RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04369
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20091019

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Wheeled Vehicle Mechanic, medically separated for “small, left parietal lobe cortical infarction” with a disability rating of 10%.

CI CONTENTION: “I was also in the ANG when I was active for deployment and when I had my Stroke. And when the Army gave me a 10% I was told could stay in the guard with it but they put me out to with nothing and I lost my job to because I was a Tec. for the Federal gov. witch you had to be in guard too. I was never given a MRB by the guard.” 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 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 - 20080509	VARD - 20090807	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Small, Left Parietal Lobe Cortical Infarction	8008	10%	Stroke Residuals	8046-8007	10%	20081112	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Small, Left Parietal Lobe Cortical Infarction. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s left parietal lobe cortical infarction began in March 2006. He had just finished 20-30 minutes of physical therapy (PT) and was playing football for no more than 20 to 30 seconds when his right side went completely numb and he fell to the ground. The right leg stayed numb for approximately 30-40 minutes and the chest and arm stayed numb for approximately 3 hours. He was admitted to the hospital. MRI of the brain showed a small left parietal cortical infarct of acute to subacute onset.

The 19 November 2007 MEB NARSUM examination, 23 months prior to separation, noted complaints of occasional episodes of right-sided weakness and poor coordination, and a vague sense of numbness and dizziness promptly relieved by rest. The skin felt tingly, like it was asleep, especially in the scalp. He felt weak on the right side as well, the same as the stroke but not as severe, and without dysarthria. The CI had not identified exacerbating factors, except perhaps when performing heavy work.  This occurred about 3-4 times per month and had been constant

at this frequency for almost 2 years since the stroke. The CI reported to work regularly and could perform light clerical tasks without a problem. He could drive, work in an office, and walk 2 miles a day for exercise. Physical examination was unremarkable. Neurological examination showed motor strength was 5/5 through the bilateral upper and lower extremities with normal tone and bulk with variable give-way weakness in the right arm and leg. Sensations were decreased in the right upper and lower extremity. Finger tapping was slow on the right. Gait was normal. The remainder of the examination was normal. Since he had not had another stroke, the examiner noted the recurrent episodes of right-sided numbness was likely reactivation of old symptoms due to some other physiologic stressor rather than transient ischemic attacks.

At the 12 November 2008 VA Compensation and Pension (C&P) examination, 11 months before separation, the CI reported daily headaches, dizziness with standing, hearing loss and tinnitus, and mild memory loss but there were no residuals of stroke clearly present. Physical examination showed widespread decrease in pain sensation and mild weakness over the entire right upper and lower extremity and not following any particular pattern. The same-day VA C&P brain and spinal cord examination noted the general examination findings were doubtful in view of a recent normal MRI. VA records showed continued treatment for stroke with residual right-sided strength loss and lack of sensation. After review of the STR, the examiner assessed the findings showed left parietal lobe cerebrovascular accident with residual sensory loss. Follow-up STRs in 2009 revealed no specific stroke residuals.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the left parietal lobe cortical infarction 10%, coded 8008 (brain, vessels, thrombosis), citing minimal residuals of infarction. The VA also rated the stroke residuals 10%, analogously coded 8046-8007 (brain, vessels, embolism), based on the C&P examination, citing the CI did not meet the criteria for a higher evaluation under the 8008 code. The NARSUM examination noted normal neurological examination with mild subjective complaint of diminished cutaneous sensation on the right side of his body, thereby meeting criteria for a 10% rating for minimal residuals. There was no evidence of a recently active disease to warrant a higher 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 left parietal lobe cortical infarction.

BOARD  FINDINGS:   In the matter of  the left  parietal lobe cortical infarction  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:

2	PD-2017-04369

AR20200000182, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX:

	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.