RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02210
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20030429

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E3, Information Systems Operator, medically separated for “migraine headaches” rated at 0%.  Irritable bowel syndrome was determined to have existed prior to service (EPTS) and was not rated.

CI CONTENTION:  The CI requested that 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 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 - 20030306	VARD - 20040511	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches…	8100	0%	Migraine Headaches	8100	0%	20030820	
Irritable Bowel Syndrome…	7319	---	No VA Placement	
Idiopathic Thrombocytopenic Purpura (ITP)	Not Unfitting	Idiopathic Thrombocytopenic Purpura (ITP)	7799-7705	NSC	20030820	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Migraine Headaches.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s migraine headaches began in July 2002 around the time she was diagnosed with ITP (idiopathic thrombocytopenic purpura), which was treated with prednisone (see below).  She was seen in the emergency room on 3 July 2002 complaining of a migraine headache with nausea the night before.  On 12 July 2002 the CI had a frontal headache without nausea, vomiting, blurred vision or neck pain, which was treated with Tylenol (acetaminophen, a pain reliever).  A note indicated concern that the headaches were related to steroid withdrawal and nortriptyline (an antidepressant medication used for nerve pain) was prescribed.  Magnetic resonance imaging (MRI) of the brain in September 2002 was normal and without any intracranial hemorrhage.  After neurological evaluation in October 2002 the CI’s headaches were reasonably controlled with nortriptyline at bedtime and Imitrex (sumatriptan) and Fioricet (acetaminophen, butalbital, and caffeine) for migraine headache exacerbation, especially if the medications were taken early in the course of a headache and she rested.  Once the CI was weaned off prednisone, the migraines occurred two to three times per month.  The NARSUM indicated the CI, who was still in AIT, had a difficult time sitting at a desk doing computer work and she felt drowsy from the medication.  As a result the CI was unable to do heavy mechanical activities or drive a vehicle.  She was seen in neurology consultation on 10 July 2003, approximately 2 months post-separation, where she noted having retro-orbital migraine headaches with throbbing and associated photophonophobia (light and sound sensitivity) and nausea two or three times a month.  She had the headaches more frequently when she did computer work and she ameliorated the headaches by lying in a dark, quiet room.  Neurological examination was normal without any sign of increased intracranial pressure.  The neurologist suggested stopping the nortriptyline and instead trying Lexapro (escitalopram, an antidepressant) and injectable Imitrex.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated September 2002, 7 months prior to separation, the CI reported she was diagnosed with migraine headache in July 2002 and had problems with dizziness from the migraine medications.  

At the VA Compensation and Pension (C&P) examination in August 2003, performed 8 months after separation, the CI reported headaches started when she was placed on steroid therapy and she was doing better on Lexapro and imitrex injections with headaches approximately two times per month.  She felt sitting in front of a computer might precipitate a migraine.  Neurologic examination was unremarkable.  The examiner opined the etiology of the migraine headaches was unclear and raised stress, change in diet, corticosteroid withdrawal or the corticosteroids themselves may have precipitated the migraines.     
 
The Board directed attention to its rating recommendation based on the above evidence. The PEB assigned a 0% rating using code 8100 for migraine headaches not requiring prophylactic therapy not considered prostrating, occurring monthly.  The VA assigned a 0% rating using code 8100 for migraine headaches.  Board members noted there was no evidence of “characteristic prostrating attacks averaging one in 2 months over last several months.”  The Board concluded there was no evidence to support a rating of 10% or higher than the rating adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the migraine headaches condition.  

Irritable Bowel Syndrome (IBS).  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) indicated the CI’s IBS began at age 15 with intermittent episodes of constipation and diarrhea along with crampy abdominal pains.  The PEB using code 7319 (irritable colon syndrome (spastic colitis, mucous colitis, etc.) did not rate the IBS condition as it was EPTS, present since age 15.  The VA did not rate or address the IBS condition.  There was no evidence in the record of service aggravation; workup did not find an etiology for the IBS; and treatment was instituted to ameliorate the CI’s IBS symptoms.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the irritable bowel syndrome condition.  

Contended PEB Condition-Idiopathic Thrombocytopenia (ITP).  The Board’s main charge is to assess the fairness of the PEB’s determination that idiopathic thrombocytopenia purpura (ITP) was not unfitting.  The history of ITP condition was profiled and was implicated in the commander’s statement, but was not judged to fail retention standards.   The CI presented in June 2002 with abdominal pain with possible biliary colic when the platelet count was markedly decreased with the nadir (lowest point) at 18,000.  The CI was treated with tapering doses of prednisone (a steroid) for 8 weeks and the platelet count normalized in mid July 2002 and was 238,000 on 2 August 2002, while in October 2002 it was 231,000 and the condition was felt to be in remission. At the VA examination in August 2003 the examiner opined that the fact that the ITP resolved within 2 months suggested that the thrombocytopenia was secondary to either vaccination or a viral illness.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the ITP contended condition;  and so, no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the migraine headaches condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the irritable bowel syndrome condition and IAW VASRD §4.114, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended idiopathic thrombocytopenia condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140508, 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 XXXXXXXXXXXXXXXXXXXXX AR20160013537 (PD201402210)

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