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

From: To:

Subj: Ref:

IN   REPLY  REFER  TO:

1850
CORB:003
20 Feb 20

Director, Secretary of the Navy Council of Review Boards 
PD-2017-01225

PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

(a) DoDI 6040.44
(b)	PDBR ltr dtd 27 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy.

2.	On 12 February 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.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-01225
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20061115

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

CI CONTENTION: The condition continues to worsen. 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 - 20060808	VARD - 20070717	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Closed Head Injury	9304	10%	

Post-Concussion Syndrome Status Post Cerebral Concussion	

9304-9327	

10%	

20060725	
Chronic Daily Headaches	
Cat II					
Cognitive Impairment						
Depressive Disorder						
Persistent Post- Concussive Symptoms						
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	
	
ANALYSIS SUMMARY:

Closed Head Injury. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s head injury began in August 2005 after falling head-first down a ladder well. His head struck the ladder and ground. He experienced a prolonged state of unconsciousness for one day. A head CT scan was normal. A follow-on head MRI revealed no evidence of post- traumatic abnormality.

During the 18 March 2006 MEB NARSUM examination, 6 months prior to separation, the CI reported post-concussive symptoms. He had headaches that occurred every other day, or while concentrating or during stress. He had cognitive symptoms to include frustration, uninhibited behavior, and dizziness. The mental status examination (MSE) was unremarkable except for two cognitive delays. A closed head injury with associated grade III concussion with prolonged unconsciousness was diagnosed.  Cognitive impairment was considered indefinite.

Cognitive testing performed in January 2006 showed a mild-to-moderate memory impairment and severe attention impairment. In August 2006, the examiner opined that the symptoms had plateaued with no headache or cognitive symptom improvement. He was able to perform activities of daily living.

At the 25 July 2006 VA Compensation and Pension (C&P) neurological examination, 4 months before separation, the CI reported a bad memory which required him to write things down. He had occasional dizziness and fatigue but headaches were almost constant. He had no nausea, vomiting, light or sound sensitivity. Physical examination was unremarkable. The MSE showed he answered questions very slowly due to cognitive impairments. A cerebral concussion with post-concussion syndrome producing headaches, memory loss, and dizziness was diagnosed. The examiner opined that the majority of the CI’s memory loss was due to depression.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the head injury condition 10%, coded 9304 (dementia due to head trauma). The Navy PEB also listed “chronic daily headaches, cognitive impairment, depressive disorder and persistent post-concussive symptoms” as related Category II conditions that contributed to the primary unfitting condition but were not separately ratable. The VA rated the head injury condition 10%, dual coded 9304-9327 (dementia due to head trauma-organic mental disorder, other), based on the C&P examination, citing minimal functional limitations secondary to depression.

The panel first considered the Category II headaches (not prostrating) and persistent concussive symptoms. Based on the CI's 15 Nov 2006 date of separation, the panel adjudicated the case IAW VASRD 2006 and determined they were purely subjective head injuries and are subsumed under the 9304 code. In accordance with VASRD 2006 (criteria for brain disease due to trauma), the CI was not diagnosed with multi-infarct dementia [dead brain tissue due to blood supply failure] associated with his brain trauma.

The panel then considered the Category II cognitive impairment and agreed that it was a purely neurological disability following brain trauma. This impairment is also subsumed under code 9304 also IAW VASRD 2006 because the preponderance of STR clinical evidence revealed that the impairment was the result of dementia due to head trauma.

Panel members also considered the Category II depressive disorder for a separate rating. During the 18 March 2006 MEB NARSUM examination, 6 months prior to separation, the CI reported having a depressed mood, anxiety, crying spells and suicidal ideation. His symptoms were responding well to treatment and he was not drinking. The MSE showed slightly decreased memory recall; otherwise, the examination was essentially normal. The examiner opined that the CI would continue to have static cognitive impairment indefinitely. A mental health diagnosis was not rendered. The depressive disorder was not implicated by the non-medical assessment or 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. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the Category II conditions, so no additional disability ratings are recommended.

The panel then considered a rating recommendation for the unfit head injury. Panel members agreed that the CI’s traumatic brain injury symptoms were most appropriately rated under code 9304; and therefore, the maximum rating was 10% IAW VASRD 2006 criteria. There is no other rating option to support a higher rating. 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 closed head injury condition.

BOARD FINDINGS: In the matter of the closed head injury condition and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication. In the matter of the Category II chronic daily headaches, cognitive impairment, persistent post-concussive symptoms, and depressive disorder conditions, the panel recommends no change from the PEB determinations. 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.