RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05782
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20041031

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Rifleman, medically separated for “cognitive disorder” with 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 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 - 20040823	VARD - 20051019	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cognitive Dysfunction	8045-9304	10%	

Cognitive Disorder with Headaches Secondary to Head Injury	

9304	

30%	

20031123	
Post Concussive Syndrome	

Cat II					
Closed Head Injury						
Post Traumatic Headaches						
Traumatic Brain Injury (TBI)						
Status Post (S/P) Closed Head Injury with Associated Grade
3 Concussion						
Right Sensory Radial Neuropathy	

Cat III	Right Thumb Numbness Secondary to Right Wrist Tendon Injury	8515	10%	20050927	
Right Forearm Laceration		No VA Placement	
Clavicle Fracture, S/P Open Reduction Internal Fixation
(ORIF)		Left Clavicle Fracture, S/P ORIF	5203	10%	20050927	

Multiple Orthopedic Injuries		Thoracolumbar Strain	5237	10%	20050927	
		Right Knee Strain	5260	10%	20050927	
		Left Knee Strain	5260	10%	20050927	
		Cervical Strain, History of C2-3 Dislocation	5237	10%	20050927	
		Right Wrist, Flexor-Extensor Tendon Injury, S/P Repair with
Scar	5215	10%	20050927	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Cognitive Dysfunction. According to the service treatment record (STR) and MEB neuropsychological (NP) addendum, the CI’s cognitive dysfunction began in May 2002 after falling from a 4-story building. He suffered posttraumatic amnesia for about 2 days, which was suggestive of a TBI, and he also had a left clavicle fracture and right wrist tendon ruptures which required surgery.

At the 23 November 2003 VA Compensation and Pension (C&P) examination, 11 months before separation, the CI reported significant memory problems, headaches that occurred in the context of stress, and mood changes related to frustration. He could not remember new things, but past memories were intact and his sleep had improved (up to 9 hours a night). Psychological testing was performed in March or April 2003, but results were not available yet. He denied impulse control issues, but reported some irritability. The mental status examination (MSE) was unremarkable and he was able to recall 4/4 words after several minutes, correctly spell a word forward and backwards, and perform serial seven subtractions (good attention/concentration).

During the 19 July 2004 MEB NP addendum examination, 3 months before separation, the CI reported that while his headache frequency had declined, intensity remained the same, with headaches precipitated by stress and occurring every 1-2 months. He described a recent increase in cognitive difficulties including decreased attention span, difficulty following conversations and formulating thoughts, problems with learning new information, and decreased reading comprehension and retention. He was not taking any medication. The MSE was unremarkable, but he complained of decreased energy, endurance, and not feeling rested, even though he slept about 9 hours a night. The examiner noted some concern that the CI had not devoted his fullest attention and effort during the testing, and thus, the results were not wholly reliable. The test results showed that scores varied from average to severe impairment for performance of learning and memory, and appeared to have declined from the previous evaluation in 2003, which showed scores in the superior range. It was noted that the pattern of declining memory performance was unusual compared to the typical TBI patient, who generally showed improvement over time. The CI performed in the average range on tests of nonverbal problem solving ability and cognitive flexibility. Diagnoses of cognitive disorder, not otherwise specified, by history, TBI, post traumatic headaches, and post concussive syndrome were recorded with a Global Assessment of Functioning (GAF) score of 70 for mild symptoms. The examiner again cautioned interpretation of the results since the CI moved quickly through the testing and expressed frustration because he had to be reevaluated for the addendum.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated cognitive dysfunction 10%, dual coded 8045-9304 (residuals of TBI: - dementia due to head trauma), and listed post-concussive syndrome, closed head injury, posttraumatic headaches, TBI, and status post closed head injury with associated grade 3 concussion as Category II conditions (contribute to the primary unfitting condition but not separately ratable). Panel members agreed that these related diagnosis were properly subsumed under the rating for the cognitive condition by the PEB to avoid pyramiding (§4.14). The VA rated cognitive disorder 30%, coded 9304 (dementia due to head trauma), based on the C&P examination, citing a GAF of 60-62, headaches, diminished relationships, memory impairment, mood and affect described as anxious and nervous, and reported sleep disturbance. Upon deliberation, the panel noted that the C&P examination showed some irritability and memory problems, but the MSE was fairly normal with no gross impairment in recall, or problem with concentration. The MEB NP examination, most proximate to separation, found inconsistent results from previous testing, documented cognitive disorder by history, and a GAF score in the mild range. There was no report of forgetfulness, getting lost, or being confused, and no complaints of chronic insomnia, panic attacks, or mood symptoms interfering with performance. The panel noted that the VARSD

in effect at the time of separation captured brain injuries under the generic category of brain disease due to trauma under code 8045. There are two different scenarios for rating under this code: analogously with purely neurological deficits, or based on purely subjective symptoms. In the absence of associated neurological disabilities (seizures, nerve paralysis, etc.), rating of this condition under 8045-9304 is limited to 10%, and cannot be combined with any other rating for a disability due to brain trauma. Therefore, a higher rating is not possible under this code. Panel members also considered a rating under VASRD 4.130, using code 9304, but since there was minimal evidence of occupational or social impairment due to primary mental health symptoms, including symptoms related to memory or concentration problems, a higher rating was not justified. 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 cognitive dysfunction.

Contended PEB Conditions: Right Sensory Radial Neuropathy, Right Forearm Laceration, Clavicle Fracture, Multiple Orthopedic Injuries. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. Limited duty forms were not found in the STR, and none of the conditions were implicated in the non-medical assessment (NMA), or failed retention standards (based on the JDETS). The NMA stated the CI was an excellent performer but “his performance has only been degraded by the impact that his current medical condition has brought on him which prevents him from performing his normal military duties and deploying for operational commitments in his MOS.” There was no performance- based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the cognitive dysfunction and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication. In the matter of the contended right sensory radial neuropathy, right forearm laceration, clavicle fracture, and multiple orthopedic injuries, the panel recommends no change from the PEB determinations as not unfitting. 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 TIIE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN 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.