IN REPLY REFER TO

1850
CORB:003
12 Feb 20

From: To:

Director, Secretary of the Navy Council of Review Boards 
PD-2017-02203

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

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

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy of 15 October 2019 for appropriate action.

2.	On 31 January 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:  XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02203 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20070215

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Trainee, medically separated for “vertigo” with a disability rating of 10%.

CI CONTENTION:  Review all conditions.  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 - 20070105	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vertigo	6204	10%	
No VA Examination Proximate to Separation in Evidence	
Headaches	Cat III		
Low Back Pain	Cat III		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: NA	
	
ANALYSIS SUMMARY:

Vertigo. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s vertigo began in March 2005 following a mastoidectomy. The CI developed dizziness on rising from a sitting position and vertigo. He also had chronic daily headaches. MRI of the brain in August 2006 was normal.

During the 8 November 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 3 months prior to separation, the CI reported dizziness, numbness at the top of his ear, headaches

and hearing loss since surgery. The 12 December 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of chronic daily headaches and dizzy spells. The CI was unable to run and exercise due to lightheadedness and his ear felt muffled. He did not have vertigo at nighttime and it was not present when he rolled over during sleep. There were no auditory symptoms. Physical examination revealed normal tympanic membranes on the right and left ears without discharge or findings behind the tympanic membrane. Eye exam was negative for nystagmus.

An audiometry evaluation in January 2006 showed mild high frequency hearing loss in the left ear. However, a repeat audiogram in October 2006 showed “near normal hearing sensitivities bilaterally with mild asymmetry in the left ear.” There was 100% recognition scores bilaterally. The nystagmus test had findings of questionable pathologic significance. A specialty physician reportedly stated there was no identifiable explanation for the vertigo, but it was felt that the condition was not secondary to the surgery.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the vertigo 10%, coded 6204 (peripheral vestibular disorders). The higher rating of 30% under the 6204 code required evidence of dizziness and occasional staggering. Panel members agreed the evidence did not support the higher rating since staggering was not a reported symptom. Panel members were unable to find any applicable code that would support a rating higher than that adjudicated by the PEB. 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 vertigo.

Contended PEB Conditions: Headaches and Low Back Pain. The panel’s main charge is to assess the fairness of the PEB’s determination the contended conditions were not unfitting. The headache condition was listed as “post-lumbar puncture headaches” on limited duty forms, but low back pain was not mentioned on any limited duty forms. The back condition may have been implicated in the non-medical assessment when the commander noted the CI could not lift more than 15 pounds, but neither condition was judged to fail retention standards. There was no compelling performance-based evidence from the record that showed either 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 determinations for either of the contended conditions so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the vertigo and IAW VASRD §4.87, the panel recommends no change in the PEB adjudication. In the matter of the contended headaches and low back conditions, the panel recommends no change from the PEB determinations as not unfitting. 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 20170228, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record