RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:	CASE:  PD-2017-0560	2
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20071031
SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, CBRN Specialist, medically separated for “Grade III concussion” with a disability rating of 10%.
CI CONTENTION: No specific contention was made. 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 - 20070906	VARD - 20080117	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Grade III Concussion	8045-9304	10%	No VA Placement	
Left Temporal Lobe Contusion	Cat II	No VA Placement	
History Of TBI Age 16	Cat II	No VA Placement	
Recurring Headaches Multiple Times Per Week, Post Traumatic	Cat II	Migraines	8045-8100	0%	20071010	
Subarachnoid Hemorrhage	Cat II	No VA Placement	
Traumatic Brain Injury	Cat II	No VA Placement	
Bilateral Tinnitus	Cat II	Tinnitus	8045-6260	10%	20071010	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Grade III Concussion. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s concussion condition began in March 2007 after falling from an upper bunk in his barracks and sustaining a left temporal contusion and subarachnoid hemorrhage. The CI was seen by outpatient neurosurgery and treated with prophylactic Dilantin for 2 months. Without medication for 3 weeks the CI denied black out or seizure activity. The 4 April 2007 concussion clinic examination rendered a diagnosis of moderate concussion. The CI had a history of traumatic brain injury (TBI) at age 16 per medical records.

The 25 July 2007 MEB NARSUM examination, 3 months prior to separation, noted complaints of two to three headaches per week in the left temporal area, described as stabbing or pulsating

and rated 5/10 on the pain scale. They increased with physical activity, including running. He also reported daily bilateral tinnitus. There was an unremarkable physical and normal neurological examination. The standard assessment of concussion score was 28/30, which was acceptable. Diagnoses rendered were Grade III concussion with related left temporal lobe contusion, history of TBI, recurring headaches multiple times per week, post traumatic; subarachnoid hemorrhage, TBI, and bilateral tinnitus.

At the 10 October 2007 VA Compensation and Pension (C&P) examination, 3 weeks before separation, the CI reported headaches, predominantly on the left side of the head which induced nausea and were throbbing, both photophobic and phonophobic in nature. The headaches occurred about five times per day. He denied any functional impairment as a result of this condition. The CI was able to go to work but he required medication. He was able to perform activities of daily living. Physical examination showed an elevated blood pressure and normal physical examination.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the concussion condition 10%, dual coded 8045-9304 (residuals of TBI - dementia due to head trauma). The PEB also listed left temporal lobe contusion, history of TBI age 16, recurring headaches multiple times per week - post traumatic, subarachnoid hemorrhage, TBI and bilateral tinnitus conditions as related Category II diagnoses contributing to the disability in this case. The panel concluded the Category II diagnoses were not separate conditions which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding). The VA did not rate the concussion condition, but rated the Category II tinnitus condition 10%, dual coded 8045-6260 (residuals of TBI - recurrent tinnitus), and the Category II migraine condition 0%, dual coded 8045-8100 (residuals of TBI - migraine) based on the C&P examination.

The panel noted that in rating TBI, the VASRD considers 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 (8045-9304). The VASRD further notes that the 10% rating will not be combined with any other rating for a disability due to brain trauma, and that ratings in excess of 10% for brain disease due to trauma under diagnostic code 9304 (psychiatric disorders) are not assignable in the absence of a diagnosis of multi-infarct dementia associated with brain trauma.

The evidence clearly showed that the CI’s ratable disability was a direct consequence of TBI. The panel also considered the option of recommending a rating under 8100. The C&P examination noted no loss of earning power due to headaches. Members noted there was no evidence of “prostrating” attacks, meaning the CI had to stop what he was doing and seek medical attention. There was no evidence of frequent visits to the emergency room or to a neurology clinic regarding the headaches, thus there was insufficient evidence to justify a conclusion that a higher rating under 8100 was warranted. 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 concussion condition.

BOARD FINDINGS: In the matter of the Grade III concussion condition and IAW VASRD
§4.124a/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:

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

Ill REPLY REFER TO ,
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno 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.