RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02171
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Infantry, medically separated for “headaches, post-concussion,” with a disability rating of 10%.

CI CONTENTION:  The CI requests all conditions be considered.  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 - 20070212	VARD - 20070524	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Headaches, Post-Concussion	8045-9304	10%	Migraine Headaches Status Post-Concussion	8100	10%	20070423	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Headaches, Post-Concussion.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s headache condition began in July 2006 after slipping and falling in the barracks shower.  There was no apparent loss of consciousness, but he reportedly felt dazed.  Shortly thereafter, he reported onset of severe headache and dizziness, without associated changes in vision, nausea, weakness, numbness or confusion.  Radiographic imaging (MRI, CT scan) of the brain were unremarkable with the exception of “small incidental arachnoid cyst” in the posterior fossa, without mass effect, found on MRI.  The CI was diagnosed with a mild concussion.  His headaches continued and at times lasted up to several hours, and were associated with sensitivity to light and sound, and on occasion nausea and dizziness during more severe pain.  Treatment did not result in improvement sufficient to allow the initiation of Basic Training.  The MEB forwarded “migraine headaches after concussion” for PEB adjudication.

At the MEB examination (recorded on DD Form 2807 and 2808) dated 2 November 2006, approximately 4 months prior to separation, the CI reported he was not taking any medications.  He endorsed frequent headaches, dizziness, problems with sleep and memory.  He indicated that his symptoms were related to concussion and migraines.  Although the CI noted that he was not taking medications, the examiner recorded the use of headache prevention and abortive medications.  At the MEB NARSUM on 10 November 2006, the CI reported his headache frequency had improved since the onset, but he continued to experience them at least 3-4 times a week.  His pain was described as throbbing, lasting up to several hours, worsened by routine physical activity, particularly running, jumping, or climbing stairs.  Physical examination, including the neurological examination, was unremarkable. 

At the VA Compensation and Pension (C&P) examination on 23 April 2007, 2 months after separation, the CI reported he was employed and only took over the counter medications for his headache as needed (once a week).  He reported that he wakes up with headache about 3-4 times a week, and with resting in bed, the headache resolves in about an hour.  He noted that he was unable to work during a headache, but he had not missed any work due to headache.  Physical examination, including the neurological examination was unremarkable.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the condition at 10% coded analogously 8045-9304 (dementia due to head trauma), citing headaches 3-4 per week, and a normal MRI study.  The VA rated the condition of migraine headaches status post-concussion at 10%, coded under the migraine headache code, 8100, for characteristic prostrating attacks averaging 1 in 2 months over last several months.  The VARSD in effect at the time of separation captured brain injuries under the generic category of brain disease due to trauma (8045).  There are two different scenarios for rating under this code; analogously with purely neurological deficits, or purely subjective symptoms.  In the absence of associated neurological disabilities (seizures, nerve paralysis, etc.), rating of this condition under 8045-9304 is limited to 10%, and cannot be combined with any other rating for a disability due to brain trauma.  The Board found no evidence that would support any neurological disability, and therefore, only 10% was supported.  The Board considered the 8100 code; however, the Board concluded the use of this code provided no additional benefits to the CI.  The Board agreed that a 10% rating, but no higher, was justified for the headache condition under the code 8045, and there was no justification for a higher rating under the 8100 code since prostrating attacks were not present.  There were no additional applicable codes to consider for rating the condition.  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 headache, post-concussion condition.

BOARD FINDINGS:  In the matter of the headache, post-concussion 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 20140514, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXX, AR20160014862 (PD201402171)

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