RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00710
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070126

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Air Traffic Control Operator, medically separated for migraine headaches, with a disability rating of 10%.  

CI CONTENTION:  His migraine headache condition continues to worsen.  He also has a TBI condition which led to mental health, seizure and vision conditions.  The applicant’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  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 Physical Evaluation Board (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 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 PEB - 20061108	VARD - 20070613	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	0%	Traumatic Migraine Headaches, Status Post Facial Fracture with Reconstructed Nose and Left Orbit	8100	10%	20070403	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Migraine Headaches.  According to service treatment records (STR) and the MEB narrative summary (NARSUM), the CI had a history of migraine headaches since September 2004. The CI had a history of head trauma in February 2004 secondary to a motor vehicle accident.  In 2006 he had a fall where his head hit a concrete floor and lost consciousness. He was diagnosed with post traumatic migraine headaches.  The migraine headaches were treated with daily Gabapentin and as needed Imitrex injectable.  Review of treatment records reveals three encounters of care for headache in the 12 months before separation.  Of these, none were for acute headache.  The MEB NARSUM dated 22 August 2006, noted reports of migraine headaches 2-3 times per week with the inability to function for a period of an hour to a day if abortive therapy fails.  The neurologic examination was normal.  At the time of the neurology clinic appointment on 25 September 2006, the CI intermittent, severe headaches 2-3 times a month with fatigue and light and sound intolerance.  The neurologic examination was normal.  At the VA Compensation and Pension (C&P) examination on 3 April 2007, performed 3 months after separation, the CI reported intermittent headaches with period of remission.  The neurologic examination was normal.  The commander’s statement dated 23 June 2006, reported debilitating migraine headaches to the point of not being able to perform simple tasks, but that the CI reported to work every day except for medical appointments.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 0% (code 8100 migraine) citing headache responding to injectable Imitrex 2-3 times a month.  The VA rated the headache condition 10% (code 8100) citing recurrent headaches without objective evidence of characteristic prostrating attacks.  Rating guidance under diagnostic code 8100 is based on the frequency of “prostrating attacks” over the “last several months.”  The VASRD does not further define prostrating attacks; however, commonly accepted definitions include “utter physical exhaustion or helplessness” (Webster's New World Dictionary of American English), “complete physical or mental exhaustion” or “extreme exhaustion or powerlessness” (Dorland's Illustrated Medical Dictionary).  Although the profile indicated the administration of quarters for headache not responding to medication, review of STR in the 12 months prior to separation does not show quarters or prostrating headaches occurring on average one in 2 months or more frequently to support a rating higher than the 0% adjudicated by the PEB.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 0% for the migraine headache condition was appropriately recommended in this case. 

BOARD FINDINGS:  In the matter of the migraine 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.  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 20140201, 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, AR20160005589 (PD201400710)

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:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA