RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01787
BRANCH OF SERVICE:  Army	BOARD DATE:  20150318
SEPARATION DATE:  20040805

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Field Artillery Surveyor) medically separated for cognitive disorder, not otherwise specified (NOS).  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 cognitive disorder, NOS condition, characterized as “cognitive disorder” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “cognitive disorder, NOS” as unfitting, rated 10%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20040617	VA - (2 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cognitive Disorder	8045-9304	10%	Cognitive Disorder NOS	9327	30%	20041029	
Other x 0 (Not in Scope)	Other x 4		
Combined:  10%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20041214 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Cognitive Disorder Condition.  The narrative summary (NARSUM) documented the CI’s history of reported changes in his memory after a motor vehicle accident (MVA) in 1997 while on duty.  The CI was an unrestrained passenger in a truck which drove off a road and into a ditch.  His head hit the windshield; however, he denied any loss of consciousness or loss of memory for the accident.  Since the accident he noticed cognitive changes, specifically he had difficulty with short term memory manifested by inability to recall details of recent conversations, and occasional anomia (inability to name objects; often produced by small stroke but can be a symptom of early onset Alzheimer).  The CI underwent neuropsychological testing for the NARSUM on 16 April 2004, and was diagnosed with cognitive disorder NOS.  The examiner noted that the CI had a childhood history involving many years of speech therapy, and had been an average student in high school.  He attended a year of college where he studied electrical construction and maintenance involving basic house wiring.  Testing results documented a low average intelligence quotient, with demonstrated weakness on measures of information processing and language skills.  Processing speed fell in the extremely low range; there was visible slowing in speech and motor activity, opined to be disabling for him in daily life.  The examiner did indicate that it was highly probable that these limitations were developmental and long-standing in nature and were not likely the result of any recent trauma.  The CI demonstrated strengths in the areas of nonverbal reasoning, spatial and visuospatial reasoning, opined to be of great benefit if he decided to return to college to pursue a career in basic house wiring or a related field of study.  The CI performed in the average range on tests of immediate and delayed recall when challenged with repeating short story paragraphs; however, he performed below average on measure of visual memory.  The examiner indicated that although the CI felt his memory had not been as good as it was prior to his MVA, objective evidence supported he had no significant problem with his memory.  At the NARSUM dated 23 April 2004, the CI reportedly stated that he had always had slowed speech and mild stuttering since childhood.  He denied any weakness, paraesthesias, diplopia, dysarthria, dysphagia, vertigo, or headaches.  Physical examination recorded slowed speech with flat affect and mild occasional stuttering, and mild anomia for low frequency words (words not frequently used).  A mini-mental status examination (MSE) of 30/30 (intact short and long-term memory, and recall) was documented and all cranial nerves were intact, and no evidence of neuromuscular deficit or neurosensory loss.  The diagnosis of cognitive disorder NOS was assessed.  The VA Compensation and Pension (C&P) general examination dated 29 October 2004, approximately three months after separation, the CI reported problems with short term memory and slow speech that he associated with the MVA in 1997.  Slow speech was noted but his neurological examination was normal.  At the C&P mental examination, approximately 3.5 months after separation (10 Nov. 2004), his MSE was essentially normal except for slowness of speech, and an unkempt appearance.  Short-term memory and concentration was assessed as “good.”  The examiner assessed cognitive disorder NOS and opined that the CI’s problem was consistent with long-standing level of intellectual functioning, and that the military had not caused or exacerbated his condition, and therefore, his condition was not service-connected.  The examiner assessed his cognitive disorder NOS condition as mild with impairments in verbal and expressive language skills and assigned a Global Assessment of Functioning (GAF) score of 90.

The Board directed attention to its rating recommendation based on the above evidence.  The Informal PEB rated the condition of cognitive disorder NOS at 10% coded analogously 8045-9304 (brain disease due to trauma with purely subjective complaints).  The VARSD in effect at the time of separation captured brain injuries under the generic category of brain disease due to trauma (8045).  There are two different scenarios for rating under this code; analogously with purely neurological deficits, or 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.  The VA rated the condition of cognitive disorder NOS at 30%, coded 9327 (organic mental disorder, other).  The Board found absence of evidence that would support any neurological disability, and therefore, only 10% was supported under the 8045-9304 coding.  The Board next considered code 9327, which allows for rating under the schedule of ratings- mental disorders, 4.130; however, found no advantage to this rating scheme, since there was insufficient evidence to support the higher rating of 30% (Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks [weekly or less often], chronic sleep impairment, mild memory loss [such as forgetting names, directions, recent events]).  The record demonstrated no objective finding of memory loss, forgetting names, mood symptoms, or anxiety symptoms, and only the subjective report of short-term memory loss.

After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB determination for the cognitive disorder NOS 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 cognitive disorder NOS condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140424, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150013663 (PD201401787)

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 and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA