RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01671
BRANCH OF SERVICE:  MARINE CORPS	SEPARATION DATE:  20081129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Marine, medically separated for “Bell’s palsy” with a disability rating of 10%.

CI CONTENTION:  Additional unfitting conditions were not considered.  The 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 - 20070226	VARD - 20140320	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bell’s Palsy	8207	10%	Residuals of Traumatic Brian Injury	8045	10%	20131009	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Bell’s Palsy.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s Bell’s palsy (paralysis of the facial nerve) condition began in June 2008.  On 14 June 2008, he experienced a syncopal episode during basic training which resulted in a laceration to the back of the head.  He was then seen in the emergency room on 20 June 2008 for recurrent headaches with pain behind the eyes and right eyelid droop with some blurring of vision on the right.  A head computed tomography (CT) showed acute sinusitis and magnetic resonance imaging (MRI) of the brain was normal except for noted bilateral maxillary sinusitis.  The CT and MRI studies were repeated with contrast with the same findings, and the CI had multiple courses of antibiotics for sinusitis.  He was also diagnosed by a neurologist with Bell’s palsy and treated with antiviral medication and a course of steroids without significant benefit.  Ophthalmology and neuro-ophthalmology evaluations confirmed the Bell’s palsy diagnosis, as well as eye muscle weakness, which was thought to be a pre-existing condition.  An otolaryngology specialist noted the CI’s history of previous care for recurrent parotiditis (inflammation/infection of the parotid gland) as an adolescent.  At primary care visits between July and September 2008, the CI’s symptoms showed gradual improvement with resolution of facial and eye movement pain as well as right eyelid weakness.  

The 25 August 2008 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of right-sided facial and eye muscle weakness and recurrent headaches.  Physical examination showed weakness of right eye lateral and inferior gaze, gross sensory deficits to all three branches of the facial nerve, and motor weakness of the right side of the face, corner of              the mouth and forehead creases.  There was no mention of difficulty closing the right eyelid.  The MEB examiner indicated the potential for eventual resolution of the Bell’s palsy but noted that the symptoms of 3 months duration might be chronic.  The 2 October 2008 Joint Disability Evaluation Track System form noted a diagnosis of Bell’s palsy that might improve over time.  Objective findings noted right-sided facial weakness with some function and not total paralysis.  There was no VA examination proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the Bell’s palsy condition 10%, coded 8207 (seventh [facial] cranial nerve).  The CI filed an original disability claim over 4 years after separation for traumatic brain injury (TBI) symptoms. The VA rated the Bell’s palsy condition 10%, coded 8045 (residuals of TBI), based on the VA Compensation and Pension (C&P) evaluation approximately 5 years after separation, noting the CI was diagnosed in the service with new onset Bell’s palsy following a head injury and eye muscle weakness judged to be pre-existing.  At the C&P evaluation, the CI reported recurrent headaches and difficulty focusing while driving.  The examiner noted subjective symptoms with pertinent findings of peripheral right visual field loss and right-sided Bell’s palsy with residual deficit.  Based on the evidence, the panel agreed it would be highly speculative to consider a diagnosis of TBI resulting from the CI’s syncopal episode as he underwent comprehensive follow-up evaluations by multiple specialists who all agreed with the diagnosis of Bell’s palsy.  Additionally, the neuro-ophthalmologist opined that the eye muscle weakness was pre-existing.  Therefore, the panel deliberated a rating recommendation for the PEB diagnosis of Bell’s palsy.

Rating criteria for code 8207 are subjective for facial nerve paralysis with a 10% rating for “incomplete, moderate,” 20% rating for “incomplete, severe” and 30% for “complete.”  There was no evidence of complete paralysis at the time of separation to support a 30% rating.  The serial STR examinations indicated the CI had persistent residuals of right-sided weakness, but the associated pain had resolved (either due improvement in the Bell’s palsy or to treatment of infections), and right eyelid weakness seemed to have improved.  Therefore, the panel concluded a paralysis characterization of “moderate” and not “severe” was appropriate in this case.  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 Bell’s palsy condition.  

BOARD FINDINGS:  In the matter of the Bell’s palsy condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication. There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends no modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, undated, 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

      In accordance with reference (a), I have reviewed the cases listed below 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:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

		
							XXXXXXXXXXXXXXXXXXX
	     				Principal Deputy, Assistant 
						Secretary of the Navy
						(Manpower and Reserve Affairs)
						Performing the Duties of the 
						Assistant Secretary of the Navy
						              (Manpower and Reserve Affairs)