Benign Cerebellar Brain Tumor in Childhood	Pre-existing					
Residual Cognitive Deficits of Unclear Etiology	Cat II	Memory Loss	9399-9310	NSC	STR	
Cognitive Disorder	Cat II					
Stable Right Superior Quadrantanopsia	Cat II	Right Temporal Visual Deficit	6099-6009	NSC	STR*	
		Left Temporal Visual Deficit	6099-6009	NSC	STR*	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	
* Service treatment record (Missed VA exams 20081205 (Brain) and 20081209 (Hearing & Vision))

ANALYSIS SUMMARY:

Right Tentorial Fibrous and Transitional Meningioma, Resected.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was treated for a childhood benign brain tumor (at age 11, but different ages are cited in the record) with surgery twice and follow-on radiation.  The initial (childhood) presentation was a 2-year history of headaches with a grand mal seizure in 1994.  He was initially denied accession, but later approved for enlistment after intervention by his US Senator.  Following accession, he performed adequately but did report mild cognitive difficulty with slower than average advancement and minor disciplinary problems.  In August 2007, he was evaluated for a 2-3 month history of dizziness, light-headedness and confusion.  An MRI showed a brain mass which was then resected.  It was found to be a meningioma.  Prior to surgery for the meningioma, baseline cognitive testing showed mild cognitive limitation as well as a left upper quadrant visual field defect.  Repeat neuropsychological testing on 5 March 2008 showed a mild, organically based cognitive impairment which was thought to render him unfit for full duty.  At the MEB narrative summary dated 04 April 2008, which was dictated by the treating neurosurgeon, the CI reported that the pre-surgery confusion had resolved, but that the visual field defect persisted.  It was also thought that the meningioma was secondary to the prior radiation.  The neurological examination was intact other than a right superior quadrantanopsia (loss of a quarter of a visual field) and a right hemianopia (loss of one side of the visual field in both eyes).  It was noted that the visual field loss would not preclude return to full duty, but would limit his occupational choices.  At the MEB NASUM addendum dated 27 June 2008, it was recorded that the CI had declined cognitive rehabilitation and that it was unclear if his current deficits pre-dated the recent tumor.  It was also noted that cognitive deficits are common after radiation therapy which he had as a child.  The CI failed to report to his VA Compensation and Pension (C&P) examination scheduled on 05 December 2008.  Following separation, the CI initially worked in an oil field and then quit work to attend school.  A VA examination on 7 July 2009, 7 months after separation, was negative for neurological complaints and his examination was normal other than “altered vision” for which he wore contacts (these would correct a refractive error, but not a visual field defect).  In neurology on 19 August 2009, he was found to have no focal neurological deficits and noted to have no problem with cognition.  There are no further, pertinent records proximate to separation in evidence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB initially found the condition to be pre-existing, but then, after reconsideration in response to a rebuttal, assigned a 10% rating under the 8003 code (new growth in the brain, benign with residuals).  Category II conditions included residual cognitive deficits of unclear etiology, stable tight superior quadrantanopsia, and cognitive disorder.  He was also noted to have a history of childhood brain tumor(s).  The VA initially assigned a 0% rating using the 8003 code and determined that memory loss and the visual defect were not service connected as the CI did not show for his examination.  A 10% rating was then assigned, retroactive to separation, based on a review of the service treatment records.  The memory loss and the visual defect remained denied.  These ratings were upheld on review on 26 July 2011.  Subsequently, the VA rated the residuals from the surgery at 30% effective 22 April 2011.  It also later rated the memory loss at 10% following a decision rating officer review, but then incorporated this into a mental health rating for posttraumatic stress disorder (PTSD).  These examinations were accomplished remote from separation and outside the 12 month window assigned higher probative value.  

The Board considered the evidence.  It shows that the CI had a visual field defect, but that it was not incompatible with all military occupations and did not render the CI separately unfit for duty although it did impair duty and precluded some ratings.  The memory loss/cognitive disorder was also noted to impair (but not to preclude) duty, but it was not clear how much predated the meningioma as the CI reported impairment prior to this.  The Board noted that following separation, the CI worked in an oil field and then planned to attend school.  The evidence does not support a finding that either of these conditions was separately unfitting.  The Board then considered the tumor itself.  The evidence is that there was complete removal without residual tumor remaining.  This supports the 10% rating adjudicated by the PEB.  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 condition.  

BOARD FINDINGS:  In the matter of the right tentorial fibrous and transitional meningioma, resected condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended residual cognitive deficits of unclear etiology, stable right superior quadrantanopsia, and cognitive disorder conditions, the Board unanimously recommends no change from the PEB determinations as Category II and not separately ratable.  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 20141017, 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 11 Aug 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:

		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXX, former USN