RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXX	CASE: PD-2017-01040
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060601

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Seaman Apprentice, medically separated for “cognitive disorder” with a disability rating of 10%.

CI CONTENTION:  No specific contention was made.  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 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 - 20060303	VARD - 20061013	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cognitive Disorder, NOS, S/P Left Anterior Thalamic Stroke	8099-
9399-
9304	
10%	Lacunar Infarct of the Left Thalamus	8007	10%	20060807	
			Cognitive Disorder	8007	NSC	20060807	
			Stroke	8007	NSC	20060807	
Adjustment Disorder	Cat II	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Cognitive Disorder. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI began having problems in October 2004 after he woke up with a headache accompanied by right sided weakness and paresthesias. His symptoms lasted for a few hours and resolved. He went to the emergency room (ER), and was released with a normal head CT scan, but continued to have weekly headaches. He then presented again to the ER due to speech deficits and crying spells, and was found to have had a left anterior thalamic stroke.

During the 30 December 2004 neuropsychological (NP) examination, 17 months prior to separation, the CI noted complaints of memory problems, which he described as worsening over time rather than improving. He also reported intermittent depressed mood since the stroke accompanied by irritability, loss of interest in activities, decreased appetite, and problems falling asleep. Test results showed average intelligence and overall cognitive performance on several measures  was  in  the  borderline  to  mildly  impaired  range.    A  brain  MRI  revealed  findings

consistent with an old infarct within the left thalamus. The examiner opined that the results of the evaluation were consistent with the presence of a very mild, organically based, cognitive impairment resulting from the stroke. The examiner also opined that the findings of mild mood problems reflected a mild adjustment problem related to the stroke. The 10 January 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of “inability to remember.” The examiner noted the headaches had resolved. Two separate NP evaluations diagnosed mild cognitive disorder, NOS, and adjustment disorder. Memory problems were noted, but overall it was felt that the CI could return to active duty. However, when he returned to active duty he felt he was not able to do the job, was anxious and complained of problems with memory. The physical and neurological examinations were unremarkable. The examiner opined that due to the location of the stroke, the CI’s memory complaints and mood symptoms were directly linked to a lesion in the thalamus.

At the 7 August 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported memory and headache improvement (no longer migrainous). The CI reported that his memory problems were resolving and had not caused any problems with his work as an insurance agent. The neurological examination was normal including normal memory.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the cognitive disorder 10%, analogously coded 9304 (dementia due to head trauma). The PEB also listed adjustment disorder with mixed anxiety and depressed mood as a related Category II condition (a condition that contributed to the primary unfitting condition but was not separately ratable). The impairment from the adjustment disorder was properly subsumed under the overall rating for the cognitive disorder IAW §4.14 (pyramiding). The VA did not rate the cognitive disorder or stroke, but rather found them to be not service-connected. However, the VA did rate lacunar infarct of the left thalamus 10%, coded 8007 (brain, vessels, embolism of) based on the C&P examination, citing “a minimum evaluation of 10 percent is assigned for ascertainable residuals.”

The panel first agreed that a higher rating was not achievable under the 8007 code because there was no evidence of active bleeding. A higher rating under the 8045 code requires a diagnosis of multi-infarct dementia associated with brain trauma. Therefore, the panel considered a rating under the General Rating Formula for Mental Disorders (VASRD §4.130) for the cognitive disorder; however, the STR only supported a 10% rating for mild cognitive impairment but this provided no rating benefit to the CI. At the time of the C&P examination, the CI’s memory problems were resolving. Panel members agreed, there was no applicable codes that would result in a rating higher than 10%. After due deliberation, considering all 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 cognitive disorder.

BOARD FINDINGS: In the matter of the cognitive disorder and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication. 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.

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY   REFER  TO,
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 19 Nov 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.