RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01494
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20061123

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Multichannel Transmissions Operator/Maintainer, medically separated for “vertigo,” 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 - 20061012	VARD – N/A	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vertigo	6299-6204	10%	No VA Claim	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Vertigo.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s vertigo (sensation of motion) condition began in February 2005.  Computerized tomography and magnetic resonance imaging were normal.  The MEB forwarded “vertigo” for PEB adjudication.  At the 28 July 2006 MEB examination (recorded on DD Forms 2807 and 2808), 4 months prior to separation, the CI reported almost daily episodes of dizziness and gait imbalance lasting minutes to hours.  He also reported more severe episodes occurring 1-2 times per week with unsteadiness and a spinning sensation.  Physical examination revealed normal neurological tests and normal hearing.  At a neurology evaluation dated 23 August 2006 the CI reported transient attacks of dizziness several times a week and lasting several minutes to over an hour.  The examiner noted that cardiac, ENT (ear-nose-and-throat), neurologic, and neuroimaging evaluations were negative.  The physical examination was normal including gait and coordination.  Formal evaluation for vertigo in July 2006 documented some abnormalities with his rotary chair testing and videonystagmography (VNG) that showed some abnormal eye movements that were suggestive of a central neurological cause.  However, upon review by a neurologist and in light of all other examinations and radiology tests being normal, he discounted the rotary chair and VNG findings as often unreliable without other evidence of neurologic dysfunction.  He further stated that in 10-20% of cases of unspecified dizziness a distinct cause cannot be determined.  At the MEB NARSUM examination on 13 September 2006, 3 months prior to separation, the CI reported feeling off balance a lot as if he were drunk. He reported acute episodes 1-2 times per week described as a sensation that the room was spinning to the point where he had to sit or hold onto something while standing.  The acute episodes lasted about 10-15 minutes.  His detailed physical examination was completely normal.  The NARSUM and STR documented a thorough work-up of the CI’s vertigo.  He had onset of vertigo with dizziness beginning in February 2005.  The dizziness initially occurred with bending over or turning his head.  He had no associated vomiting.  He had complete cardiology, neurological and audiological evaluations as well as a head evaluation.  A thorough review of the STR documented multiple examination entries regarding normal neurological examinations including normal tests of balance (Romberg).  Of note, hearing (audiometric testing) was normal ruling out a vestibular cause.  The CI did not file a VA Compensation and Pension claim.  The Board directed attention to its rating recommendation based on the above evidence.  

The PEB rated the vertigo condition 10%, analogously coded 6204 (peripheral vestibular disorder), citing undetermined etiology, occurring twice weekly.  The Board agreed that the evidence supported a 10% rating, coded 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 balance difficulties with the vertigo, but multiple neurological evaluations recorded normal gait and no abnormalities of balance or coordination were noted on examination.  Therefore, Board members agreed 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 the record for a higher rating coded as 6205 (Meniere’s syndrome).  The vertigo episodes were not associated with tinnitus.  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 and IAW VASRD §4.87, 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 20150610, 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

20 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002496  (PD201501494)

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