RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-04797
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050922

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

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 – 20050419	VARD - 20070227	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-concussive Syndrome with Chronic Headaches	8045-9304	10%	Post Concussive Syndrome with Residual Headaches	8045	10%	20051220	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Post-concussive Syndrome with Chronic Headaches.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s headache condition began after an IED explosion while deployed in August 2003.  Following the incident, the CI complained of frequent headaches, insomnia, poor memory and concentration.  The record was inconsistent on the presence of unconsciousness at the time of explosion varying from yes, no, minimal, few seconds, a minute, to several minutes.  The headaches eventually improved to the point that the CI was capable of deploying again.  However, by mid-2004, the CI developed difficulties with wearing a helmet as it caused more headache attacks.  At the 31 March 2005 MEB NARSUM examination, 6 months prior to separation, the CI complained of “headaches, memory and cognitive difficulties.”   A mental status examination and focused neurological examination were both normal.  He was diagnosed with “post-concussion syndrome” and the examiner noted that the CI “appeared to be meeting his social and occupational responsibilities, with the majority of his somatic symptoms resolving with time and appropriate medication.”

At the 20 December 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported persistent tinnitus (ringing in the ears) and headaches occurring 3 times per month lasting 5-6 hours per episode, but were relieved with medication.  A detailed neurologic examination was normal.       

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 10%, dual coded 8045-9304 (residual of traumatic brain injury (TBI)-dementia due to head trauma), citing headaches 1-2 times per week with cognitive function intact.  The VA also rated the headache condition 10%, coded 8045, based on the C&P examination, citing “purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, will be rated 10 percent and no more.”  Panel members agreed that the subjective symptoms pertaining to impaired memory and cognitive deficits supported some degree of altered brain function (encephalopathy) and therefore, IAW VASRD guidelines, such a condition should be rated under code 8045-9304.  The panel also considered diagnostic code 8100 (migraine headaches), but all panel members agreed that the headaches were not “prostrating.”   With regard to rating under code 8045-9304, all panel members agreed that given the VASRD listed facets of cognitive impairment and other residuals of TBI, none were present to a level greater than that of a 10% rating as found under the “subjective symptoms” caveat, which included tinnitus and frequent insomnia.  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’s adjudication for the post-concussive syndrome with chronic headaches.  

BOARD FINDINGS:  In the matter of the post-concussive syndrome with chronic headaches and IAW VASRD §4.124a and §4.130, 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:

[AR NUMBER], XXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

	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.

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Enclosure