RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01623
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20050913

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

CI CONTENTION:  The VA gave him a higher rating.  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 - 20050830	VARD - 20051013	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Concussive Syndrome	8045-9304	10%	Post Concussive Syndrome	8045-9304	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Post Concussive Syndrome.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s post concussive syndrome began after he was struck in the head with a pugil-stick during hand-to-hand combat training in March 2005.  He was taken to the emergency room, confused and somewhat disoriented.  Brain CT scan was read as normal.  On 9 March 2005, neurology diagnosed him with post-concussive syndrome

The 31 March 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of ongoing throbbing headaches, blurred vision, photophobia, lightheadedness, mild nausea and cognitive slowing.  He also noted he had difficulty following directions and had some confusion.

Physical examination showed that he was fully oriented and attentive, and had no apparent language or cognitive deficit.  Neurological exam was unremarkable.  The examiner referenced neuropsychological testing dated June 2005, which indicated the CI had problems with sustained attention, but improvement was anticipated.

At the 28 November 2006 VA Compensation and Pension (C&P) evaluation, 13 months after separation, the CI reported headaches about 2-3 times a week.  The headaches lasted from 45 minutes to 2 hours with no associated nausea or vomiting.  He denied dizziness, and had no other neurologic symptoms.  Physical examination was unremarkable.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the post concussive syndrome 10%, coded 8045-9304 (residuals of traumatic brain injury - dementia due to head trauma), citing complaints of headaches, dizziness and nausea with minimal if any degradation from baseline cognitive abilities.  The VA also rated the post concussive syndrome 10%, coded 8045-9304, based on the STR, citing subjective complaints of headaches, dizziness, nausea and minimal cognitive slowing.

The VARSD in effect at the time of separation captured brain injuries under the generic category of brain disease due to trauma coded 8045.  There are two different scenarios for rating under this code:  analogously with purely neurological deficits or based on purely subjective symptoms.  In the absence of associated neurological disabilities (seizures, nerve paralysis, etc.), rating of this condition under 8045-9304 is limited to 10%, and cannot be combined with any other rating for a disability due to brain trauma.  The panel found an absence of evidence that would support any neurological deficit.  The record in evidence demonstrated mild cognitive findings, complaints of headaches and mild nausea.  The CT scan was normal.  The panel noted there were no additional codes to consider which would result in a higher rating.  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 post concussive syndrome.  

BOARD FINDINGS:   In the matter of the post concussive syndrome 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. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170226, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180007966, 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.

Sincerely,					      
Enclosure