RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  	CASE:  PD1201915
BRANCH OF SERVICE:  Army	BOARD DATE:  20130605
SEPARATION DATE:  20011214

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (11B/Infantry) medically separated for a head injury.  In 1998 he had a hard parachute landing and lost consciousness and was admitted to hospital for observation.  A magnetic resonance imaging (MRI) revealed white matter lesions but he was discharged after evaluation.  He developed light-headedness, confusion and slurred speech when exercising along with headaches and a subsequent diagnosis was made of post-traumatic syndrome.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).   The MEB forwarded diagnoses of “post-traumatic syndrome” and “events involving loss of consciousness that are clinically consistent with epileptic events” to the Physical Evaluation Board (PEB) IAW AR 40-501.  The PEB combined and adjudicated “history of head injury following a parachute landing with delayed onset of seizure disorder” as unfitting, rated 0%, because the CI had a history of non-compliance.  The CI made no appeals, and was medically separated.

CI CONTENTION:  “I believe that if my records where reviewed you would see that the initial closed head injury I received was more than enough to warrant a retirement ruling.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting head injury is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  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 Board for Correction of Military Records.

RATING COMPARISON:

Service  IPEB – Dated 20011108	VA - (6yrs Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Head Injury/Delayed Seizure Disorder	8045-8911	0%	Impairment or Dysfunction in cognitive….speech Difficulties	8045	0%*	20070119	
			Headache	8100	0%*	20070119	
No Additional MEB/PEB Entries	Other x 10	20070119	
Combined:  0%	Combined:  0%	
*Derived from VA Rating Decision (VARD) dated 20070606.  VA Exam 20050211 most proximate to date of separation awarded all “NSC” ratings until CI completed C&P dated 20070119.

ANALYSIS SUMMARY:

Head Injury w/Seizure Disorder .  The narrative summary (NARSUM) notes the CI had a history of a hard parachute landing with an indefinite period of loss of consciousness in June of 1998.  A computed tomography scan of the head at that time was negative.  Service treatment records (STRs) indicated the CI presented to the emergency room 2 days later and reported slurred speech and numbness of his tongue.  An admission examination on 21 June 1998, noted the CI was fully oriented with a normal neurological exam; he was admitted to the hospital overnight for observation.  A nearly illegible neurology consultation note dated 22 June 1998, indicated slight speech difficulty and the assessment was mild traumatic brain injury.  The hospital discharge summary noted the MRI of the brain showed “significant white matter shear injury in the corpus callosum and the high right parietal area white matter.”  He was discharged as stable with post-concussive syndrome and given a 6-month profile.  At a later VA evaluation in 2007 the CI reported that he returned to parachute jumping at the end of the 6-month profile and went on to perform 74 additional jumps.  The CI presented for a neurology evaluation in January 1999 for an alteration of consciousness that occurred during a road march in which he felt lightheaded.  He reported other episodes of light-headedness, confusion or slurred speech while exercising which at times included an unsteady gait.  He reported sleeping more than usual and having difficulty waking up.  He was having infrequent headaches and reported distractibility, but no irritability.  A repeat MRI of the brain showed the severe white matter injury was somewhat resolved since the June 1998 MRI.  An electroencephalogram (EEG) in January 1999 was normal.  His diagnosis remained post-traumatic syndrome.  Records indicated the CI was provided an additional 3 month profile.  The CI was next seen in December 2000 because he was witnessed to have an apparent seizure which, according to the MEB neurology consult, consisted of “falling to the ground with some jerking movements of his body” after which he had a headache and felt sleepy.  He was diagnosed with generalized seizure secondary to head trauma.  A repeat EEG was again normal.  Records indicated the CI had already been prescribed an anti-epileptic medication (Depakote) prior to the seizure and the dose was increased.  The NARSUM indicated that following the seizure the CI was placed on the “usual seizure profile.”  The CI also had a history of headaches that began approximately a month after the head injury which included daily headaches with periodic migraine headaches at first.  At an April 2001 evaluation, the headaches were no longer everyday but occurred variably from once or twice a month up to six times per month and would last for a few days.  The headaches were associated with sound and light sensitivity and were exacerbated by certain activities.  The CI’s migraine medication was changed to a stronger abortive medication (Maxalt).

At the MEB examination performed 12 June 2001, approximately 6 months prior to separation, the CI’s headaches were noted to be improved.  The CI reported no further seizure type activity, but did report trouble falling asleep.  He was reportedly on anti-epileptic medication, but a blood test indicated no detectable drug level.  The MEB physical exam noted “detailed neurologic examination to include funduscopy was normal.”  The CI was instructed to restart his anti-epileptic medication.  The MEB neurology consult on 20 September 2001, approximately 3 months prior to separation, noted the same history as above and that the migraine headaches currently occurred about once or twice a month and were relieved by the CI’s current medication (Maxalt).  The CI reported slowed mentation since his head injury that was not confirmed by neuropsychiatric testing.  (It is unclear in the record when the noted neuropsychiatric testing was performed).  The MEB neurological examination showed the CI was fully oriented, with a normal mental status exam (MSE), cranial nerve and cerebellar function, gait, station, balance, muscle strength, and sensation.  The examiner noted that there had only been one documented seizure over the course of the CI’s evaluation; the CI was non-compliant with anti-epileptic medication; and that the migraine headaches were well controlled with the current medication.

At the VA Compensation and Pension (C&P) brain and spinal cord examination on 19 January 2007, approximately 6 years after separation, the CI reported the history of the hard parachute landing with head injury.  He reported headaches for a short time afterwards that subsided after recovering.  The CI also reported being placed on medication for seizure prevention but that he never had a seizure and the medication was discontinued 6 months after injury.  The VA examination noted difficulty obtaining the CI’s records.  On exam gait, balance, muscle strength, reflexes, and sensation were normal.  Cranial nerve and mental status evaluations were noted to be normal.  The CI was employed in a security position part-time and had not lost any time from work.  Cervical spine X-rays were unremarkable.  An EEG was scheduled, but the CI failed to keep the appointment.  At the C&P mental disorders examination on 22 January 2007, the CI reported the same history of the head injury with successful return to duty.  He denied any post-injury difficulties with attention, concentration, information processing, memory, fatigue, or decreased stamina.  His MSE was normal.  Detailed neuropsychiatric testing showed no significant abnormalities, but noted slight difficulties with visuospatial organization and information processing thought to be of very little clinical relevance.  The examiner stated “day to day functioning would not be expected to demonstrate any cognitive or functional deficits or deficiencies whatsoever.”  There was no AXIS I diagnosis and no diagnoses on AXIS II-IV.  The Global Assessment of Functioning (GAF) was estimated to be 80; the CI was noted to be underemployed, struggling financially, and completing his third college degree without a long lasting career path.  (GAF 81-90 – absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns).

The Board directs attention to its rating recommendation based on the above evidence.  The Board must provide a disability rating in accordance with VASRD rating guidelines in effect at the time of separation and the Board did so.  The PEB rated the history of head injury with seizure disorder as 8045-8911 (analogous to brain disease due to trauma) with petit mal epilepsy) at 0% and cited noncompliance with medication and that the CI was seizure free when on medication.  In 2005, the VA denied service-connection for speech problems, memory loss, headaches, and seizures due to failure to receive any STRs.  The VARD dated 6 June 2007, granted service-connection for impairment or dysfunction in cognitive abilities coded as 8045 at 0% and headache as 8100 (migraine) at 0%, and continued the denial for seizures.  The Board deliberated the rating of the CI’s head injury with seizure disorder condition.  VASRD rating guidelines in effect December 2001 for rating brain disease due to trauma coded as 8045 specified that “purely neurological disabilities” such as seizures or paralysis be rated under the applicable diagnostic code designated as a hyphenated 8045 code.  Purely subjective complaints such as headache, insomnia, etc. were rated at “10% and no more” under diagnostic code 9304 (dementia due to head trauma) not to be combined with any other rating for a disability due to brain trauma, unless there was a diagnosis of multi-infarct dementia associated with brain trauma.  The evidence in the record supports that at the time of separation the CI was treated with medication for the prevention of post-traumatic seizures and migraine headaches.  The migraine headaches were noted to be well controlled with medication.  The CI had one witnessed loss of consciousness in mid-December 2000, a year prior to separation, diagnosed as a generalized seizure.  The Board opined that the CI’s condition was appropriately coded as 8045-8910 (analogous to brain disease due to trauma with grand mal epilepsy).  The Board agreed that this met the 20% disability rating criteria specified as “at least 1 major seizure in the last two years” in accordance with the VASRD general rating formula for major and minor epileptic seizures.  The Board reviewed to see if there was a path to a higher evaluation and concluded that there was not.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the head injury with seizure disorder 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 head injury with seizure disorder condition, the Board unanimously recommends a disability rating of 20%, coded 8045-8910 IAW VASRD §§4.124a. 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	
History of Head Injury with Seizure Disorder Condition	8045-8910	20%	
COMBINED	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20121117, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(TAPD-ZB),

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for AR20130019919 (PD201201915)

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 20% 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						
						         (Army Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA