RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00813
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20040724

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Crane Operator, medically separated for “persistent headache, diagnosed as migraine” and “moderate cognitive disorder,” rated 10% each, with a combined disability rating of 20%.  

CI CONTENTION:  VA mental health rating was higher and included major depressive disorder.  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040511	VARD - 20040922	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Persistent Headache, Diagnosed as Migraine	8045-9304	10%	Residuals of Head Injury with Headaches and Vertigo	8045	10%	20040823	
Moderate Cognitive Disorder	8045-9304	10%	Posttraumatic Stress Disorder with Major Depression and Cognitive Disorder	9304-9411	70%	20040821	
Major Depression Disorder	Not Unfitting					
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

Persistent Headache, Diagnosed as Migraine.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s headache condition began in June 2003 when a tire he was changing in Iraq exploded causing facial injuries.  The CI was medevac’d and underwent facial reconstructive surgery.  The 24 November 2003 MEB NARSUM examination, 9 months prior to separation, noted complaints of daily headaches that required the CI to leave work and enter a darkened room.  His headaches persisted until he slept.  The CI was being treated by both preventive and abortive therapy with apparently little success.  A general physical examination showed no specific abnormalities other than well healed cranial scars.  At the 23 August 2004 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported headaches three times per week and dizziness.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 10%, coded 8045-9304 (residuals of traumatic brain injury (TBI) - dementia due to head trauma), citing weekly headaches.  The VA also rated the headache condition 10%, coded 8045, (residuals of TBI) based on the C&P examination, citing purely subjective complaints.  The panel noted that at the time of the CI’s PEB, per VASRD §4.124a, brain disease due to trauma with purely subjective complaints such as headache, dizziness, insomnia, etc., was rated at 10% and no more.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the headache condition.  

Moderate Cognitive Disorder.  (History of injury above.)  The 24 November 2003 MEB NARSUM examination, 9 months prior to separation, noted complaints of a bad memory, being easily distracted, and inability to stay on task.  A general physical examination showed no specific abnormalities other than well healed cranial scars.  On 5 December 2003, neuropsychology testing was generally within normal limits with the exception of mild difficulty with some executive functions including distractibility, poor multitasking, difficulty with organization, and retrieval from recent memory.  The 21 August 2004 VA C&P special evaluation for psychiatry, 1 month after separation, concluded that there was evidence of cognitive dysfunction.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the moderate cognitive disorder condition 10%, coded 8045-9304, citing losses in multi-tasking, organization, executive function, and retrieval of recent memory.  The VA rated the cognitive condition in conjunction with posttraumatic stress disorder (PTSD) 70%, coded 9304-9411, (dementia due to head trauma - PTSD), based on the C&P examination, citing significant psychiatric impairment.  The panel notes that at the time of the CI’s PEB, per VASRD §4.124a, brain disease due to trauma with purely subjective complains such as headache, dizziness, insomnia, etc., was rated at 10% and no more.  This rating is fully justified based on the findings of neuropsychological testing indicating only mild cognitive symptoms.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the moderate cognitive disorder condition.  

Contended PEB Condition:  Major Depression Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  The CI demonstrated no psychiatric impairment on neuropsychological testing 8 months prior to separation.  The panel does note that within three weeks of discharge, the CI was admitted to a VA facility for a period of 7 days and diagnosed with significant PTSD relating to his facial trauma. There is no evidence of this condition in the STR besides the 7 January 2004 evaluation that diagnosed major depressive disorder and was included in the MEB.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the headache condition and IAW VASRD §4.124, the panel recommends no change in the PEB adjudication.  In the matter of the cognitive disorder health condition and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  In the matter of the contended mental health condition, the panel agrees that it cannot recommend it for additional disability rating.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel 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, dated 20170215, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004912, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

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.

A copy of this decision has been provided to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX

Sincerely,					      
Enclosure