RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01000
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20080103

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Apprentice Level Maintenance, medically separated for “right brainstem cavernous malformation,” with a disability rating of 10%.

CI CONTENTION:  “Review 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 based on 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 - 20070904	VARD - 20090314	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Brainstem Cavernous Malformation	8003-6092	10%	Cerebral Hemangioma with Right 3rd Cranial Nerve Palsy…	8307	0%	20081113	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:

Right Brain Stem.  According to service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right brain stem cavernous malformation condition began showing symptoms in February 2006 without specific injury or trauma.  There was no surgical indication and the MEB forwarded “right brainstem cavernous formation” for PEB adjudication.

The MEB NARSUM examination on 14 June 2007, 7 months prior to separation, noted complaints of double vision that had improved greatly over the preceding months and was now only present with extreme right gaze.  The CI also experienced intermittent numbness of the right side of his face and intermittent headaches.  There was no discussion of debilitating headaches.  Physical examination showed a normal evaluation including cranial nerves.

At the 13 November 2008 VA C&P Ophthalmology evaluation, 2 months after separation, the CI complained of double vision with extreme right gaze.  Physical examination showed a mild right 6th cranial nerve paresis (lateral gaze) and otherwise normal cranial nerve examination.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the brainstem condition 10%, analogously coded 8003-6092 (benign new brain growth - diplopia, due to limited muscle function).  The VA rated brainstem condition 0%, coded 6092 based on the VA C&P examination 10 months after separation, citing the examiner did not provide adequate criteria to properly evaluate the diplopia.  The Board agreed the CI’s double vision was occasional, only with extreme right gaze and as such does not support a higher rating.  Malformations of blood vessels of the brain analogizes to code 8009 (brain, vessels, hemorrhage from) VASRD §4.124a; however rating under 8009 provides no rating benefit to the CI.  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 right brainstem cavernous malformation condition.

BOARD FINDINGS:  In the matter of the right brainstem cavernous malformation 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 20150605, 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 14 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:

		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXXXX, former USN

						  XXXXXXXXXXXXXXXXXXXXX
	     				               Assistant General Counsel
						  (Manpower & Reserve Affairs)