RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01207
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20090629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Rifleman, medically separated for “post-traumatic headaches/migraine headaches” and “anxiety disorder due to general medical condition/post- concussion syndrome,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI contends that he continues to have multiple symptoms related to Iraq and Twenty-nine Palms.  He further contends that he was initially rated at 30% by the Veterans Administration and his rating was later increased to 50%.  The CI’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 Physical Evaluation Board (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 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 based upon a 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 - 20090427	VARD - 20100122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Traumatic Headaches/Migraine Headaches	8100	10%	Traumatic Brain Injury (TBI) and Post-Concussion Syndrome with Migraine Headaches	8045-8100	30%	20091105	
Anxiety Disorder…	9400	10%	PTSD (also claimed as Combat
Stress Disorder, Adjustment Disorder, Anxiety, and
Depressed Mood)	9411	0%	20091105	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Post-Traumatic Headaches/Migraine Headaches Condition.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) neurology narrative summary (NARSUM) the CI begun having chronic headaches in March 2008.  In April 2007, he was involved in a motor vehicle accident where he hit his head against the door window.  He reportedly experienced brief loss of consciousness (LOC), and had minor cuts and bruises.  He was not hospitalized and he continued to perform his job after the accident.  The CI reported that he initially developed short-term memory problems and headaches.  His condition gradually improved and he was able to deploy to Iraq in August 2007.  

At the NARSUM dated 21 November 2008, the CI reported he had headaches that were aggravated by heat.  The headaches involved the entire head, occurred daily, and waxed and waned in severity.  At times he experienced sensitivity to sound and light-headedness.  Rest and sleep alleviated the headache as well as being out of the heat and relaxation.  He noted that he had irritability and short-term memory problems that he associated with his headaches.  Medications were not helpful; however, going home with his family resulted in complete resolution of his headaches.  It was noted that the brain MRI in July 2008 was unremarkable.  The neurological examination was normal, and the diagnoses of posttraumatic headaches, and history of closed head injury with brief LOC were recorded.  In December 2008, the CI underwent neuropsychological testing.  A cognitive disorder was not assessed.

The VA Compensation and Pension (C&P) examination was accomplished approximately 5 months after separation.  The CI reported his headaches lasted up to an hour, occurred daily, and with medication, he was able to go to work.  He also reported mild memory problems such as forgetting conversations or tasks, and he had slowness of thought.  The examiner noted that the CI indicated his symptoms, in general were stable.  

The Board directed its attention to the rating recommendation based on the evidence just described.  The PEB rated the condition of posttraumatic headaches/migraine headaches at 10% under the 8100 code (migraine headache).  The VA applied the analogous coding of 8045-8100 (migraine headaches, residuals of TBI) for a 30% rating based on the frequency of prostrating attacks.  The Board carefully considered the frequency and nature of the CI’s headaches including objective and corroborating subjective evidence, and found insufficient evidence to support a higher than 10% rating.  The higher rating of 30% requires once monthly over several months of prostrating headache attacks.  The Board could not find one single headache meeting the criteria or description of prostrating attacks.  All Board members agreed that the higher rating of 30% was not justified under the 8100 code.  The Board also considered the 8045 code which evaluates cognitive impairment and other residuals of TBI in relations to facets.  The Board undertook a careful review of the record in evidence for support of a rating higher than the 10% and based on the available evidence, and found no evidence to support a higher than 10% rating under this code.  Board members concluded the 8045 code offered no benefit to the CI.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the post-traumatic headache condition.  

Anxiety Disorder Condition.  According to the STR and the mental health (MH) NARSUM, the CI developed irritability after a motor vehicle accident in April 2007.  In August 2007, the CI deployed to Iraq; however, he did not complete the deployment secondary to the need for hernia surgery.  Since returning from deployment, the CI reportedly noted that he has had depressive and anxiety symptoms.  Treatment records for an MH condition was silent; however, the MH NARSUM indicated he received medication from his primary care provider, 4 months prior to the MH evaluation, and he participated in talk therapy.

At the MEB NARSUM dated 25 November 2008, approximately 7 months prior to separation, the CI reported his anxiety symptoms were prominent and consisted of feeling anxious, fatigue, muscle tremors, “fearful thoughts, and mild panic spells.”  Symptoms suggestive of PTSD were not recorded.  The mental status examination was unremarkable with the exception of self-reported angry and irritable mood.  The examiner opined his condition met criteria for anxiety disorder due to general medical condition (post-concussion syndrome and migraine headache).  The December 2008 neuropsychological evaluation noted above, diagnosed him with PTSD; however, exposure criterion was not described nor alluded to, and PTSD symptoms were not fully elaborated.  Clinical assessment of the condition was not in evidence.  It was noted that the CI complained of irritability, mood changes, and symptoms of anxiety and depression.  The CI was non-attendant to the scheduled VA Compensation and Pension (C&P) mental examination.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition of anxiety disorder at 10%, coded 9400.  The VA used the STRs to grant a 0% disability rating coded 9411 (PTSD).  The Board considered whether the provisions of VASRD §4.129 (Mental disorders due to traumatic stress) was applicable based on the evidence.  The Board concluded the provisions of VASRD §4.129 were not applicable in this case.  The MH NARSUM examination made no mention of the effect his symptoms had on occupational or social functioning.  He had “mild panic spells but not full blown panic attacks.”  The CI was never hospitalized psychiatrically nor was he ever treated in the ER.  The MSE was essentially normal.  The records demonstrated minimal treatment related to MH.  His MH condition was not implicated in the commander’s statement, and was not listed on the profile.  Board members concluded the CI’s condition was stable at the time of separation, and his disability was most reflective of the 10% level for mild symptoms.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the anxiety disorder condition.  

BOARD FINDINGS:  In the matter of the posttraumatic headaches/migraine headache condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the anxiety disorder due to general medical condition and IAW VASRD §4.130, 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 20140308, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 9 Aug 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, 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:

		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC

						 XXXXXXXXXXXXXXXXXXXX
	     					 Assistant General Counsel
						  						 (Manpower & Reserve Affairs)