RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  MARINE CORPS 

 
NAME:  XXXXXXXXXXX                                             
CASE NUMBER:  PD1200535                                               SEPARATION DATE:  20020228 
BOARD DATE:  20130118 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered individual (CI) was an active duty LCPL/E-3 (9971/Basic Marine), medically separated 
for  bilateral  upper  extremity  paresthesias  status  post  (s/p)  suboccipital  craniectomy  (SOC) 
duraplasty  secondary  to  Chiari  malformation.    The  CI  fainted  during  a  vaccination  in  1999, 
struck his head and suffered loss of consciousness (LOC) for about 10 seconds with amnesia for 
the  incident.    He  developed  post-concussive  headaches  and  was  placed  on  limited  duty 
(LIMDU).    During  the  LIMDU,  he  was  found  to  have  a  congenital  Chiari  malformation  while 
being  evaluated  for  the  headache.    He  subsequently  had  suboccipital  craniectomy  and 
duraplasty for the Chiari malformation.  He was also noted to have bilateral upper extremity 
paresthesias following the concussion.  The CI did not improve adequately with treatment to 
meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness 
standards.    Again,  the  CI  was  placed  on  LIMDU  and  referred  for  a  Medical  Evaluation  Board 
(MEB).    The  MEB  determined  “status  post  suboccipital  craniectomy  duraplasty”  as  medically 
unacceptable.  It was the only condition forwarded to the Informal Physical Evaluation Board 
(IPEB) for adjudication.  The IPEB adjudicated the condition as unfitting on 10 January 2001, but 
determined the condition to have existed prior to service (EPTS)  without service aggravation 
and  therefore  was  not  ratable.    The  CI  appealed  his  IPEB.    His  first  Formal  PEB  (FPEB),  on 
13 March  2001,  found  him  unfit  for  a  cranial  defect  and  rated  him  at  10%.    The  CI  filed  a 
Petition for Relief (PFR).  The Secretary of the Navy’s Council of Review Boards denied his PFR, 
determined his condition to be EPTS, and not service aggravated.  Because this was an adverse 
finding, the CI was automatically granted a second FPEB.  This was conducted on 27 November 
2001 with legal representation for the CI.  The FPEB noted that the rating of the suboccipital 
skull  defect,  which  precluded  the  wear  of  a  Kevlar  helmet,  was  prohibited  by  SECNAVINST 
1850.4D, Enc (9), para 1.(25)(e), pg 9-17 as a known and predictable side effect of the surgical 
treatment  of  the  underlying  EPTS  condition.    The  CI  was  rated  for  bilateral  upper  extremity 
(BUE)  paresthesias,  10%  each  extremity,  which  followed  a  head  injury  and  concussion  and 
preceded the surgery.  The second FPEB also noted that the post-concussive headaches, initially 
severe  and  incapacitating,  for  which  the  CI  contended,  had  improved,  and  would  not  be 
considered unfitting and were therefore not ratable.  The CI made no further appeals and was 
then medically separated with a 20% combined disability rating.   
 
 
CI CONTENTION:  The CI listed the following conditions: cervical strain, paresthesias upper right 
extremity,  attention  deficit, 
residuals  scar-post  suboccipital  craniotomy  duraplasty, 
hyperactivity, chiari malformation, paresthesias left upper extremity, headaches, TBI, Lumbar 
strain w/nerve damage.  The CI elaborated no specific contention in his application.   
 
 
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 Board determined that the unfitting 
suboccipital craniectomy duraplasty and subsequent scar as well as the BUE paresthesias to be 
within  its  purview.    The  other  requested  conditions  (cervical  strain,  attention  deficit, 

hyperactivity, headaches, TBI, lumbar strain with nerve damage) are outside the 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 Naval Records.   
 
 
RATING COMPARISON:   
 

Rating 

VA (13 Mos. Pre-Separation) – All Effective Date 20030301 
Condition 

Rating 

Code 

Exam 

Code 

8516 

suboccipital 
duraplasty 
Chiari 

Service FPEB – Dated 20011127 
Condition 
S/P 
craniectomy 
secondary 
Malformation, RIGHT 
S/P 
craniectomy 
secondary 
Malformation, LEFT 

suboccipital 
duraplasty 
Chiari 

to 

to 

8516 

↓No Additional MEB/PEB Entries↓ 

Combined:  20% 

10% 

RUE Paresthesias 

8716 

0%* 

20010126 

10% 

LUE Paresthesias 

8716 

0%* 

20010126 

s/p 
craniectomy 
w/residual 

Chiari  Malformation, 
suboccipital 
duraplasty 
headaches 
Cervical Strain 
Scar, 
craniotomy duraplasty 
0% X 0 / Not Service-Connected x 1 
Combined:  30% 

suboccipital 

skull 

s/p 

8099-8009 

5299-5290 
7800 

10%** 

20010126 

10%# 
10% 

20010126 
20010126 

20010126 

*The VARD dated 20071212 for a new claim then changes and rates as listed in chart above-breaking out each upper extremity 
and rating each at 0% effective 20020301 and then increasing them to 10% effective 20070309.   
**The  Original  VARD  has  8099-8008  Chiari  malformation,  s/p  SOC  duraplasty  with  residual  paresthesias  of  BUE  rated  10%.  
Increased to 30% effective 20091217 and coded 8099-8100.  Increased to 50% effective 20101215. 
#Increased to 20% effective 20091217. 
TBI added at 10% effective 20101215. 
 
 
ANALYSIS SUMMARY:  The Disability Evaluation System (DES) is responsible for maintaining a fit 
and  vital  fighting  force.    While  the  DES  considers  all  of  the  member's  medical  conditions, 
compensation  can  only  be  offered  for  those  medical  conditions  that  cut  short  a  member’s 
career, and then only to the degree of severity present at the time of final disposition.  The DES 
has neither the role nor the authority to compensate members for anticipated future severity 
or  potential  complications  of  conditions  resulting  in  medical  separation  nor  for  conditions 
determined  to  be  service-connected  by  the  Department  of  Veterans  Affairs  (DVA)  but  not 
determined to be unfitting by the PEB.  However the DVA, operating under a different set of 
laws  (Title  38,  United  States  Code),  is  empowered  to  compensate  all  service-connected 
conditions  and  to  periodically  re-evaluate  said  conditions  for  the  purpose  of  adjusting  the 
Veteran’s disability rating should the degree of impairment vary over time.  The Board’s role is 
confined to the review of medical records and all evidence at hand to assess the fairness of PEB 
rating  determinations,  compared  to  Veterans  Affairs  Schedule  for  Rating  Disabilities  (VASRD) 
standards,  based  on  severity  at  the  time  of  separation.    The  Board  also  noted  that  DoDI 
1332.38; E3.P4.5.6. “Treatment of Pre-Existing Conditions” specifies that “generally recognized 
risks  associated  with  treating  preexisting  conditions  shall  not  be  considered  service 
aggravation.” 
 
S/P  SUBOCCIPITAL  CRANIECTOMY  DURAPLASTY  SECONDARY  TO  CHIARI  MALFORMATION 
Condition.  On 19 August 1999, the day after accession, the CI was receiving vaccinations when 
he fainted and hit his head with a 10 second LOC and amnesia for the event.  He had a small 
laceration, but his examination was otherwise unremarkable.  He fully recovered and was able 

   2                                                           PD1200535 
 

resonance 

imaging 

(MRI) 

resonance 

and  magnetic 

to return to training within a few days.  He again presented 20 December 1999 complaining of 
headaches  and  fainting.    At  a  neurology  referral  on  6  January  2000,  he  gave  a  history  of 
persistent headaches since the trauma which were followed by a LOC of several seconds to  
2 minutes.  The neurological examination including sensation was normal.  He was evaluated 
with  magnetic 
angiogram, 
electroencephalogram,  Holter  monitor,  echocardiogram,  and  found  to  not  to  have  an 
underlying neurological or cardiac problem on these tests.  Despite medications, his symptoms 
persisted and he was further evaluated with a CAT scan and MRI of the head; the latter showed 
cerebellar herniation and a diagnosis of congenital Chiari malformation were made.  A 24 April 
2000 neurology examination documented normal objective findings, but subjective numbness 
of  the  fingertips.    During  a  1  June  2000  neurology  evaluation,  his  examination  was  again 
normal.  On 20 June 2000 he was evaluated by neurosurgery and compression of the brainstem 
from the herniation was determined.  Slight weakness of the triceps and biceps was noted as 
well as slightly impaired joint position sense.  The CI’s 29 June 2000 neurology evaluation noted 
non-dermatomal subjective sensory complaints.  On 17 July 2000, a suboccipital craniectomy 
(SOC) with duraplasty was performed to relieve the pressure.  A 11 September 2000 neurology 
evaluation documented decreased sensation in the ulnar distribution of the hands.  He did well 
post-operatively  although  he  did  have  an  episode  of  viral  meningitis  on  1  November  2000.  
Although his pre-operative headaches improved, he continued to have difficulty with the wear 
of a Kevlar helmet and also noted duly impairment from sensory disturbances which were in an 
ulnar distribution bilaterally.  The MEB narrative summary was dictated on 4 October 2000, 17 
months prior to separation, by the treating neurosurgeon.  He noted that the post-operative 
skull  defect  and  scar  interfered  with  the  wear  of  the  Kevlar  helmet.    The  motor  and  cranial 
nerve examinations were normal.  Sensation was not addressed.  At the MEB examination on 
27 October 2000, the CI reported no specific complaints.  The MEB examiner made no specific 
annotations  regarding  the  neurological  examination.    At  the  VA  Compensation  and  Pension 
(C&P) examination on 26 January 2001, 13 months prior to separation, the CI reported a history 
of  headaches  and  forearm  numbness  without  comment  on  current  symptoms.    He  did  note 
chronic neck pain with weakness, stiffness, fatigue and lack of endurance.  On examination, he 
had normal posture and gait.  A disfiguring 12 cm post-surgical scar was documented.  The left 
dominant  CI  was  noted  to  have  normal  strength  in  BUE  and  both  lower  extremities  (BLE).  
Reflexes were normal, but sensation decreased to pinprick in the forearms.  No comment was 
made if it was in a dermatomal or peripheral nerve distribution.  A 29 January 2001 neurology 
note  documented  that  the  CI  was  symptom  free  for  headaches.    He  had  a  narrow  gait,  but 
some difficulty with tandem walking.  Muscle strength and tone were normal.  Sensation was 
decreased  to  pinprick  over  BUE  just  above  the  elbow  in  a  glove  distribution.    A  C&P 
examination on 9 July 2007 documented a normal sensory examination in all four extremities.  
The 29 January 2010 C&P examination noted that the sensory examination was inconsistent.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  determined  that  the  s/p  SOC  with  duraplasty  secondary  to  Chiari  malformation  was 
unfitting, and coded it 8516 for a mild impairment of the ulnar nerve.  It noted in the discussion 
that the sensory loss could be attributed to the underlying Chiari malformation, but that the 
history of the head trauma and concussion preclude a finding of natural progression.  The Board 
noted that the use of code 8616 for ulnar neuritis would have been more accurate, but that this 
provides no advantage to the CI.  The PEB also determined that the Chiari malformation and 
attendant surgery and post-operative residuals to be EPTS conditions and not ratable.  Type I 
Chiari malformation is considered to be a congenital condition and, by definition, EPTS.  IAW 
DoDI 1332.38; E3.P4.5.6., the treatment and sequelae of an EPTS condition are not considered 
service aggravation for the purpose of disability rating.  The VA rated the Chiari malformation 
with BUE paresthesias at 10%, coding it analogously to 8008, thrombosis of brain vessels.  The 
VA subsequently changed the coding to analogous to 8100, migraine headaches, and increased 
the  rating  to  30%  effective  17  December  2009  and  50%  effective  15  December  2010.    The 
12 December 2007 VA rating decision separated the paresthesias for each upper extremity and 

   3                                                           PD1200535 
 

loss. 

rated them 0% effective 1 March 2002 (separation) and 0% from 9 March 2007.  Both were 
coded 8716 for ulnar neuralgia.  The Board first considered the PEB adjudication that the Chiari 
malformation  was  congenital  and  therefore  an  EPTS  condition  and  concurred  with  this 
adjudication.  Accordingly, under DODI 1332.38, the surgical residuals are also not ratable.  The 
Board then considered the bilateral paresthesias of the upper extremities.  It noted that the 
neurology  examinations  showed  a  variable  distribution  of  the 
  Subsequent  VA 
examinations remote from separation were either normal or inconsistent.  The action officer 
opined  that  this  is  not  consistent  with  a  permanent  neurological  deficit  at  the  time  of 
separation.    However,  DoDI  6040.44  states  that  the  Board  cannot  recommend  a  lower  total 
combined rating than that adjudicated by the PEB.  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 Chiari 
malformation, s/p surgery, with bilateral upper extremity sensory deficits.   
 
 
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  s/p  suboccipital  craniectomy  duraplasty  secondary  to 
Chiari malformation condition and IAW VASRD §4.124a, the Board unanimously recommends 
no change in the PEB adjudication.  In the matter of the contended scar condition, the Board 
unanimously recommends no change from the PEB determination as an EPTS related condition.  
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 
Status Post Suboccipital Craniectomy Duraplasty with Right Upper 
Extremity Sensory Deficit 
Status  Post  Suboccipital  Craniectomy  Duraplasty  with  Left  Upper 
Extremity Sensory Deficit 
Post-operative scars 

VASRD CODE  RATING 
8516 

10% 

8516 
EPTS 

10% 
--- 

COMBINED (w/BLF)  20% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120505, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

   4                                                           PD1200535 
 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL 

                                  OF REVIEW BOARDS  
 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS 

Ref:   (a) DoDI 6040.44 

             (b) CORB ltr dtd 31 Jan 13 
 

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for 
the reasons provided in their forwarding memorandum, approve the recommendations of the PDBR 
that the following individual’s records not be corrected to reflect a change in either characterization 
of separation or in the disability rating previously assigned by the Department of the Navy’s 
Physical Evaluation Board: 
 
-    former USMC 
 
                  -    former USMC 
-    former USMC 
 
-    former USN  
 
-    former USN  
-    former USN  
-    former USN   

 
 

 

 

 
 
 
 

     

 

 
      
 

 
 
 

 
 
 

 
 
 

 
 
 

  XXXXXXXXXXXXX 
  Assistant General Counsel 
     (Manpower & Reserve Affairs) 

   5                                                           PD1200535