RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00791
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050422

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Unit Supply Specialist, medically separated for “post-concussive syndrome,” with a disability rating of 10%.

CI CONTENTION:  The CI’s condition continues to worsen and negatively impacts daily living.  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 based upon a 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 - 20050307	VARD - 20081117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Concussive Syndrome	8045-9304	10%	Post-Concussion Syndrome with Fluid on the Brain and Migraine Headaches	8099-8045	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

Post-Concussive Syndrome.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s post-concussive syndrome condition began in September 2004 after a fall that involved direct trauma to the right occipito-parietal aspect of the head.  She denied loss of consciousness or change in mentation.  She had daily headaches that were debilitating and prostrating for several hours every day due to the intensity of the pain.  A scan showed subdural hygromas with no acute changes noted.  Magnetic resonance imaging (MRI) showed many abnormalities of brain structure: chronic bilateral subdural hygromas, multiple venous malformations, an old right frontal lobe infarction and disordered sulci, thinning of the corpus callosum and optic chiasm atrophy.  Neuropsychological testing showed minimal whole brain impairment. There were no glaring areas of cognitive dysfunction.  She was placed on prophylactic headache medication which decreased the frequency of the headaches to one per week.  She also received abortive headache medication as well.  The MEB forwarded “post-concussion syndrome” and “multiple brain abnormalities” for PEB adjudication.  

The MEB NARSUM examination on 8 February 2005, 2 months prior to separation, noted complaints of daily headaches, described as “band-like” at her initial visit.  She was placed on prophylactic headache medication after her initial visit which decreased the frequency of the headaches to about once a week.  Significant relief of the more severe pain within minutes to a few hours with abortive medication was noted.  The headaches were debilitating for a few hours at least four times per month despite adequate migraine therapy.  There was concern regarding the multiple brain abnormalities acquired during the pre-natal/neonatal period.  She was at high risk of developing more severe acute complications due to bleeding, even with minor traumatic events.  A diagnosis of mild post-concussive syndrome and multiple brain abnormalities existing prior to service (EPTS) were rendered.  Physical examination was unremarkable.  The CI failed to attend the scheduled VA Compensation and Pension examination.  

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the post-concussive syndrome 10%, coded 8045-9304 (residuals of traumatic brain injury – dementia due to head trauma), citing neuropsychological testing that revealed minimal whole brain impairment with no glaring areas of cognitive dysfunction and most likely due to multiple congenital/developmental neurologic abnormalities.  The VA denied service connection for the post-concussion syndrome with fluid on the brain and migraine headaches condition, citing the post-concussion syndrome neither occurred in nor was caused by service.    

VA code 8045, per the VA Schedule for Rating Disabilities (VASRD) in effect at the time, stipulates, “Purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, will be rated 10 percent and no more under diagnostic code 9304.” The Board considered the option of recommending a rating under 8100 but, there was insufficient evidence justifying a conclusion that there were “characteristic prostrating attacks” as would be required for a higher rating under 8100.  Members agreed, however, that a 10% rating is readily supported under the PEB code and, compliant with the rating language of the VASRD in effect for that code (see above).  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 syndrome condition.  

BOARD FINDINGS:  In the matter of the post-concussive syndrome condition and IAW VASRD §4.124a, the Board 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 20150603, w/atchs
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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170000786 (PD201500791)

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