RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05522
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20061122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Basic Airmen, medically separated for “post-concussive syndrome” with a disability rating of 10%.

CI CONTENTION:  The VA provided a higher rating.  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 Physical Evaluation Board (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 - 20061115	VARD - 20070802	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Concussive Syndrome	8199-8100	10%	Cognitive Disorder…	9304-9434	50%	20070613	
Adjustment Disorder with Depressed Mood	Not Unfitting					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Post-Concussive Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI fell while running during a physical fitness test in August 2006, and hit his head on the pavement, losing consciousness for about 2 minutes.  He subsequently developed headaches and partial right eye vision loss, and was diagnosed with post-concussive syndrome and adjustment disorder with a depressed mood by a neurologist.  The headaches were treated with steroids, and an MRI showed no evidence of acute intracranial trauma but noted a cyst as an incidental finding.  On 5 September 2006, the CI went to the emergency room (ER) with complaints of a headache, memory loss and suicidal ideation.  During psychiatric examination, he denied active suicidal/homicidal ideation with no actual attempts, but reported feeling depressed and frustrated about the long medical hold.  He was treated with fluids and released.  The 29 September 2006 MEB NARSUM, 2 months prior to separation, noted complaints of intermittent post-concussive syndrome, but physical findings were unremarkable.  Follow-up behavioral health notes recommended a return to duty.
At the 13 June 2007 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported a history of head trauma and depression at age 15, which was treated with an anti-depressant for about a month and then discontinued.  He currently had several severe headaches a week and complained of concentration problems, but was taking no medications.  He had worked as a security guard from March to May 2007, but quit because he could not handle working 13-hour days for 6 days a week, and preferred working a standard 40-hour work week.  The mental status examination revealed a restricted affect, but good memory, attention, and concentration.  He was a perfectionist about his work and hobbies and reported mild impairment in social relationships, although he had a high school friend he talked to everyday, and lived and got along well with his sister (although he had problems with her spouse).  He was looking for a job, and leisure activities included collecting coins and playing board and video games.  His intellect and functioning, estimated from grades and test scores, met high average levels.  Psychometric findings showed a decline in memory and concentration which indicated a mild to moderate impairment.  He was diagnosed with Axis I cognitive disorder not otherwise specified (NOS) and depressive disorder NOS, with Axis II schizoid traits and a Global Assessment of Functioning score of 65 (mild symptoms, impairment).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated post-concussive syndrome 10%, analogously coded 8199-8100 (migraine headaches).  The VA rated cognitive disorder 50%, dual coded 9304-9434 (dementia due to head trauma-major depressive disorder), based on the C&P examination, citing the 50% mental health (MH) rating criteria for reduced reliability and productivity.  Although psychometric testing noted a decline in memory and concentration, panel members agreed the CI’s functioning and intellect were of an average to high capacity, with no ratable VASRD §4.130 symptoms noted in repeated behavioral analyses or the NARSUM.  The panel then considered a rating under code 8100, with a 30% rating requiring “characteristic prostrating attacks occurring on an average once a month over last several months;” a 10% rating stipulating “characteristic prostrating attacks averaging one in 2 months over last several months;” and a 0% rating for “less frequent attacks.”  Additionally, DoDI 1332.39 defines “prostrating” as a need for the CI to “stop what he or she is doing and seek medical attention.”  The panel noted no reports of an inability to work during headaches and no evidence of frequent ER or neurology visits to treat them, and thus adjudged there was no evidence of prostrating headaches to support a higher rating than the 10% adjudicated by the PEB.  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 post-concussive syndrome.

Contended PEB Condition:  Adjustment Disorder with Depressed Mood.  IAW DoDI 1332.38, adjustment disorder is a condition that does not constitute a physical disability; therefore, the panel has no basis for recommending it as unfitting.  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 post-concussion syndrome and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder, the panel agrees it cannot recommend it for additional disability rating.  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:

SAF/MRB

Dear XXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05522.

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 rating modification or re-characterization 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 modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.

						

		

								

Attachment:
Record of Proceedings