RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2013-00042
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20140108
SEPARATION DATE:  20091028

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-5 (3P071/Security Forces Craftsman) medically separated for migraine headaches.  By 2005 they continued to occur more frequently and became longer in duration.  The CI was diagnosed with chronic headaches and was treated with various medications but found little to no relief.  The headaches could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards. He was placed on limited duty and referred for a Medical Evaluation Board (MEB) within the DoD/VA Disability Evaluation System (DES) Pilot Program.  The chronic condition characterized as “severe headaches” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The MEB also identified and forwarded two other conditions (obstructive sleep apnea [OSA] and sleep walking for PEB adjudication.  The Informal PEB (IPEB) adjudicated “migraine headaches” as unfitting, rated 10% and the remaining conditions (OSA, bilateral plantar fasciitis, lumbosacral strain and acid reflux) were determined to be Category II,  can be unfitting but not compensable or ratable, and sleepwalking, Category III, not separately unfitting and not compensable or ratable.  The CI appealed to the Formal PEB (FPEB) which considered the proposed ratings by the VA and affirmed the PEB findings and rating.

CI CONTENTION:  The CI submitted two applications requesting review.  In his first submission, the CI states: “No consideration was given for other service connected ailments such as obstructive sleep apnea, parathyroid disease, memory loss or Post Traumatic Stress Disorder (PTSD).”  In his second submission, the CI states: “While serving on active duty, I was medically separated for migraine headaches.  I appealed the medical separation percentage through the AF medical appeals board.  My appeal was denied and I was medically separated with a 10% disability rating.  VA granted me 80% service connected disability IAW VASARD standards.  Ever since my separation, my neurological symptoms have decreased dramatically to include: temporary blindness (diagnosed by physicians as ocular migraines), prostrating headaches which causes me to miss more than more than 10 days per month of work etc.  Because of my worsening symptoms, I have been placed on strict regiment of headache prevention medicine as well as other narcotics. I also underwent parathyroid surgery in June 2011; at Bethesda Naval Center in Bethesda Maryland. I would like the board to review my case for medical retirement consideration.” 

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 headache condition is addressed below.  Additionally, the CI’s contention for a rating of his OSA condition is addressed below.  The remaining conditions requested; pararthyroid disease, memory loss or PTSD is not 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. The Board also acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the military Disability Evaluation System has neither the role nor the authority to compensate service members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans' Affairs, operating under a different set of laws.

RATING COMPARISON:

Service FPEB – Dated 20090727	VA - (6 Mos. Pre-Separation	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	10%	Migraine Headaches	8100	10%	20090107	
OSA	Not Unfitting	OSA	6847	50%	20090107	
Bilat Plantar Fasciitis	Not Unfitting	Bilat Plantar Fasciitis	5099-5020	10%	20090122	
Lumbosacral Strain	Not Unfitting	Lumbosacral Strain	5237	10%	20090122	
GERD	Not Unfitting	GERD	7399-7346	10%	20090122	
Sleepwalking	Not Unfitting	No VA Entry	
No Additional MEB/PEB Entries	Other x 4 	20090122	
Combined:  10%	Combined:  80%	
Derived from VA Rating Decision (VARD) dated 20090514 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:

Migraine Headaches.  The CI had a long history of headaches starting 25 October 1999.  In the VA pre-discharge examination on 2 November 2000, he reported headaches every other day, lasting 2 to 3 hours, not responding to medications and not taking any medications.  The exam documented a full workup including a CT scan of the head which was negative within the last 3 months prior to that examination.  On 27 January 2004, the CI reported “serious” headaches made his vision blurry.  On 14 September 2004, the CI reported increased intensity and daily frequency of headaches, with numbness of the left cheek.  He was evaluated by neurology on 4 April 2007 and did not deploy on January 2008.  Neuropsychiatric evaluation on 17 December 2007 for cognitive evaluation revealed that he had average grades in school, played varsity sports, had a 4-year college degree, in the USAF for 11 years, satisfied with his job in security forces, he was divorcing and separated from his wife for 7 months, and two children 4 and 2-years old.  The evaluation and testing was indicative of psychological rather than physical causation for his perceived cognitive defects.

The narrative summary dictated on 12 February 2009, 8 months prior to separation, notes the CI had worsening of headaches in Korea in 2005, missed work for emergency room (ER) visits, got quarters for headaches and was not able to perform full spectrum of his military duties.  At the VA Compensation and Pension neurological disorders exam performed on 7 January 2009, the CI reported daily headaches, frontal pain which eventually enveloped over the entire head, pressure lasting hours or days which may affect sleep when present at bedtime.  He reported that hardly a day went by that he was free of headaches.  Neurological exam was normal.  The diagnosis was chronic daily headache syndrome (chronic muscle contraction headaches).  The commander’s statement dated 27 January 2009 stated the CI was non-deployable due to his medical condition and that he had missed 5-10 days of work due to medical appointments or ER visits.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the migraine headache condition using VASRD diagnostic code 8100 (migraines) for a 10% rating.  The VA applied the same 8100 code with a rating of 10%.  The Board found one ER visit for dizziness and headache on 3 May 2009, and three clinic visits for headaches on 11 January 2008, 28 March 2008, and 7 May 2008, for a total of four visits within the 12 months prior to separation.  The evidence did not meet the VASRD description for a higher 30% rating of: “characteristic prostrating attacks occurring on an average once a month over last several months.”  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 migraine condition at the time of separation.

Contended Conditions.  The Board’s main charge with respect to these conditions is an assessment of the fairness of the PEB’s determination that they were not unfitting.  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.  An established principle for fitness determinations is that they are performance-based; and, the Board is confronted in this case with the lack of any evidence that the limitations imposed by the OSA condition prohibited the performance of the duties required of his AFSC.   

Obstructive Sleep Apnea Condition:  The CI was diagnosed with OSA by polysomnogram performed on 20 November 2007.  A CPAP and non-surgical therapy was recommended.  The CI had a tonsillectomy on 21 February 2008 due to enlarged tonsils.  Another polysomnogram was administered on 23 April 2008 with the CPAP.  The medical interpretation indicated “good sleep efficiency,” OSA ablated with CPAP.  The FPEB found no evidence which precluded him from adequately performing his duties or deploying and therefore determined the condition was not unfitting or ratable.  There were no profiled limitations for OSA.  The commander’s statement did not mention any related issues with the condition.  The latest Enlisted Performance Report (EPR) closing 1 September 2009 stated the CI was “truly among the best” and he received the highest marks for his duty performance including meeting physical fitness standards.  Board members agreed that there was no citable evidence which would challenge the PEB’s fitness conclusion; and, there were no clinical features or specific functional limitations which would render the condition inherently unfitting.

BOARD FINDINGS:  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 migraine headache condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the OSA condition and IAW VASRD §4.97, the Board unanimously recommends no change in the PEB adjudication 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	
Migraine Headaches	8100	10%	
COMBINED (w/ BLF)	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130722, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SAF/MRB

Dear XXXXXXXXXXXXXX:
Reference your application submitted under the provisions of DoDI 6040.44 (Title 10
U.S.C. § 1554a), PDBR Case Number PD-2013-00042.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,