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AF | PDBR | CY2012 | PD2012 01139
Original file (PD2012 01139.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx         CASE NUMBER: PD1201139
BRANCH OF SERVICE: NAVY  BOARD DATE: 20130521
Separation Date: 20020609


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty EM2/E-5 (5326/Combatant Swimmer [SEAL]) medically separated for wrist and eye injuries. He was found unconscious and beaten, the victim of an apparent mugging, in March 2001. He underwent multiple s urgeries and treatment regimens but was unable to be adequately rehabilitated to meet th e physical requirements of his r ating or sat isfy physical fitness standards and he was referred for a Medical Evaluation Board (MEB) . The wrist and eye conditions, characterized as “closed fracture of the scaphoid” and “traumatic optic neuropathy” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. The MEB also identified and forwarded sixteen other conditions (see rating chart below) for PEB adjudication. The PEB adjudicated the scaphoid and optic conditions as unfitting, rated 10% each . Twelve conditions were determined to be Category II: conditions that contribute to the unfitting condition and four conditions were determined to be Category III: conditions that are not separately unfitting and do not contribute to the unfitting conditions. The CI made no appeals, and he was medically separated.


CI CONTENTION: “My injuries are almost to mostly disabling, rendering me from a lifestyle of normalcy, also from job opportunities, from once had.”


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 ratings for the unfitting scaphoid and optic conditions are addressed below. Additionally, the Board acknowledges the CI’s implied contention for ratings of the various Category II and III conditions noted in the chart below and determined that they are included in the scope of review. Any conditions or contention either 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 Naval Records.


RATING COMPARISON:

Service IPEB – Dated 20020212
 VA - (1.5 to 2 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Closed Fracture of the Scaphoid (left)
5215 10% Postoperative Open Reduction Internal Fixation for Trans-scaphoid Perilunate Fracture Dislocation of Left Wrist 5215-5010 10% 20020410
Scar in Left Flexor Aspect of Wrist 7805 0% 20020410
Traumatic Optic Neuropathy
6009-6090 10% Traumatic Optic Neuropathy, Right Eye 6 009-6090 10% 20020425
Traumatic Optic Neuropathy w/ Visual Limitation of 20/40
Cat II
Limitation of Up gaze in the Right Eye       
Cat II
Right Orbital Fracture
Cat II Hypoglobus 6099 Not Service Connected
( NSC ) 		20020410
Right Hypoglobus Secondary to Orbital Floor Fracture
Cat II
Hypertropia
Cat II Hypertropia 6099 NSC 20020425
Exotropia
 Cat II No VA Entry
No entry
 Right Hemifacial Sensory Deficit 8307 10% 20020425
Right Wrist Fracture
Cat II Right Wrist Fracture 5299-5215 0% 20020410
Status Post Right Frontal Contusion
Cat II Right Frontal Lobe Contusion with Short Term Memory Loss,
Headaches & Pain to Loud Noises		 8045 10% 20020410
Frontal Lobe Contusions   
Cat III
History of Head Trauma
Cat II
Occupational Problems
 Cat II Occupational Problems NSC 20020410
Right Frontal Sinus Fracture, Not Considered Disqualifying
Cat II Frontal Sinus Fracture 6512 0% 20020410
Status Post Multiple Skull Fractures, Including a
Right Orbit and Bi-basilar Skull Fracture
Cat II Comminuted Right Zygomatic Complex Fracture, Post-Operative, wit h Residual Flattening of the Right Zygoma, Indented Right Temporal Area , and Auricular-To-Auricular Scar 7800 10% 20020410
Pneumothorax
 Cat III Pneumothorax 6899-6802 NSC 20020410
Resolved Cerebrospinal Fluid Rhinorrhea
 Cat III Basilar Skull Fracture With Resolved CSF Leak 8099 NSC 20020410
No Cognitive Disorder
 Cat III No Cognitive Disorder 9499 NSC 20020410
No Additional MEB/PEB Entries
 Other x 11 20020410
Combined: 20%
 Combined: 50%


ANALYSIS SUMMARY : The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which his service-incurred condition continues to burden him. The Board utilizes VA evidence proximal to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence . The Board’s authority as defined in DoDI 6044.40, however, resides in evaluating the fairness of Disability Evaluation System fitness determinations and rating decisions for disability at the time of separation. Post-separation evidence therefore is probative only to the extent that it reasonably reflects the disability and fitness implicati ons at the time of separation.

Closed Fracture of the Scaphoid Condition. There was one range - of - motion (ROM) evaluation in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Left Wrist ROM
(Degrees)
 MEB ~ 6.20 Mo. Pre-Sep
 Orthopedics ~5.5 Mo. Pre-Sep
 VA C&P ~ 2 Mo Post-Sep
Dorsiflexion (0-70)
 Not measured 55 0-40*
Palmar Flexion (0-80)
 65 0-70
Ulnar Deviation (0-45)
 0-30
Radial Deviation (0-20)
 0-15
Comment
Right hand dominant
 Left wrist in splint Grip strength: 155 on right, 110 on left without wrist pain; *with pain; lack of endurance; subjective stiffness with all ROM; mild atrophy left arm 4.5/5 motor strength of left handgrip, left wrist dorsi- , palmar flexors
§4.71a Rating
 10% 10% 10%

Following the trauma that the CI endured, he underwent an open reduction internal fixation ( ORIF) of the left wrist in June 2004 . The initial r eport of l imited d uty (LIMDU) B oard examination in April 2001 indicated that the left wrist was in a splint and would require suture removal and cast placement. The r eport of m edical B oard narrative summary ( NARSUM ) examination In December 2001, approximately 6 months prior to separation , noted that the left wrist was still being splinted. No other physical examination findings were reported. An a ddendum to the MEB NARSUM approximately 6 months prior to separation noted that the CI had undergone a course of hyperbaric oxygen treatments to help with healing of the scaphoid fracture. The examiner noted that a CT scan in November 2001 showed evidence of bridging bone but incomplete healing of the scaphoid. The examiner opined t hat it was unclear whether the function would return to allow resuming of the CI’s work or if he might require further surgery. An orthopedic note 4 months prior to separation indicated that, 9 months after the ORIF, the CI stated his wrist felt good overall. He had no pain at rest but had minor discomfort with heavy use. There had not been any interval change on X-ray and the CI still required continued Physical Medicine and Rehabilitation therapy and occupational therapy (OT). The VA Compensation and Pension (C&P) examination approximately 2 months after separation documented that there was left wrist stiffness, aching slight fatigue, and lack of endurance with overuse as well as with cold weather. The C&P physical exam findings are summarized in the chart above.

The Board directs attenti on to its rating recommendation based on the above evidence . The PEB coded the “closed Fracture of the Scaphoid ” as 5215 w rist, limitation of motion condition of , and rated 10% ( d orsiflexion less than 15º). The VA coded t he p ostoperative ORIF for trans scaphoid p erilunate f racture d islocation of l eft w rist as 5215 with 5010 a rthritis, due to trauma, substantiated by X-ray findings and rated at 10%. All exams prior to separation indicated pain limited motion, stiffness, and weakness. A CT scan found incomplete healing of the scaphoid bone. After due deliberation, considering all of the evide nce and mindful of VASRD §4.3 ( Reasonable doubt ) , the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the c losed f racture of the scaphoid condition.

Traumatic Optic Neuropathy Condition: The PEB rated the traumatic optic neuropathy with visual limitation of 20/40, limitation of up gaze in the right eye, right orbital fracture, hypertropia and exotropia and status post multiple skull fractures, Including a right orbit and bi-basilar skull fracture as Category II conditions (“Conditions that contribute to the unfitting condition”). Due to the trauma that the CI endured, he had extensive injury to the right eye and he sustained an optic nerve injury. While hospitalized, a CT scan of the face and orbit revealed a fracture of the zygomaticomaxillary complex of the right eye orbit, right sphenoid, right base of skull pterygoid, and mandibular condyle. The initial Report of LIMDU Board examination in April 2001 noted that the CI had undergone a surgical correction of his right craniofacial fractures that included an ORIF of a right zygomatical complex fracture that same month. There were physical exam findings of right eyelid ptosis, limited ROM, vision of 20/50 using the Snellen chart, and some facial asymmetry. The ear, nose, and throat (ENT) exam noted right eye extraocular movements (EOM’s) of limited upward gaze, strabismus, pupillary constriction, and right eye lags. The neurosurgeon noted the right socket several millimeters lower than the left indicating the cause for baseline diplopia an abnormal fundus, some numbness over the right lower face, and diagnosed optic neuropathy with an afferent pupillary defect. The ophthalmologist diagnosed right eye optic neuropathy. The second MEB NARSUM exam indicated a right eye slight hypo-ophthalmic state, right sided visual problems, and a slight degree of facial asymmetry in the area of the right zygoma and temporal region. An ophthalmology consult approximately 6 months prior to separation indicated vision in the right eye 20/40; a right pupil one millimeter larger than the left; 1+ afferent pupillary defect; a decrease in motility to move his right eye upwards when abducted and adducted; a 10 prism diopter exotropia and a 2 prism diopter left hypertropia; a right hypoglobus of two millimeters; and a posterior segment exam revealed 1+ pallor of his optic nerve with an increase in the size of 0.6. The examiner opined that the optic neuropathy would limit his visual recovery; it was unlikely in his right eye would ever improve past the 20/40 level; and the strabismus and right hypoglobus was not amenable to surgical correction at that time. The C&P eye exam approximately a month after separation indicated EOM’s with limited right eye superior gaze; mild to moderate enopthalmus and the examiner opined strabismus in superior gaze from the orbital fracture, and enopthalmus from the orbital fracture. The second C&P exam documented that the CI complained of diplopia on looking to the left; that when he looked to the right upper side, the eye deviated medially and became asymmetric to the right eye; and that he needed to wear sunglasses due to light sensitivity. The physical exam findings were that the right eye was lower than the left; the right zygoma was flattened with decreased sensation of the entire right side of the face; the pupils showed isocoria with the right pupil being 5 millimeter; the pupils were slow to react to light; optic atrophy was present; and when the CI looked up, the left eye turned to the left medial aspect causing diplopia.

 The Board directs attention to its rating recommendation based on the above evidence. The PEB coded the t raumatic o ptic n europathy condition as 6009 unhealed eye injury with 6090 Diplopia (31 degrees to 40 degrees- u p-20/40 [ 6/12 ] ) rated 10%. The VA used the same code as the PEB and rated the condition 10%. Ther e was ample documentation in al l the exams prior to separation regarding the multiple eye related injuries , diplopia, and limited eye motion . The o phthalmology consults noted findings of vision in the right eye 20/40 and a decrease in motility to move his right eye upwards when abducted and adducted. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the traumatic optic neuropathy condition.

Contended PEB Conditions. The contended conditions adjudicated by the PEB as contributing to an unfitting condition (Category II) were:

A. Conditions that contribute to unfitting closed Fracture of the scaphoid (left wrist) condition
         right wrist fracture

B. Conditions that contribute to the unfitting Traumatic Optic Neuropathy condition
         1. Right orbital fracture
         2. Right hypoglobus secondary to orbital floor fracture
         3. Hypertropia
         4. Traumatic optic neuropathy with a visual limitation of 20/40
         5. Exotropia
6. Limitation of upgaze in the right eye
         7. History of head trauma
8. Status post right frontal contusion
9. Occupational problems
10. Right frontal sinus fracture, not considered disqualifying
11. Status post multiple skull fractures, including a right orbit and basilar skull fracture

The contended conditions adjudicated by the PEB as not separately unfitting and not contributing to an unfitting condition (Category III) were:
1. Frontal lobe contusions
2. Pneumothorax
3. Resolved cerebrospinal fluid rhinorrhea
4. No cognitive disorder

The Board’s first charge with respect to these conditions is 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 (Reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.

 Right Wrist Fracture Condition : T he PEB determined that the right wrist fracture condition was related to the closed fracture of the scaphoid condition and therefore did not assign a separate rating for it. However, the closed fracture of the scaphoid condition affected the left wrist. The Board considered if the right wrist fracture condition was unfitting , as a condition separate fr om the left wrist fracture. The service treatment records (STRs) document that at the time of the CI’s original injury in March 2001, he sustained bilateral wrist fractures. The MEB NARSUM completed in July 2001 listed both left and right wrist fractures as diagnoses. It noted the left wrist was in a splint and it required ongoing treatment but did not include any further details about the right wrist. An MEB NARSUM a ddendum completed a week later, noted the left scaphoid fracture had not yet healed and would require further treatment but did not mention the right wrist. The MEB physical recorded on the SF 88 in November 2001 had no information about the right wrist. No LIMDU profile was available in the STR for the Board to review. The non- medical assessment (NMA) noted the CI’s medical condition required 40 hours per week away from duties and that he was on light duty, unable to fire a weapon, and was not worldwide assignable . The C&P exam completed 2 months prior to separation noted the CI’s right wrist fracture had been treated with a splint for a few weeks. At the time of the examination, the CI had stiffness of the right wrist as well as an ache with overuse and cold weather (the CI had these same issues with his left wrist). No weakness, swelling, instability was present but the CI did report slight fatigue and lack of endurance. The C&P noted the CI is right-handed. The physical findings are summarized in the chart below.

 There was one ROM evaluation in evidence, with documentation of additional ratable criteria, which the Board weighed in arriving at its rating recommendation; as summarized in the chart below.

Right Wrist ROM
(Degrees)
 VA C&P ~ 2 Mo. Pre-Sep
Dorsiflexion (70 Normal)
 55
Palmar Flexion (80)
 80
Ulnar Deviation (45)
 30
Radial Deviation (20)
 20
Comment
Right hand dominant
 Subjective pain over the dorsal wrist with dorsiflexion written in the text; ROM chart stated dorsiflexion was 0-55 degrees without pain; no heat, redness, swelling, or effusion
§4.71a Rating
 0%

The Board directs attention to its rating recommendation based on the above evidence. The PEB adjudicated the r ight w rist f racture as Category II condition (“Conditions that contribute to the unfitting condition”). The VA coded the condition analogous to 5215 w rist, limitation of motion of and rated 0% base d on th e lack of painful motion . Although the CI suffered a wrist fracture and it required splinting , there was minimal documentation in the STR. At the VA exam, there were no findings of instability, swelling, or weakness and the physical exam showed only a limitation of dorsiflexion and a slight limitation of ulnar deviation. The record c ontained conflicting evidence concerning the presence or absence of painful motion. 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 r ight w rist fracture condition.

Conditions that contribute to the unfitting Traumatic Optic Neuropathy
 Condition number s 1 through 6 : All of these conditions contribute to the same ophthalmologic functional limitation rated as the unfitting t raumatic o ptic n europathy condition and therefore cannot be rated as separate conditions.

 Conditi on number s 7 and 8 : These conditions are not medically related to the unfitting t raumatic o ptic n europathy condition and have different functional limitations . These conditions will be addressed below.

Condition number s 9 through 11 : These conditions are not medically related to the unfitting t raumatic o ptic n europathy condition but do not have any associated functional limitations that would render the CI unfit for duty. The frontal sinus fracture and multiple skull fractures including a right orbit and basilar skull fractures were treated and, although some symptoms continued, none rose to the level of unfitting. The VA noted residual chronic nasal congestion and decreased airflow from the right naris. However, this would not render the CI unfit for duty. The VA also noted moderate disfigurement related to the facial fracture and scar. However, this also would not render the CI unfit for duty. 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 these fracture conditions. The o ccupational problem condition was diagnosed by psychiatry but was not considered a major psychiatric diagnosis. The CI’s Global Assessment of Functioning ( GAF ) was assessed at 80, indicating no more than a slight impairment in social, occupational, or school functioning. 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 occupational problem condition .

Conditions not separately unfitting and not contributing to an unfitting condition (Category III)
Condition number 1 : The f rontal lobe contusions condition is related to conditions 7 and 8 above and will be discussed below along with them .

Condition number s 2 through 4 : These conditions do not have any associated limitation of function that would render the CI unfit for duty. The p neumothorax and r esolved cerebrospinal fluid rhinorrhea conditions had resolved by the time of separation and the absence of a c ognitive disorder condition, as evidenced by neuropsychiatric testing, cannot be considered unfitting. The pneumothorax was treated and resolved. There were no further complaints of difficulty breathing, hemoptysis, or exertional dyspnea. 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 p neumothorax condition. The c erebrospinal fluid rhinorrhea that occurred with the initial injury resolved with conservative management and did not recur. 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 c erebrospinal fluid rhinorrhea condition. Neuropsychiatric testing in October 2001 documented evidence that ruled out a cognitive disorder and the testing was considered adequately reliable and valid. 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 c ognitive disorder condition.

History of head trauma, Status post right frontal contusion, and Frontal lobe contusions conditions : The STR only indicates the CI was on light duty and no description of specific duty limitations is available. However, the n eurologic a ddendum to the NARSUM noted the CI should not engage in any activity that puts him at risk to fall or strike his head for at least a year and he was to do no contact sports. These restrictions would significantly interfere with the CI’s ability to perform the duties required of his rank and rating. The NMA did not mention any specific condition but noted the C I was currently assigned to a billet inappropriate for a SEAL because of his level of medical injuries. All Board members agreed that the h istory of head trauma condition would have rendered the CI incapable of continued service within his Rating, and accordingly it merits a separate rating.

The CI experienced a variety of traumatic brain injury (TBI) symptoms from the assault . The CI underwent several surgeries to repair the skull and facial fractures. The initial MEB NARSUM documented that frontal lobe contusions showed good resolution. Because of the head injury, the CI was treated with Dil antin as a seizure precaution and it was noted that there had not been any seizure activity to date. His behavior was found to be minimally cooperative given the amount of pain from the multiple injuries. The examiner noted tha t the CI had good memory recall and was oriented to person, place, and thing; however , it was noted that the CI seemed to perseverate on some issues. The Dilantin levels were non-therapeutic at 7.5 to 3.8 (normal 10-20). The report of the initial Neurop sycho logical testing on 26 April 2001 is not available for Board review, but the results were reporte d in the subsequent test report discussed below and in the psychiatric a ddendum to the MEB NARSUM . This initial testing revealed impairments in visual learning/memory and diminished performances on tests of vocabulary skills, cognitive flexibility, sequential thinking, verbal reasoning, visuom o t o r tracking , and visual construction. The n europsychology evaluation approximately 5 months prior to separation indicated that the CI still had intermittent feelings of dysphoria and frustration secondary to limitations in activities. Most of the test results were in the average or above average range. However, results were in the low average range for working and short-term memory. After a battery of neuropsychological testing, the results determined no cognitive disorder was present despite history of head trauma. The examiner opined that the CI appeared to have made a “full and relatively rapid recovery from a significant head injury” and that “from a neuropsychological perspective , ” the CI was “fit for full duty status . ” A psychiatric a ddendum to the MEB exam approximately 5 months prior to separation indicated that the CI ’s initial neuropsychological testing revealed impairments in visual learning, memory, diminished performances on vocabulary skills, cognitive flexibility, sequential thinking, verbal reasoning, v isu omotor tracking , and visual construction. The MEB examiner documented that the CI easily became angry and depressed and that these episodes lasted from several hours to several days; he was more easily irritated; he was serious and had a restricted affect; he had so me difficulty with serial seven s ; and his mini- mental exam showed remote memory was grossly intact. An overall GAF was 80 (If symptoms are present they are transient and expectable reactions to psychosocial stressors) and the examiner opined tha t the CI was deemed psychiatrically fit and suitable for full duty. Neither the MEB NARSUM nor any of the addenda provided any information about the presence or absence of headaches at the time of the completion of these examinations . The n eurologic a ddendum completed approximately 5 months prior to separation noted that , at the previous n eurosurgery follow-up (unknown date) , the CI denied headaches, memory dysfunction, and personality changes. The CI marked “no” for the frequent or severe headache item on the r eport of m edical h istory SF Form 93 completed for the MEB in November 2001, 6 months prior to separation . The C&P exam completed 2 months prior to separation noted short-term memory issues as well as weekly severe throbbing frontal headaches . These headaches were accompanied by photophobia and phonophobia and were relieved b y taking Tylenol and lying down. The C I had not had these headaches prior to his assault. The CI also reported loud noises were very painful , he was light sens itive and required sunglasses, and he was occasionally hypersensitive to touch. The physical examination noted short-term memory of 3/5 objects at five minutes. Additionally, a follow-up C&P examination in January 2005 noted continued headaches and short-term memory issues. A much later C&P examination in July 2010 documented continued headaches as well as multiple long-term effects of the head injury .

invalid font number 31502 The Board directs attention to its rating recommendation based on the above evidence. 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He also documented short-term memory loss, pain with invalid font number 31502 loud invalid font number 31502 noises, light invalid font number 31502 sensitivity requiring invalid font number 31502 sunglasses invalid font number 31502 , and invalid font number 31502 invalid font number 31502 occasional invalid font number 31502 hypersensitiv invalid font number 31502 ity invalid font number 31502 to touch. The Board adjudged that the C&P examination was closer to invalid font number 31502 , but still prior to, separation invalid font number 31502 and therefore had the higher probative value. invalid font number 31502 The CI separated prior to the introduction of the current TBI rating criteria. The VASRD in effect at the time of separation noted that purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, wo invalid font number 31502 uld be rated 10% and no more. This 10% invalid font number 31502 rating would not be combined with any other rating for a disability due to brain trauma. The invalid font number 31502 CI’s subjective complaints of headaches and short-term memory problems invalid font number 31502 as well as short-term memory problems invalid font number 31502 documented on neuropsychology testing support a 10% rating. invalid font number 31502 invalid font number 31502 After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was sufficient cause to recommend a change in the PEB fitness determination for the invalid font number 31502 h invalid font number 31502 istory of head trauma invalid font number 31502 condition. Considering all of the evide invalid font number 31502 nce and mindful of VASRD §4.3 invalid font number 31502 ( invalid font number 31502 Reasonable doubt invalid font number 31502 ) invalid font number 31502 , the Board recommends a disability rating of invalid font number 31502 10 invalid font number 31502 % for the invalid font number 31502 h invalid font number 31502 istory of head invalid font number 31502 invalid font number 31502 trauma invalid font number 31502 condition. invalid font number 31502


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 c losed f racture of the s caphoid condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the t raumatic o ptic n europathy condition and IAW VASRD §4. 79 , the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended h istory of h ead t rauma condition, the Board unanimous ly agrees that it was unfitting and unanimously recommends a disability rating of 10%, coded 8045 IAW VASRD §4.124a. In the matter of all other contended 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 recommends that the CI’s prior determination be modified as follows ; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
Closed Fracture of the Scaphoid
5215 1 0%
Traumatic Optic Neuropathy
 6009-6090 10%
History of Head Trauma
8045 10%
COMBINED
 3 0%



The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 120707 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans ’ Affairs Treatment Record





xx
President
Physical Disability Board of Review
invalid font number 31502

MEMORANDUM FOR DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
          COMMANDER, NAVY PERSONNEL COMMAND
                                          
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) PDBR ltr dtd 9 Aug 13 ICO
(c) PDBR ltr dtd 17 Jul 13 ICO
(d) PDBR ltr dtd 16 Jul 13 ICO
(e) PDBR ltr dtd 9 Aug 13 ICO
(f) PDBR ltr dtd 9 Aug 13 ICO
(g) PDBR ltr dtd 29 Jul 13 ICO
(h) PDBR ltr dtd 8 Aug 13 ICO

1. Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (h).

2. The official records of the following individuals are to be corrected to reflect the stated disposition:

a. former USMC : Disability separation with a final disability rating of 20 percent (increased from ten percent) effective 15 October 2001.

b. former USN : Disability retirement with assignment to the Permanent Disability Retired List with a 40 percent disability rating (increased from 20 percent) effective 2 May 2003.

c. former USN : Disability retirement with assignment to the Permanent Disability Retired List with a 30 percent disability rating (increased from 20 percent) effective 2 June 2009.

d. former USN : Disability separation with a final disability rating of 20 percent increased from ten percent) effective 5 October 2004.

e. former USMC : Disability separation with a final disability rating of 20 percent (increased from ten percent) effective 31 July 2002.

f. former USMC : Disability separation with a final disability rating of 20 percent (increased from ten percent) effective 1 August 2005.

g. former USMC : Disability separation with a final disability rating of 20 percent (increased from ten percent) effective 2 July 2002.
        
3. Please ensure all necessary actions are taken, included the recoupment of disability severance pay if warranted, to implement these decisions and that subject members are notified once those actions are completed.

 xx
                                                       Assistant General Counsel
                                                      (Manpower & Reserve Affairs)
 invalid font number 31502

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  • AF | PDBR | CY2009 | PD2009-00629

    Original file (PD2009-00629.docx) Auto-classification: Denied

    If the CI were instead rated under codes for vertigo and headache, the rating would be more favorable to the CI. Minority Opinion : The Action Officer recommends separate migraine headaches and vertigo coding and rating in this case regarding the very strong evidence of the migraine headaches and vertigo as separately unfitting conditions. To say that a 10% rating more accurately reflects the disability picture of the CI, rather than the use of an alternate scheme that rates the individual...

  • AF | PDBR | CY2013 | PD-2013-01362

    Original file (PD-2013-01362.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination. Accordingly, the Board recommended no re-characterization or modification of your separation.I have carefully reviewed the...

  • AF | PDBR | CY2014 | PD-2014-01252

    Original file (PD-2014-01252.rtf) Auto-classification: Denied

    RATING COMPARISON : FPEB – 20090325 VA Rating Decision 1 - 20120227TDRL Placement – 20070725 CodeRatingConditionCodeRating Proximate ConditionTDRLPlacementTDRL RemovalTDRL 2 TDRL 3 Removal Fractured Right Dominant Scaphoid…5299-521230%---Right Wrist Fracture5003-5215NA10%Arthritis Due to Trauma, Right (Dominant) Wrist5010---10%Other x 1 (Not in Scope)Other x 2 RATING: 30% → 10%RATING: 20% 1. BOARD FINDINGS : IAW DoDI 6040.44, provisions of DoD or Military Department regulations or...

  • AF | PDBR | CY2011 | PD2011-00455

    Original file (PD2011-00455.docx) Auto-classification: Approved

    (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. Under VASRD §4.124a, for code 8045 effective the CI’s date of separation: RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows; and, that the...

  • AF | PDBR | CY2011 | PD2011-00248

    Original file (PD2011-00248.docx) Auto-classification: Denied

    Neurologic examination performed on December 3, 2004 was normal and he was ambulating without difficulty. However, the Board also noted residuals of frontal lobe injury not merely restricted to mild memory dysfunction that included problems other cognitive functions (decreased verbal processing, attention, and concentration), irritability, anger, and problems with impulse control reflected in neuropsychological testing and the initial VA mental health clinic encounter 9 months after...

  • AF | PDBR | CY2013 | PD2013 01539

    Original file (PD2013 01539.rtf) Auto-classification: Approved

    The CI non-concurred and the Reconsideration PEB only adjudicated the “posttraumatic arthritis, right ankle…” as unfitting, rated 10%, identifying all other conditions as not unfitting. Right Ankle Condition . Physical Disability Board of Review

  • AF | PDBR | CY2009 | PD2009-00544

    Original file (PD2009-00544.docx) Auto-classification: Approved

    The CI was referred to the Physical Evaluation Board (PEB), determined unfit for Deafness in Left Ear with Tinnitus, and separated at 10% disability using the Veterans Affairs Schedule for Ratings Disabilities (VASRD) and applicable Air Force and Department of Defense regulations. At this time he no longer had any vertigo, incoordination, or headaches but continued to have tinnitus, absolute hearing loss in the left ear, and left facial nerve palsy. The 2008 PEB determined the CI was unfit...

  • AF | PDBR | CY2014 | PD-2014-01693

    Original file (PD-2014-01693.rtf) Auto-classification: Denied

    invalid font number 31502 Service IPEB – Dated 20060316VA - (3 Mos. Chronic Upper Back Pain Condition . The CI was seen in pain managementprior to deploying for pain medications due to the chronic clavicle and shoulder pain.

  • AF | PDBR | CY2013 | PD-2013-01431

    Original file (PD-2013-01431.rtf) Auto-classification: Denied

    invalid font number 31502 invalid font number 31502 Service IPEB – Dated 20040225VA* - Based on Service Treatment Records (STR)ConditionCodeRatingConditionCodeRatingExam Chronic Subjective Back Pain with L4-5 Spondylolisthesis523910%Degenerative Disc Disease (DDD) and Spondylolisthesis5239-523540%STRChronic Arthritis Right Knee5003---%Arthritis, Right Knee5010-525910%STROther x0 (Not in Scope)Other x0 (Not in Scope) Combined: 10%Combined: 50%*Derived from VA Rating Decision (VARD) dated...

  • AF | PDBR | CY2012 | PD2012 01789

    Original file (PD2012 01789.rtf) Auto-classification: Approved

    The PEB adjudicated “chronic bilateral knee pain secondary to bilateral patella-femoral arthrosis, s/p bilateral lateral retinacular release”as unfitting, rated 0% with application of the VA Schedule for Rating Disabilities (VASRD).The sixremaining conditions were determined to be not unfitting. Pre-SepLeftRightLeftRightFlexion (140 Normal)140135> 105>105Extension (0 Normal)00CommentStable kneeStable kneePainful motion noted at MEB§4.71a Rating10%10%10%10%*The MEB ROM numbers are from the...