RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01361
BRANCH OF SERVICE:  Navy 	SEPARATION DATE: 20060314 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Corpsman, medically separated for “third ventricular colloid cyst, causing obstructive hydrocephalus” rated 10%.

CI CONTENTION:  The CI contends she has had an increase in migraine headaches and a regrowth of the colloid cyst.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20051128	VARD - 20060927	
Condition	Code	Rating	Condition	Code	Rating	Exam	
…Colloid Cyst…	8003	10%	Colloid Cyst Removal 	7819	0%	20060621	
S/P Resection…Cyst	Cat II					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Colloid Cyst.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent surgery for removal of a ventricular colloid cyst that was causing hydrocephalus (cyst blocking flow of cerebrospinal fluid in the brain ventricles) with symptoms of headaches (HAs) and visual disturbances in June 2005.  Following the initial surgery, the ventricular fluid was re-accumulating and the CI underwent a second procedure for placement of a ventriculoperitoneal (VP) shunt (to drain cerebrospinal fluid).  At post-operative follow up visits the VP shunt was functioning well with resolution of all fluid collections and the CI reported no HAs or other neurological symptoms.  

The MEB NARSUM examination on 17 August 2005, 7 months prior to separation, noted the CI was without HAs or neurological symptoms and the shunt was functioning well.  A full physical examination including neurological examination was normal.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 26 September 2005, 6 months prior to separation, the CI reported that HAs had resolved since surgery.  

A JDETS note dated 24 October 2005 indicated that since the surgeries the CI was doing well, without HAs, neurological problems, or any residuals and indicated that the CI was able to work, but was not deployable due to the VP shunt.

In November 2005, the CI went to the emergency room for evaluation of a headache.  At the ER the CI reported she had had rare HAs since her surgery but she had a headache that was present for days and had worsened that day.  She denied any associated systemic symptoms, neck pain, or neurological symptoms.  A complete evaluation including a CT scan of the head showed no evidence of hydrocephalus or acute intracranial process.  The headache was treated symptomatically and the CI was referred to neurosurgery for her scheduled follow-up.  

At the 27 September 2006 VA Compensation and Pension (C&P) Neurology evaluation, performed 6 months after separation, the CI reported that since the ventricular cyst surgery she had “had a headache about once a month,” graded 5/10 in intensity and lasting about 12 hours.  The HAs were helped by over the counter medication (Excedrin) and during the HAs she tried “to somewhat limit her activities.”  A complete neurological examination was normal.  The VA neurologist’s impression was that the CI had migraine HAs but that “symptoms specifically related to the resection of the colloid cyst” were relieved by the surgery and that the CI had “no impairment in her ability to function related to the colloid cyst removal or the VP shunt.” 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Category I, unfitting “third ventricular colloid cyst, causing obstructive hydrocephalus” condition 10%, coded 8003 (Brain, new growth of, benign).  The PEB also adjudicated “status post resection of the third ventricular colloid cyst, placement of right parietooccipital ventricloperitoneal shunt” condition as a related Category II condition.  In this case the Category II condition refers to the same disability as the unfitting Category I condition and cannot be separately rated IAW VASRD §4.14 (Avoidance of pyramiding).”  The VA rated the “colloid cyst removal with shunt placement” condition 0% coded 7819 (benign skin neoplasms), based on the C&P examination 6 months after separation, citing no impairment due to the cyst or VP shunt and no compensable characteristics of the surgical scars.  

The was no evidence to support higher than the 10% minimum for residuals of a benign growth of the brain coded under 8003 as adjudicated by the PEB.  Following the cyst removal and placement of the VP shunt, records indicated the CI was doing well without neurological problems or other residuals.  The CI was seen in the emergency room for a headache in November 2005 that was fully evaluated and not thought to be related to her previous surgeries or recurrent hydrocephalus.  At the VA examination, 6 months after separation, the examiner indicated the CI had migraine HAs, but also noted there was no residual impairment related to the cyst removal or the VP shunt.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the ventricular cyst condition.  

BOARD FINDINGS:  In the matter of the “third ventricular colloid cyst, causing obstructive hydrocephalus” condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150618, 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 10 May 17

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and 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:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN

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