RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200927 SEPARATION DATE: 20020408 BOARD DATE: 20130123 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Soldier, SGT/E-5(13B/Cannon Crew Member), medically separated for benign paroxysmal positional vertigo (BPPV). The CI’s condition began in February 1997 when he reported 5 days of dizziness upon waking and lightheadedness throughout the day. The CI related that the hatch of an armored vehicle fell down on his head. At that time, he was wearing a Kevlar helmet and there was no loss of consciousness, nor was medical care sought. He was initially diagnosed and treated for right acute otitis media (ear infection) and vestibular labyrinthitis. It was felt his history was consistent with BPPV and he was prescribed vestibular exercises. The CI did not improve adequately with treatment to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent P3/E2 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded BPPV involving the right posterior semicircular canal and possibly other canals as medically unacceptable IAW AR 40-501. The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the BPPV as unfitting, rated 0%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with a 0% disability rating. CI CONTENTION: The CI writes: “Head injuries (X2), left calf condition, severe migraine headaches, vertigo.” The CI also attached a memo with attachments indicating more history and disability concerns, as well as a claimed 100% VA disability. The Board also reviewed the Congressional and Senatorial letters forwarded by the CI. SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI 6040.44 Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings for unfitting conditions will be reviewed in all cases. The unfitting vertigo condition meets the criteria prescribed in DoDI 6040.44 for Board purview; and, is addressed below. The head injuries, migraine headaches and left calf conditions are not within the Board’s purview. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Service PEB – Dated 20011221 VA (1 Week Pre-Separation) – All Effective Date 20020404 Condition Code Rating Condition Code Rating Exam Benign Paroxysmal Positional Vertigo 6299-6204 0% Benign Paroxysmal Positional Vertigo w/Associated Headaches and Photophobia* 8045-6205 30%* 20040404 & 02 .No Additional MEB/PEB Entries. Residuals of L Calf Muscle Injury 5399-5024 10% 20040404 0% X 1 / Not Service-Connected x 2 20040404 Combined: 0% Combined: 40%* *VARD of 4/24/03 removed Headaches from 8045-6205 condition, and rates tension headaches (8100) at 50%, effective 20020422 (combined 70%). ANALYSIS SUMMARY: Benign Paroxysmal Positional Vertigo. In February 1997 CI presented to PCC with a five day history of dizziness upon awakening and, light headedness. He was diagnosed with otitis media and vestibular labyrinitis; treated with antibiotics and given medication to control dizziness. He was referred to otolaryngologist (ENT) in March 1997, was found to have a normal exam with normal gait, negative Romberg and negative Hallpike maneuver (test for vertigo and is positive if nystagmus is produced; maybe diagnostic of BPPV). The presumptive diagnosis of BPPV was given. Two weeks later Hallpike test was positive, and a profile was initiated. He subsequently underwent audiograms, and vestibular function tests (VNG-videonystagmography-2) over a 3 year period. The audiograms were normal and the last VNG was abnormal (2 years prior to separation). The CI continued to complain of positional dizziness and vertigo for several months. Ten months prior to separation the CI underwent another audiogram, and additional tests designed to detect nystagmus, and results supported the diagnosis of BPPV. At the MEB narrative summary (NARSUM) exam (approximately 6 months prior to separation), the CI reported positional dizziness and vertigo; he denied tinnitus and hearing loss. The physical exam was normal and a review of medical records was performed. An acknowledgement of his condition as recurrent and unpredictable with prognosis that episodes of vertigo will likely continue resulted in the recommendation to not retain CI due to BPPV. At the VA Compensation and Pension (C&P) exam (4 days prior to separation), the CI reported dizziness and lightheadedness during the exam. He also reported photophobia. He was diagnosed with BPPV with severe re-associated headaches and photophobia. The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the condition at 0% using analogous code 6299-6204 (Peripheral vestibular disorder, associated with Otitis Media). The VA rated the condition at 30% coded 8045-6205 (Meniere’s disease associated with brain disease due to trauma). There was no physician diagnosis of Meniere’s disease or syndrome in the treatment record. The Board acknowledges the fact that the CI suffered headaches and experienced photophobia with headaches; however, these conditions were not adjudicated by the PEB and therefore are not within the scope of the Board. All Board members agreed that the medical records provided evidence of objective tests to support a 10% rating under the code 6204 (Peripheral vestibular disorder) for occasional dizziness with objective findings. The records did not support the higher rating of 20% since staggering was not identified in any of the examinations proximate to separation. The Board acknowledged the VA’s decision to rate the condition of BPPV with associated headaches and photophobia under the above mentioned code. The Board considered the rating criteria and determined there was not sufficient evidence in the records supporting the use of the 8045-6205, absent consideration of non-vestibular type symptoms outside the scope of the Board, or undue speculation. There were no reported episodes of gait disturbance, the audiograms were normal, and although the records indicated episodes of tinnitus in the past, none were recorded in the 12 months prior to separation. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the BPPV condition. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the BPPV condition, the Board unanimously recommends a disability rating of 10%, coded 6299-6204 IAW VASRD §4.87. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation: UNFITTING CONDITION VASRD CODE RATING Benign Paroxysmal Positional Vertigo 6299-6204 10% COMBINED 10% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120613, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxx, AR20130006054 (PD201200927) 1. I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation. This decision is final. 2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum. 3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures. BY ORDER OF THE SECRETARY OF THE ARMY: Encl xxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)