RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2014-01669
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Unit Supply Specialist, medically separated for “migraine headaches,” with a 10% disability rating.  

CI CONTENTION:  “Does not reflect actual severity of condition.”  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 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 - 20090130	VARD - 20090821	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	10%	Migraine Headaches	8100	30%	20090429	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Migraine Headaches Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI developed headaches in 2005-2006.  The headaches worsened and increased in frequency in December 2007 and was first treated for migraine headaches in March 2008.  His initial treatment failed to relieve his symptoms and he was referred to neurology.  Further treatment failed.  Despite treatment, the migraine headache condition could not be adequately treated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  

Review of treatment records revealed 28 encounters of care (includes primary care, neurology, ophthalmology, imaging and wounded warrior specialty care) for headache in the 12 months before separation.  Of these, 14 were for acute headaches.  The CI received 24-48 hours quarters for his migraines in April, June, July and August 2008.  At the time of the neurology clinic appointment on 30 September 2008, the CI reported that he had an overall decrease in headache frequency since starting Topamax in mid-August, but had had a total of three prostrating episodes since then where he was required to go to sick call and was placed on quarters.  On examination, the CI was noted to be in no acute distress and exam was normal.  The examiner continued him on Topamax, placed him on a P3 profile and initiated an MEB.  

The commanders statement dated 7 October 2008 provided no detailed information, however the NARSUM examiner stated that he contacted the commander to clarify this point and the commander stated that the CI could perform his duty requirements when he did not have headaches but the lost time for migraine treatments and quarters made the CI unable to effectively perform his duties.  

The MEB NARSUM dated 15 January 2009, noted that the CI had tried multiple medications to include Midrin, Topamax, Celexa, Seroquel and Trazadone to treat and prevent his headaches.   The CI was not working in his primary MOS due to frequent medical visits required for his migraine headaches and quarters as well as sensitivity to light and noise.  The treatment records fell silent with regard to care for headaches between 24 November 2008 and the time of separation, 4 months later.  

At the VA Compensation and Pension (C&P) examination on 29 April 2009, performed 1 month after separation, the CI reported headaches 2-3 times per week, lasting about 2 hours.  “He claims he has to go to quiet area during the episodes.  1/2 are prostrating.”  The examination was essentially normal with regards to headache or neurologic findings.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 10% (code 8100 migraine) citing 3 prostrating headache in the previous 6 months that required him to go on sick call and quarters.  The VA rated the headache condition 30% (code 8100) citing that the CI had reported having 1-2 migraine headaches per week, each lasting up to 2 hours with 50% of the attacks being prostrating.  

Rating guidance under diagnostic code 8100 (migraine headache) 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).  The definition does not include any requirement to seek medical attention.  The VASRD §4.124a rating schedule for 8100 (migraine) is excerpted below for convenience:  

With very frequent completely prostrating and prolonged attacks
productive of severe economic inadaptability-------------------------------50
With characteristic prostrating attacks occurring on an average once
a month over last several months---------------------------------------------30
With characteristic prostrating attacks averaging one in 2 months over
last several months-------------------------------------------------------------10
With less frequent attacks------------------------------------------------------------0

The Board considered the neurology, primary care, emergency room and VA C&P evaluations along with the evidence of the treatment records and commander’s statement to accurately assess the overall disability picture (§4.2) at the time of separation.  There was not sufficient evidence of very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability to warrant a 50% rating, and the Board deliberated on the 30% and 10% disability levels.  
Records indicated decreased daily headaches after a change of medication in mid-August; however, with continued severe headaches.  The Neurologist (in September 2008) indicated three prostrating headaches since mid-August (over once a month).  The commander’s comments to the NARSUM examiner in January 2009 indicated lost time for migraine treatments significantly interfered with duty, and the VA C&P exam history indicated prostrating headaches on average greater than once a month.  Review of the records supported a conclusion that the CI experienced prostrating headaches occurring on average once per month to support a rating of 30%.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a separation rating of 30% for the migraine headache condition coded 8100.  

BOARD FINDINGS:  In the matter of the migraine headache condition, the Board unanimously recommends a disability rating of 30%, coded 8100 IAW VASRD §4.124a.  There were no other conditions within the Board’s scope of review for consideration.  

The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Migraine Headaches	8100	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140401, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

JUL 27 2016

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, AR2016001 0638 (PD201401669)

1. Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual's separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual's original medical separation for disability with severance pay.

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:

a. Providing a correction to the individual's separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

b. Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

d. Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

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:

Enclosure

CF:
( ) DoD PDBR
( ) DVA