RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01827
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030325

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantry, medically separated for “post-concussion syndrome,” with a disability rating of 10%.

CI CONTENTION:  The CI’s condition continues to worsen and negatively impacts daily activities.  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 - 20030102	VARD - 20030812	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Concussion Syndrome	8045-9304	10%	Post-Concussion Syndrome	8045-9304	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Post-Concussion Syndrome Diagnosis.  The panel noted that its recommendations must be premised on the VASRD in effect at the time of separation, which preceded the current rating guidelines.  The available codes for rating traumatic brain injury in 2003 were 8045 (brain disease due to trauma) and 9304 (dementia due to head trauma).  

According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s post-concussion condition began after he sustained two separate head injuries on active duty.  The record shows that the CI participated in football, wrestling, and boxing prior to service.  The first recorded injury occurred on 8 November 1999.  The CI reported that he hit his head on an airplane and was stunned, but did not have a loss of consciousness (LOC).  He was given instructions for a closed head injury and released from the emergency room (ER).  The CI was next evaluated for a closed head injury on 3 December 2000.  He was seen in the ER had reported that he had a bad landing (parachute jump) the day prior and hit his head.  He denied a LOC, but reported a headache.  His examination was unremarkable and he was released again with instructions to return for an increase in symptoms.  A CT of the head was accomplished the next morning; it was normal other than a soft tissue nodule in a sinus.  This had been present on a prior CT 1 year before.  The next day the CI was seen in primary care for persistent nausea and vomiting as well as confusion.  He reported he had been struck by another parachutist and, on landing, hit his head with LOC as his legs had been kicked out (from under him).  The panel observed the CI denied LOC 2 days previously.  He was thought to have a concussion and placed on restricted duty for 2 weeks.  A subsequent line of duty report dated 8 November 2001 recorded that the CI reported that he fell from 100 feet.  The CI was evaluated in the ER for a headache on 7 March 2001.  He reported 2 prior concussions, in September 2000 and December 2000.  Neuropsychological testing on 2 May 2001 showed information retrieval problems and eye/hand coordination below normal limits.  Overall intellectual functioning and attention/concentration were normal though.  A brain MRI on 18 July 2001 was normal.  The head CT was repeated on 18 October 2001 and was normal.  The mass previously seen in a sinus was no longer apparent.  Over the next year, the CI continued to report ongoing symptoms.  He was then entered into the MEB process.

The initial 26 November 2001 MEB NARSUM was based on an examination dated 25 October 2001.  It noted that the CI sustained 2 Grade III concussions (one with LOC) in October and December 2000.  The panel observed that the records most proximate to the CHIs actually recorded that there was no LOC.  The CI reported ongoing headaches and a decreased ability to concentrate and to learn.  On examination, the mini-mental status examination was normal with 29/30 items correct.  The neurological examination was normal.  A PEB was recommended.  The PEB process was then discontinued on 10 December 2001 to obtain a mental health addendum.  The 7 May 2002 mental health addendum noted the CI initially had a head injury in late June 2000 when he hit his head and was dazed.  He then had a second injury in December 2000 in which he struck his head on landing and was unconscious for 20 minutes.  Again, the panel noted the history did not match the records proximate to the injuries.  The CI also endorsed ongoing headaches and cognitive difficulties.  The mental status examination was normal.  

Neuro-psychological testing was repeated on 13 and 21 August 2002.  It was thought to show a decline in the areas of visual-motor, visual-spatial, and short term memory.  Executive function was also impaired.  He was diagnosed with a cognitive disorder, NOS (not otherwise specified).  

An addendum to the mental health evaluation was dated 8 October 2002.  It noted that the CI had a closed head injury on two occasions, October and December 2000, the first associated with LOC and no comment on the second.  The CI reported ongoing headaches and problems with memory and concentration.  A review of the records shows that during the last 12 months of service, the CI was placed on quarters for his headaches a total of 4 days.  

There was no VSA compensation and Pension examination in evidence proximate to separation.  The MEB was dated 15 November 2002 and referred the CI to a PEB for post-concussive syndrome.  

The panel directed attention to its rating recommendation based on the above evidence.  The initial PEB, dated 10 December 2002, recommended that the CI be placed on TDRL at 30% for post-concussive syndrome, coded 8045 (brain disease due to trauma) and 9304 (dementia due to head trauma).  The PEB was informally reconsidered on 2 January 2003 after an additional review of the medical evidence.  This PEB retained the 8045-9304 codes, but recommended permanent separation at 10%.  The VA also rated the CI at 10% and used the 8045-9304 codes.  It relied on the STR.  
The panel observed that the CI had subjective complaints, but typically had a normal neurological examination.  Neurological abnormalities such as hemiplegia, seizures, nerve palsies were not present.  The cognitive dysfunction was subjective albeit supported by formal testing.  These and the headaches are limited to a maximum rating of 10%.  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 post-concussion syndrome condition.  

BOARD FINDINGS:  In the matter of the post-concussion syndrome condition and IAW VASRD §4.124a and 4.130, 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 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 20150703, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009266, XXXXXXXXXXXXXXXXXX 

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure