RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03865 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20061130

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Rifleman, medically separated for “post-concussive syndrome” with a disability rating of 10%.

CI CONTENTION: He originally did not want to reveal his symptoms as he desired to stay in the Marine Corps but later realized this was a mistake as his condition worsened and now affects his life negatively in many ways.  The complete submission is at Exhibit A.

SCOPE OF REVIEW: The panel’s scope of review is defined in Do DI 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 - 20060726	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Concussive Syndrome	8045-6620	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Post-Concussive Syndrome. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s post-concussive syndrome condition began in December 2004 after being knocked unconscious and kicked in the head trying to defend a friend in a fight while on leave. He was reportedly kicked in the head after he fell. The CI had no recall after walking out of the bar.  Since the injury he experienced dizziness and imbalance with occasional headaches.

The CI was seen in a neurology clinic in January 2005 and a diagnosis of moderate traumatic brain injury (TBI) and post-concussive symptoms was rendered. Symptoms persisted and he was treated with an anti-depression medication. In August 2005, he reported an increase of symptoms. Whenever he turned his head quickly or looked upwards, he became dizzy and had significant nausea with gagging but no vomiting. His headaches also worsened, becoming more frequent and severe. This worsening correlated to increased levels of responsibility and activity at work. Neuroimaging was normal. The only physical examination finding was nausea with gaze upward and he was referred for video nystagmography, which shoed central nervous system dysfunction. The 13 February non-medical assessment noted the CI was not fulfilling his contract as a security force guard Marine. He had been in either light duty or limited duty {LIMDU) since his head injury.

The 2 March 2006 MEB NARSUM (neurology) examination, 9 months prior to separation, noted complaints of symptoms of nausea and dizziness if someone or something crossed his vision quickly. He also had symptoms when he looked up all the way. He had returned to his duties as a Marine and felt there was some improvement of symptoms which reflected central and peripheral nervous system dysfunction, both the result of trauma. Dizziness returned while running and he could not track more than one target. The CI was not able to perform his expected duties, even after 12 months of LIMDU. He was to remain in treatment and avoid the factors (exertion and head/eye movements) that elicited his symptoms. Physical examination showed nausea and gagging with gazing upward and nausea and dizziness with people or objects crossing his vision quickly. There was no VA Compensation and Pension examination proximate to the CI’s date of separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the post-concussive syndrome 10%, dual coded 8045-6620 (residuals of TBI). Since the 6620 code was not found among current or past VASRD codes, the panel was unclear regarding the condition referenced or whether 6620 was a misrepresentation of an intended code. Given the CI’s residuals of dizziness/vertigo, the relevant code of 6204 was considered the likely intended code. However, the panel considered the VASRD rules in effect at the time for the 8045 code (TBI) which states: “Purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, will be rated 10% and no more under the diagnostic code (as specified and in this case, 6204). This 10% rating will not be combined with any other rating for a disability due to brain trauma. Ratings in excess of 10% for brain disease due to trauma under diagnostic code 6204 (peripheral vestibular disorders) are not assignable in the absence of a diagnosis of multi-infarct dementia associated with brain trauma.” The evidence clearly shows the CI’s ratable disability was a direct consequence of TBI. The PEB’s rating was consistent with the above VASRD criteria. 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 post-concussive syndrome.

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

 	

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

IN   REPLY   REFER TO:
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 25 Jul 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 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.