RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03454
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080402

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Security Forces Craftsman, medically separated for “traumatic brain injury (TBI)” with a disability rating of 10%.  

CI CONTENTION:  Review of all conditions requested.  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 FPEB - 20080207	VARD – 20080818	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild TBI with Cognitive Dysfunction…	8045	10%	TBI Secondary To Subdural Hematoma Status Post Craniotomy	8045-9304	10%	20080603	
Obstructive Sleep Apnea	Cat II	Sleep Apnea	6847	50%	20080603	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70% 	

ANALYSIS SUMMARY:  

TBI.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s TBI began in January 2007 after suffering a blow to the eye while engaged in hand to hand combat training.  He immediately experienced headaches and blurry vision.  His symptoms worsened and a CT scan of the head showed a left side subdural hematoma which was confirmed by MRI.  Shortly afterwards, the CI developed aphasia and underwent emergency surgery (burr-hole evacuation).  Since the injury, he experienced bilateral tinnitus, memory deficits, difficulty concentrating, and fatigue.  The CI underwent multiple consults with neurology as well as neuropsychology and ENT evaluations.  All specialists agreed that his prognosis was good, but they did not recommend continued service in security forces.  

The neuropsychological evaluation (NP) 9 months prior to separation noted complaints of tinnitus and ringing in both ears, fatigue, decreased attention and focus, restless sleep and snoring, emotional sensitivity, right-sided headaches, and episodes of “zoning out.”  The examiner found the CI to have clear and coherent speech, he was able to comprehend and follow both oral and written instructions, and he was attentive to tasks at hand and able to sustain attention.  Intellectual testing revealed intellectual abilities in the superior range; however, the overall impression noted mild deficiencies in verbal retrieval and in some executive functions.  The examiner opined that the CI’s cognitive symptoms will continue to improve, but that “the focus on his physical symptoms and accompanying stress and frustration appears to be contributing to his subject cognitive complaints.”  The examiner also noted that the majority of the test results showed no impairments in cognitive function.  The 19 September 2007 MEB NARSUM examination, 7 months prior to separation, noted complaints of status post mild TBI with Left subdural hematoma.  The CI reported he had fears of the possibility of deployments.  Physical examination was unremarkable.

At the 3 June 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported TBI status post subdural hematoma.  Physical examination showed no evidence of any neurological deficits.  CI was alert and oriented.  His comprehension of command was normal and behavior was appropriate.  Short term memory was mildly impaired.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the TBI 10%, analogously coded 8045 (residuals of TBI).  The VA coded 8045 of traumatic brain injury), based on the C&P examination, citing occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress; or symptoms,  controlled by continuous· medication.  

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.  Panel members agreed, there was no evidence of any objective neurological deficit and no multi-infarct dementia.  Therefore, a higher rating is not possible under this code.  

The panel next considered if a rating under VASRD §4.130 would be of benefit to the CI. The panel noted that the clinical observation during the NP test was unremarkable.  There was no report of significant mood symptoms, panic attacks, or significant memory problems.  The examiner found the CI to have clear and coherent speech, he was able to comprehend and follow both oral and written instructions, and he was attentive to tasks and able to sustain his attention.  Intellectual testing revealed intellectual abilities in the superior range.  The examiner noted mild deficiencies in verbal retrieval and some executive functions.  However, it was stated that the CI’s frustration and stress related to his physical symptoms contributed to his subject cognitive complaints.  The examiner also noted that the majority of the test results showed no impairments in cognitive function.  Panel members concluded the evidence demonstrated the CI’s condition was best reflective of the 10% level of disability for “occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress.”  Therefore, panel members agreed, rating the condition under VASRD §4.130 was of no advantage to the CI.  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 condition.  

Contended PEB Condition:  Obstructive Sleep Apnea.  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 profiled or implicated in the commander’s statement, and did not 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 traumatic brain injury and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the contended obstructive sleep apnea condition, 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.  

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03454.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.