RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03213 BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20050331

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve O3, Pharmacist, medically separated for “status post [S/P] traumatic brain injury” with a disability rating of 10%.

CI CONTENTION: In addition to his left upper extremity (LUE) numbness, the CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). 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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20050118	VARD - 20060817	
Condition	Code	Rating	Condition	Code	Rating	Exam	
S/P Traumatic Brain Injury	8045-9304	10%	Organic Brain Syndrome	8045-9304	10%	20041207	
Cognitive Disorder	Cat II					
LUE Numbness	Cat III	Loss of Sensation to Left Arm	8515	10%	20041207	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Traumatic Brain Injury (TBI). According to the service treatment record and MEB narrative summary (NARSUM), the CI suffered a TBI in January 2004 after a bicycle accident where he hit his head against a pole. A head CT showed a skull fracture of the right temporo-parietal head region and the CI underwent emergent craniotomy and hematoma evacuation. After surgery he had a generalized seizure. The CI was comatose for about 10 days and was noted to have significant cognitive deficits and expressive aphasia.

The 8 September 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of short-term memory problems, easy irritability and occasional word-finding difficulty. The CI denied episodes of seizures, dizziness, weakness or headaches, but complained of persistent numbness of his LUE that had not improved since the injury. Physical examination showed normal gait and muscle tone with intact cranial nerves, sensation and cerebellar function.

During the 22 October 2004 neuropsychological evaluation, 5 months prior to separation, the CI reported increased emotionality, noting he was more irritable since the injury. He reported that the pharmacy department continued to value his expertise and wished him to continue. It was noted that the CI’s cognitive function had improved, but he continued to have mild to moderate impairments in word finding and in some aspects of verbal memory and verbal working memory. The psychologist opined that based on the CI’s overall functioning and mild language impairments, he was “deemed fit for duty with limitation.”

At the 7 December 2004 VA Compensation and Pension (C&P) examination, 4 months before separation, the CI reported continued problems with short-term memory, concentration and attention. The examiner noted that despite the CI’s cognitive deficits, he was working as a pharmacist. Physical examination was unremarkable with the exception of decreased sensation over the right parietal area, right low back and LUE.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the TBI 10%, dual coded 8045-9304 (residuals of traumatic brain injury and dementia due to head trauma). Panel members agreed that the Category II cognitive disorder, which contributed to the primary unfitting condition (TBI) but was not separately ratable, was an intertwined diagnosis, and the overall cognitive impairment from this condition was properly subsumed under the rating for the TBI to avoid pyramiding (§4.14). The VA also rated the TBI 10%, analogously coded 8045-9304, based on the C&P examination, citing “purely subjective complaints such as headache, dizziness, and insomnia, recognized as symptomatic of brain trauma.” The VARSD in effect at the time of separation captured brain injuries under the generic category of brain disease due to trauma (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. Therefore, a higher rating is not possible under this code. The panel also considered a rating under the 9304 code, but there was minimal evidence of occupational or social impairment since the CI continued to work as a pharmacist without clinically significant problems, and there was no report of mood symptoms interfering with performance. 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 TBI.

Contended PEB Condition: LUE Numbness. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was not noted on limited duty forms, implicated in 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 the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the TBI and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication. In the matter of the contended LUE numbness, the panel recommends no change from the PEB determination 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:

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

IN REPLY REFER TO,
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:	

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno 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.