RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1200421 SEPARATION DATE: 20050101 

BOARD DATE: 20130221 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty, SGT/E-5 (31B/Military Police), medically separated 
for arteriovenous malformation (AVM) of the brain. The CI was evaluated for deployment in 
April 2004, and found to be hard of hearing in the left ear. An audiogram showed significant 
sensorineural hearing loss (SNHL) and he was referred to the ear, nose and throat specialist. As 
part of the evaluation of hearing, a magnetic resonance imaging (MRI) of the brain was 
ordered, that revealed a congenital AVM involving the hypothalamus and the right optic nerve. 
The AVM of the brain condition could not be risk mitigated for his Military Occupational 
Specialty (MOS). The AVM condition was disqualifying for enlistment, and hence found 
contrary to further service, and the CI was referred for a Medical Evaluation Board (MEB). 
Moderate SNHL and chronic iliotibial band syndrome (ITBS), identified in the rating chart below, 
were also identified and forwarded by the MEB as meeting retention standards. The Physical 
Evaluation Board (PEB) adjudicated the AVM of the brain as unfitting and rated 0%, with 
application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The PEB 
adjudicated the moderate SNHL and chronic ITB syndrome as not unfitting. The AVM condition 
was determined to have existed prior to service (EPTS) and was not permanently aggravated by 
service but was compensable IAW 10 USC 1207a (eight year rule). The CI made no appeals, and 
was medically separated with a 0% disability rating. 

 

 

CI CONTENTION: “10% was awarded for my wrist only, nothing for my hearing, knees, etc.” 

 

 

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 conditions hearing loss and knee as 
requested for consideration meet the criteria prescribed in DoDI 6040.44 for Board purview; 
and, are addressed below, in addition to a review of the unfitting AVM condition. The other 
requested condition, (wrist) is 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 20041109 

VA (1 Mos. Post-Separation) – All Effective Date 20050102 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Large arteriovenous (AV) 
malformation of the brain 

7199-7113 

0% 

NO VA ENTRY 

 

Hearing Loss 

Not Unfitting 

Left Ear Hearing Loss 

6100 

0% 

No C&P 
exam 

Right Ear Hearing Loss 

6199-6100 

NSC 

Iliotibial band syndrome 

Not Unfitting 

L knee Iliotibial band syndrome 

5099-5019 

0% 

20050223 

.No Additional MEB/PEB Entries. 

Left wrist strain 

5299-5215 

10% 

20050223 

Combined: 0% 

Combined: 10% 



 


ANALYSIS SUMMARY: 

 

Arteriovenous Malformation Condition. The narrative summary (NARSUM) noted an MRI with 
a coincidental finding of an AVM involving the hypothalamus and the right optic nerve. The CI 
related that he had undergone an imaging study for other reasons prior to his enlistment. The 
CI stated that civilian neurosurgeons felt that surgery or any other treatment would be too risky 
compared to allowing the condition to play out its natural history. The CI reported that when 
he entered military service, he did not describe his medical condition, because he felt it was not 
significant based on this information. Due to the 2-4% risk of hemorrhage per year, and 
spontaneous morbidity or mortality, the PEB found the CI unfit for continued service, with a 
condition that EPTS, without permanent aggravation by service, but compensable by the 8 year 
service rule. At the MEB exam, 8 months prior to separation, the CI “denies headaches, 
seizures, focal weakness or any other neurologic changes, except for a history of decreased 
vision in the right eye.” The MEB physical examiner noted “the arterial venous malformation of 
the brain… has caused no problems for the patient and he has no neurologic deficits 
whatsoever.” The commander’s statement referenced the dangers of deployment and being in 
a military environment, but cited no impairment of duty due to the AVM. At the VA 
Compensation and Pension (C&P) exam 7 weeks after separation, there was no comment or 
entry on the AVM condition. 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
PEB coded 7199-7113, as analogous to arteriovenous fistula, traumatic, stating “The condition 
while presently asymptomatic is incompatible with the rigors of military service.” There was no 
history of trauma or bleeding. The Board considered alternative analogous coding under 7112 
(Aneurysm, any small artery) or 8009 (Brain, vessels, hemorrhage) and could find no path to 
coding to qualify for any higher rating than 0% under VASRD §4.31 (0 % evaluations). The 
Board considered other coding under the central nervous system and vascular system, but 
could find no better coding than 9199-7113, analogous to arteriovenous fistula, traumatic, and 
noted that there were no deficits or sequellae, including the member’s right eye vision changes 
correctable to 20/20, that could be directly related to the presence or service aggravation of 
the AVM itself, according to the service treatment record (STR). After due deliberation, 
considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the 
Board concluded that there was insufficient cause to recommend a change in the PEB 
adjudication for the AVM condition. 

 

Contended PEB Conditions. The contended conditions adjudicated as not unfitting by the PEB 
were ITBS and hearing loss. The Board’s first charge with respect to these conditions was an 
assessment of the appropriateness of the PEB’s fitness adjudications. The Board’s threshold for 
countering fitness determinations is higher than the VASRD §4.3 (Resolution of reasonable 
doubt) standard used for its rating recommendations, but remains adherent to the DoDI 
6040.44 “fair and equitable” standard. 

 

Chronic Iliotibial Band Syndrome. The CI stated his left knee was injured while rappelling out of 
a helicopter in 1998. The record shows he had several courses of physical therapy, ultrasound 
phonophoresis with steroids, anti-inflammatory medications steroid injections and eventually a 
left neoprene knee brace in Jan 2002 all directed at the IBTS. Although both knees are 
frequently mentioned in the STR, the left knee was usually more painful and symptomatic than 
the right. Treatments were aimed at correcting subtle left leg length differences with ¼ inch 
left lift shoe in 2001, and participation in run-walk programs. The CI underwent multiple knee 
MRI exams, and had numerous P/L2 and P/L3 profiles. 

 

The Board considered if there was a preponderance of evidence that the left knee condition 
would have rendered the CI unfit for duty. The Board considered the commander’s statement 
about the CI’s L2 profile knee causing the CI a “lack of agility” and found no other STR evidence 


to support this. The Board found evidence that the CI had continued to successfully pass two 
12 mile road marches, the first in May 2002 and the second in August 2003, despite his left 
knee condition. The Board noted that the CI passed his modified Army Physical Fitness Test in 
March 2004, 9 months prior to separation. The Board noted the L2 profile knee condition did 
not limit the CI’s ability to deploy. The Board noted that the CI was preparing to deploy in May 
2004, under ongoing permanent knee L2 profile restrictions from April 2002, and that in all 
likelihood if it were not for the PEB deeming his AVM condition incompatible with the rigors of 
military service, he would have proceeded to deployment. Given this information, the Board 
opined that there was no preponderance of the evidence that the CI’s left knee condition would 
have been in and of itself unfitting. 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 fitness determination for the chronic IBTS condition and no 
additional disability rating is recommended. 

 

Hearing Loss. The Board turned its attention to the fit vice unfit determination for the CI’s left 
ear hearing loss. The Board noted that the commander’s letter referenced the CI’s poor 
hearing as causing difficulty with performing his duties of his MOS, despite him wearing a 
hearing aid. The audiologist evaluation indicated 100% speech discrimination in both ears and 
hearing loss between 250-2K cycles per second hearing frequency. The Board noted the CI was 
permanently profiled H2 hearing loss as “Moderate to mild mixed hearing loss from 250-3000 
Hz in the left ear,” without duty restrictions by the audiologist, but recommendations of “No 
exposure to noise in excess of 85dBA or weapon firing without the use of properly fitted 
hearing protection. Hearing aid issued to improve communication in quiet environments. 
Annual audiogram required.” 

 

The Board directed attention to its fitness recommendation based on the above evidence. The 
final profile was H1, despite prior H2 profile and audiogram evidence which fit an H2 profile. 
The Board noted that both H1 and H2 hearing profiles are not unfitting in the military police 
MOS. 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 fitness 
determination for the hearing loss condition and no additional disability rating is 
recommended. 

 

 

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 AVM condition and IAW VASRD §4.104, the Board 
unanimously recommends no change in the PEB adjudication. In the matter of the contended 
chronic IBTS and hearing loss conditions, the Board unanimously recommends no change from 
the PEB determinations as not unfitting. There were no other conditions within the Board’s 
scope of review for consideration. 

 

 

RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Large Arteriovenous Malformation of the Brain 

7199-7113 

0% 

RATING 

0% 



 

 


The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120427, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxx, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 
for xxxxxxxxxxxxxxxxx, AR20130005534 (PD201200421) 

 

 

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 xxxxxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)