RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02303
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20150505
SEPARATION DATE:  20030131

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Sonar Technician Submarine]) medically separated for migraine headaches.  The condition could not be adequately rehabilitated to meet the physical requirements of his Rating or satisfy physical fitness standards.  He was issued a placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  The “vertebral basilar migraine headaches,” were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The MEB also identified and forwarded two other conditions (idiopathic syncope and adjustment disorder with anxiety and depression) for PEB adjudication.  The Informal PEB adjudicated “vertebral basilar migraine headaches” as unfitting (Category I), rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be Category III and found not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  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 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/Naval 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 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 IPEB – Dated 20021122	VA* - (~4 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vertebral Basilar Migraine Headaches	8100	10%	Migraine Headaches with Syncope	8100	NSC	20030521	
Idiopathic Syncope	Category III					
Adjustment Disorder with Anxiety and Depression	Category III	Adjustment Disorder with Anxiety and Depression	9434	NSC	20030520	
Other x 0 (Not in Scope)	Other x 3	20030521	
RATING:  10%	RATING:  0%	
*Derived from VA Rating Decision (VARD) dated 20030610 (most proximate to date of separation [DOS]).
ANALYSIS SUMMARY:

Migraine Headaches.  The narrative summary (NARSUM), dated 28 August 2002, and treatment record noted the CI had a history of migraine headaches without clear relief by numerous trials of medications.  Headaches in early 2001 were noted as being from 10 seconds to 10 minutes with dizziness and up to 3-4 times a week.  Treatment notes in November 2001 indicated Advil relieved his headaches and the physician stated that there were inconsistencies in the CI’s complaints.  Headaches increased in frequency to 3-4 per week and included dizziness, sensitivity to light and sound with nausea, and rare vomiting.  Evaluations including brain imaging (MRI and CT), electroencephalogram, and laboratory testing documented no significant abnormalities.

At the NARSUM exam, approximately 5 months prior to separation, the CI reported migraine headaches 2-3 times per week with a dull, constant headache most of the time.  The MEB physical exam was essentially normal and noted no neurologic abnormalities.  The NARSUM/MEB summary stated “The patient’s current headache condition has failed to completely resolve with multiple medication trials and intervention from his attending neurologist.  His headaches, although persistent, have been intermittent in nature and have yet to impact his ability to perform the duties of his rate and rank.  Further on-going care will need to be entertained regarding adjustment of medication and titration to headache relief.”

The commander’s non-medical assessment (NMA) statement, dated 25 September 2002, indicated that migraine headaches prevented the CI from performing normal duty assignments, but did not comment on frequency of headaches.  The NMA indicated that lost work due to treatment, evaluation, and/or recuperation was an average of 4 hours per week.

At the VA Compensation and Pension (C&P) exam, performed approximately 4 months after separation, the CI reported mild headaches preceding severe headaches.  When headaches occurred he tried “to lay down in a dark room, relax and take a couple of aspirin.”  Headaches occurred almost daily and seemed to be brought on by bright lights; these lasted 30 minutes to 2-3 hours.  With a headache, he was bothered by bright lights and sounds.  Aspirin sometimes aborted the headaches, and with “not very frequent” severe headaches, he had tunnel vision.   The examiner noted, “When he has the headaches he has to rest.”

The Board directed attention to its rating recommendation based on the above evidence.  The rating options under 8100 for migraine headaches, which are open to consideration in this case, rely on the frequency of “prostrating” attacks.  The DoDI 1332.39 (in effect at separation, but since rescinded) required that “the Service member must stop what he or she is doing and seek medical attention.”  However, VASRD §4.124a does not require seeking medical attention for an attack to be considered prostrating, and a common (court-sanctioned) approach is to apply the clear English definition of prostrating.  The Board carefully considered the frequency and nature of the CI’s headaches including objective evidence and corroborating subjective evidence.

Members agreed that there was little clear evidence of specific episodes of prostrating headaches.  There was insufficient evidence of characteristic prostrating attacks occurring on an average of once a month over the last several months for any rating over the PEB-awarded 10%.  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 headache condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the syncope and adjustment disorder conditions were not unfitting.  The Board’s threshold for countering fitness determinations is preponderance of the evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.

Adjustment Disorder.  IAW DoDI 1332.39 in effect at the time, adjustment disorder was a condition which did not constitute a physical disability and it is therefore not ratable or compensable.

Syncope.  The record indicated that the CI had onset of “blackouts” beginning prior to boot camp with increasing frequency to 1-3 per week by March 2001.  Comprehensive clinical evaluation including cardiac, neurologic, and vascular specialty evaluations and testing found no etiology for the CI’s complaints of “blackout episodes” (syncope).  “Blackout spells” were accompanied with dizziness and subsequent headaches and had not been observed or led to bruising or indications of falling.  Frequency appeared to have decreased from nearly daily to having been almost resolved.  The NARSUM indicated that the CI reported “he had not had any recurrent syncopal episodes until recently while on leave 27 July 2002” when he had an episode while running with 5-10 minutes of being motionless on the ground (observed by his girlfriend).  He did not have any seizure activity or symptoms.  The CI denied any further episodes, and the examiner stated “it has been at least a few months since he has had other syncopal episodes.  Curiously, none of these episodes have ever been witnessed by members of his command.”  There were no exam abnormalities associated with the syncope condition.  The NARSUM/MEB summary stated “The Medical Board is unable to offer any relevant recommendations regarding the patient's alleged syncopal episodes as none of the occurrences have been witnessed by an objective party or corroborated by medical testing and/or members of his command.  Given his report of syncopal episodes and recurrent migraine headaches, his suitability for deployment is in question.”  Syncope and vertigo (dizziness) were listed on the CI’s LIMDU and syncope was listed on the MEB NAVMED 6100/1.  The syncope condition was not implicated in the NMA statement, which addressed only the HA condition.

At the VA C&P exam performed approximately 4 months after separation, the CI reported passing out 2-3 times a week while in the military, but “he says this has resolved … and is no longer concerned about having a syncopal episode.”

There was insufficient performance based evidence from the record that the syncope condition significantly interfered with satisfactory duty performance.  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 fitness determination for the syncope condition and so no additional disability rating is recommended.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the migraine headache condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended idiopathic syncope and adjustment disorder with anxiety and depression conditions, the Board unanimously agrees that it cannot recommend them for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  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 20140422, 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 XX Sep 15

      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:

- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC