RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-02349
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050511

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Cavalry Scout, medically separated for “chronic intermittent headaches” and “periodic minor seizures,” rated 10% each, with a combined disability rating of 20%.  

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 - 20050322	VARD - 20060403	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Intermittent Headaches	8045-9304	10%	Chronic Intermittent Headaches, Post Traumatic	8045-8100	10%	20060202	
Periodic Minor Seizures	8912	10%	Seizure Disorder, Post Traumatic	8045-8911	10%	20060202	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Intermittent Headaches.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s headache condition began in March 2004 after exposure to an IED blast while deployed in Iraq.  He lost consciousness.  A neurology consultation performed on 21 June 2004 diagnosed post-traumatic headaches.  

During the 22 February 2005 MEB NARSUM, 2 months prior to separation, the CI reported dull and throbbing headaches which could last 4 to 24 hours, approximately 3 to 4 times per week.  He took a barbiturate or Tylenol for headaches as needed.  The commander’s statement signed on 8 March 2005 implicated the CI’s chronic headaches which prevented the CI from performing his military duties; however, the commander did not document “prostrating attacks” which required the CI to stop what he was doing and seek medical attention.  

At the 2 February 2006 VA Compensation and Pension (C&P) general examination, 9 months after separation, the CI reported pain to the entire head, and sensitivity to light and noise.  He was able to go to work as a security guard but required medication.  There was no functional impairment or time lost from work.  He was able to perform activities of daily living (ADL).  Headache symptoms occurred up to 2 times per week; treated with Excedrin migraine.  Physical examination showed normal vital signs and no objective chronic headache factors.  

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-dementia due to trauma), citing post-concussive onset while deployed, and normal examination and imaging.  The VA also rated the headache condition 10%, coded 8045-8100 (residuals of traumatic brain injury-migraine), based on the C&P examination, citing characteristic prostrating attacks averaging one in two months over the last several months.  

In accordance with DoDI 6040.44, the panel is required to recommend a rating IAW the VASRD in effect at the time of separation, which was the 2005 VASRD, for codes 8045-9304, 8912 (epilepsy, Jacksonian and focal motor or sensory), and 8100 (migraine).  The panel first considered a rating under code 8100.  A 30% rating requires “characteristic prostrating attacks occurring on an average once a month over last several months.”  A 10% rating requires “characteristic prostrating attacks averaging one in 2 months over the last several months”.  The VASRD does not define “prostrating”; however, DoDI 1332.39 states “the CI must stop what he or she is doing and seek medical attention.”  Members noted there was no STR evidence of “prostrating” attacks; thus there was insufficient evidence to support a rating higher than the 10% rating adjudicated by the PEB.  

The panel next considered a rating recommendation utilizing codes 8045-9304.  VASRD 2005 code 8045 criteria states “Purely neurological disabilities, such as hemiplegia, epileptiform seizures, facial nerve paralysis, etc., following trauma to the brain, will be rated under the diagnostic codes specifically dealing with such disabilities, with citation of a hyphenated diagnostic code (e.g., 8045–8207).  Purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, will be rated 10 percent and no more under diagnostic code 9304.  This 10 percent rating will not be combined with any other rating for a disability due to brain trauma.  Ratings in excess of 10 percent for brain disease due to trauma under diagnostic code 9304 are not assignable in the absence of a diagnosis of multi-infarct dementia [multi-small localized dead tissue areas due to blood supply failure] associated with brain trauma.”  

The panel noted that a brain MRI on 17 June 2004 showed no significant white matter lesions or infarcts.  Consequently the maximum 8045-9304 rating is 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 headache condition.  

Periodic Minor Seizures.  According to the STR and MEB NARSUM, the CI’s seizure condition began after exposure to the aforementioned IED blast.  An electroencephalogram performed in June 2004 was normal.  A neurology consultation on 21 June 2004 documented one seizure episode, on or about 19 June 2004, where the CI reported kicking his arms and legs for about 5 to 10 minutes.  He was seen at the Mercy Medical Center emergency room.  

A neurology consultation on 25 October 2004, 6 months before separation, diagnosed partial complex seizure disorder with probable simple partial seizures.  The CI was treated with anti-convulsion medication.  A primary care visit on 19 November 2004 documented no further seizures.  During the MEB NARSUM the CI reported photophobia and drowsiness post tremor and post headache.  Daily activities were affected by the drowsiness and ability to be in bright lights and drive.  The examiner documented one seizure episode for which the CI was seen by a Mercy Medical Center medical provider after the CI had a heated discussion with his wife.  The MEB NARSUM also documented the CI had subsequent tremors without loss of consciousness that were not related to heated arguments and were of a recurring left arm and leg tremor nature.  No further specificity was offered.  The CI reported trying to wean his seizure medication but had a staring spell and left arm tremor witnessed by his wife.  Again no further specificity was offered.  The CI was diagnosed with post-traumatic seizure disorder.  

At the C&P evaluation the CI reported a typical attack can be described as a left arm and leg shake.  Seizures occurred due to stress and were alleviated on their own.  The CI reported that “over the last 2 years he had 2 attacks in total averaging 2 each year.”  He kept no seizure diary.  The CI reported the left arm tremor symptoms occurred intermittently as often as 2 times per year with each occurrence lasting for 5 to 10 minutes.  His ability to perform daily functions was not compromised, he was not receiving any seizure treatment, and there was no functional impairment.  The condition did not result in time lost from work as a security guard, and he could perform ADLs.  The neurological examination showed no abnormalities.  The examiner opined that there was no pathology to render a seizure disorder diagnosis.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the periodic minor seizures 10%, coded 8912 (epilepsy, Jacksonian and focal motor or sensory), citing a confirmed seizure disorder diagnosis.  The VA also rated the seizure disorder 10%, coded 8045-8911 (residuals of traumatic brain injury-petit mal seizure disorder, post traumatic), based on the STR and C&P examination, citing a confirmed diagnosis of a seizure disorder; no other evidence demonstrated a higher rating.  

The panel agreed that STR evidence showed the CI’s Jacksonian type tremors analogous to periodic minor seizures began after the IED exposure.  A brain MRI on 17 June 2004 showed no significant white matter lesions or infarcts.  Consequently the maximum 8045-9304 rating is 10%, per VASRD 2005, which cannot be combined with another rating due to the absence of a multi-infarct dementia diagnosis associated with brain trauma.  The panel therefore found no evidence to support a rating higher than the 10% adjudicated by the PEB.  

The panel also considered a rating under code 8912 citing the STR confirmed seizure disorder diagnosis.  Panel members agreed that the Jacksonian type seizure meets the VASRD criteria for a minor seizure.  Under the VASRD General Rating Formula for Major and Minor Epileptic Seizures, a 20% rating requires “at least 2 minor seizures in the last 6 months.”  The 25 October 2004 neurologist consultation and MEB NARSUM examinations documented one seizure episode and rendered seizure diagnoses.  The primary care visit on 19 November 2004 noted no further seizures.  The C&P general examination noted the CI had reported 2 attacks in total in the last 2 years, averaging 2 each year.  After considerable deliberation the panel agreed there was no corroborated STR or VA evidence of 2 minor seizures in the last 6 months prior to separation to support a 20% 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 seizure disorder.

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 seizure condition and IAW VASRD §4.124, 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 20170228, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180015111, 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