RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01510
BRANCH OF SERVICE:  Army	BOARD DATE:  20141223
SEPARATION DATE:  20040514

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Personnel Information System Management) medically separated for mixed chronic daily headaches and superimposed migraine.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty however; the CI’s profile indicated a modified physical fitness test.  She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The mixed chronic daily headaches and superimposed migraine condition, characterized as “headaches” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The Informal PEB adjudicated “mixed chronic daily headaches and superimposed migraine” as unfitting, rated 0% citing criteria of VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “My back was denied and I continue to have back issues and I was given a permanent profile for my back while in the military.  I applied for stress and it was denied.  I was/and now still tacit Prozac.  I have migraines that continue to effect me daily.  Requesting to have, my stress disorder re-evaluated.  I can’t sit for too long or stand for too long.  I continue to have tingling pains in my wrist, left one.  My rashes continue to grow in around continue to have swollen ankles from walking (taking) fluid pills.”

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 IPEB – Dated 20040128	VA - Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mixed Chronic Daily Headaches and Superimposed Migraine without Aura	8100	0%	Recurrent Migraine Headaches	8100	10%	STR	
Other x 0 (Not in Scope)	Other X 13		
Combined:  0%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20050520 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Mixed Chronic Daily Headaches and Superimposed Migraine Condition.  The narrative summary (NARSUM) noted the CI developed frontal headaches in June 2002 during her fourth pregnancy.  Headaches were initially felt to be stress and tension related.  The CI was treated with numerous medications with ineffective response or intolerance to the medication, or refusal to take medication because of pregnancy issues.  A CT scan of the head, obtained on 15 September 2003, revealed only frontal sinusitis which was treated with antibiotics.  On evaluation by a neurologist on 3 November 2003, the CI reported mild daily headaches which were superimposed with more severe headaches two to three times a week.  These headaches were described as “sharp” and “thumping pain” associated with photo-phobia but not nausea or vomiting.  The duration of the headache was until sleep.  The examiner reported that the CI was under significant problems with tension at work and dealing with the demands of being in the military.  He opined that ‘’there appears to be a considerable amount of external stressors at both at work and at home which contribute to headache frequency and severity.”  He further noted that “unless issues at home and work are resolved, prognosis for improvement is poor and secondary gain issues will likely be important.”  The neurologic physical examination was normal.  A diagnosis of “mixed daily headaches with superimposed migraines without aura” was made.  A magnetic resonance imaging of the head, obtained in December 2003 was normal.  On a family practice visit on 10 November 2003, the CI reported that she “will live with headaches but cannot do what the army wants and would rather get a permanent profile.”  The CI was offered prophylactic headache medication, but she declined as she was trying to become pregnant at the time.  A commander’s statement on 10 December 2003, reported the “pain from migraines is definitely affecting her performance of duty.”  On a family practice visit on 5 January 2004, the CI reported weekly headaches brought on by “wearing Kevlar, doing sit-ups, running and jogging.”  At the MEB NARSUM evaluation on 7 January 2004, 5 months prior to separation, the CI reported that she had been on “quarters a lot” since onset of the headache condition.  The neurologic physical exam was normal.  At this time the CI was taking no headache medication.  The CI did not attend a VA Compensation and Pension examination scheduled for 8 February 2005.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both adjudicated the migraine headache condition under VASRD code 8100 (migraine) but at different rating levels.  The PEB rated 0% and the VA, using service treatment records, rated at 10%.  Under code 8100 a rating of 0% requires “characteristic prostrating attacks” less frequent than one in 2 months over a several month period.  The next higher rating, 10%, requires “characteristic prostrating attacks” averaging one in 2 months over a several month period.  The next higher rating, 30%, requires “characteristic prostrating attacks” averaging once a month over a several month period.  The highest rating, 50%, requires completely prostrating attacks productive of severe economic inadaptability.  The rating options under 8100 for migraine headaches, which are open to consideration in this case, rely on the frequency of “prostrating” attacks.  
When rating headaches under this code, the Board, under VA guidance, uses the clear English definition of “prostrating.”  The Board carefully considered the frequency and nature of the CI’s headaches including neurology evaluations, objective clinical evidence, any corroborating statements from supervisors, and placement of CI on quarters for the condition.  The Board noted the record in evidence supported that the headaches were predominately of a tension/stress nature with some migraine characteristics.  The Board noted the headaches, when severe, were “sharp” and “thumping” with no mention that they were overpowering, overwhelming or “prostrating.”  The Board found no statements from supervisors or co-workers of episodes which could be considered “prostrating,” no documentation of withdrawal from duty for episodes of prostration and no documentation that the CI was placed on quarters for the condition in the several months prior to separation.  The Board further noted the statement of the CI that she could “live with the headaches.”  The Board agreed that the record in evidence did not support episodes of “prostration” from the headache condition in the several months prior to separation.  The Board found no other appropriate codes for rating consideration.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the consensus of the Board was that the ratable threshold was met for the 0% criteria, excerpted above; the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the 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 PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the headache condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130914, 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 XXXXXXXXXXXXXXXXXX, AR20150008329 (PD201301510)

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						 
CF: 
(  ) DoD PDBR
(  ) DVA