RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXX	CASE:  PD-2013-01400
BRANCH OF SERVICE:  Army	BOARD DATE:  20141212
Separation Date:  20040407

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-4 (Automated Logistical Specialist) medically separated for headaches.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The headache condition, characterized as “chronic migraine headaches” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “chronic migraine headaches with history date back to 1991, prior to entry on active duty” as unfitting, but concluded based on “compelling evidence” that it “existed prior to service and there was no evidence of permanent service aggravation.”  Therefore, it was not rated.  The CI appealed to the Formal PEB (FPEB) which adjudicated “chronic migraine headaches with onset to 1991 while on a previous tour of active duty in 1991” rated 0% with application of the VA Scheduled for Rating Disabilities (VASRD).  The CI made no further appeals and was medical separated.

CI CONTENTION:  His condition has worsened and hasn’t gone away.  His complete submission is at Exhibit A.

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 FPEB – Dated 20040319	VA - (11 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Migraine Headaches	8100	0%	Migraine Headaches	8100	30%	20050301	
Other x 0 (Not in Scope)	Other x 0	
Rating:  0%	Combined:  30%	
Derived from VA Rating Decision (VARD) dated 20050309 (most proximate to date of separation [DOS])
Original VARD was not available for review.
ANALYSIS SUMMARY: 

Chronic Migraine Headache Condition.  The CI first experienced severe headaches in 1992 and was diagnosed with migraine headaches associated with anxiety and tension headache.  The CI was discharged in March 1992, joining the National Guard in October 2000.  In May 1996, a trans-cranial Doppler exam (ultrasonic study of the vessels in the brain) was completed and was consistent with migraine headaches.  He was followed by a civilian neurologist for ongoing medical treatment.  The migraines were sometimes accompanied by photophobia (sensitivity to light) with a rapid pain onset and sometimes lasting into the next day.  He was prescribed migraine specific medication.  In December 1999, the CI sustained head trauma and reported that his headaches worsened.  A magnetic resonance angiogram of the intracranial vessels and a brain magnetic resonance imaging study were both normal.  During 2001, the migraines showed a slight improvement with medication.  The CI’s civilian neurologist noted that the CI ran out of his migraine medication and that the migraines caused severe debilitating nausea and occurred every 10-14 days.  All of the migraine medication was renewed at that July visit.  The CI was activated in September 2002.  In December 2002, a neurologist noted that the CI was taking his medications and that he had an increase in migraines and did not think that he could stand in sunlight or in a dusty environment or do fitness training more than 10 minutes as there were all triggers for his migraine headaches.  The examiner documented that although the CI missed only one whole day of work and part of another day, he self-limited his activity.  The examiner opined that the headaches were poorly controlled with a minimum dose of medication and increased the medication doses.  The commander’s statement documented that the CI’s performance had been outstanding and there were no limitations in his current duty position and there was no mention of his migraine headaches impacting his MOS performance.  The MEB narrative summary exam approximately 7 months prior to separation documented that the CI had one headache per week with photophobia, sonophobia (sensitivity to loud noises) and almost complete disability.  Although the CI had his medication changed, he still noted a disabling headache weekly and was unable to perform his MOS duties.  The CI missed three half-days of work during the prior 5 months.  His physical exam was normal.  The examiner opined that the CI suffered from migraine headaches for approximately 12 years and although the frequency of the headaches had decreased from multiple events daily to one headache a week, they were still disabling.  The examiner further stated that although the CI’s absence from work was minimal, his ability to perform his job was in question.  The VA Compensation and Pension exam performed 10 months after separation documented that the CI experienced headaches three to four times per week, starting upon awakening and increased as the day went on.  The headaches were associated with nausea and visual problems.  The migraine medication reduced the severity of the headache but did not eliminate them.  Approximately two to three times per month, the CI was unable to function due to the severity of the headaches and had to remain in bed for the entire day.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded the chronic migraine headaches condition as 8100 and rated at 0%.  The VA coded the migraine headaches condition as 8100 and rated at 30%.  The VASRD does not define prostrating, complete, prolonged, or characteristic; therefore, the Board used the evidentiary standard of reasonable doubt (IAW VASRD §4.3) when weighing evidence.  To determine whether the CI met the criteria for a prostrating event, the Board considered evidence of the stoppage of work or current activity, measures taken to alleviate the headache (time off from work, accommodations like having to go to a darkened/quiet room), evidence of self-management (medications, sleep), treatment notes and the commander’s statement.  The MEB examiner opined that although the CI went to work daily when he had a severe disabling headache, he questioned his ability to perform his duties when this type of headache occurred.  Although the evidence is clear that the CI had migraines, the commander did not implicate the migraines in any way interfering with the CI’s MOS duties and documented that the CI’s performance had been outstanding and there were no limitations in his current duty position.  Board members agreed that the evidence exceeded the 0% rating criteria.  The Board discussed the 10% rating criteria - with characteristic prostrating attacks averaging one in 2 months over last several months versus the 30% rating criteria - with characteristic prostrating attacks occurring on an average once a month over last several months.  The Board strongly considered the commander’s statement and the evidence that the CI, on average, missed less than one day of work a month over the past 5 months due to his headaches.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic migraine headache 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 FPEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the chronic migraine headache condition, the Board unanimously recommends a disability rating of 10%, coded 8100 IAW VASRD §4.124a.  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, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Chronic Migraine Headaches	8100	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

			

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 XXXXXXXXXXXXX, AR20150008330 (PD201301400)

1.  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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						

CF: 
(  ) DoD PDBR
(  ) DVA