RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD -2014-02899
BRANCH OF SERVICE:  Army	Separation Date:  20030728

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Personnel Specialist) medically separated for migraine headaches, rated at 0%.  

CI CONTENTION:  The CI requests the Board consider all conditions.  She was not evaluated for her hip or depression conditions.  Her 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 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:  

FPEB - Dated 20030505	VA* - (~4 Mos. Pre-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8199-8100	0%	Migraine Headaches	8100	30%	20030325	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 2 	
RATING:  0%	RATING:  30%	
*Derived from VA Rating Decision (VARD) dated 20030804 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Migraine Headaches Condition.  According to service treatment records and the MEB narrative summary (NARSUM), the CI began experiencing severe headaches with nausea, vomiting, sensitivity to light and requiring quiet and rest in August 2000.  The headaches increased in frequency to 2 to 3 times per week and lasted 1 day to 3 weeks.  She was hospitalized from 27 September 2002 to 2 October 2002 for complete medical evaluation concluding with the diagnosis of migraine headaches.  Radiologic studies (MRI and CT scan) were normal.  She was treated with numerous medications for migraines.  Review of treatment records reveals 23 encounters of care for headache in the 12 months before separation.  Of these, four were for acute headache.  In the 6 months prior to separation there were six visits for her headache condition of which one was for acute headache resulting in placement on quarters.  Despite treatment, the CI’s migraine headache condition could not be adequately treated to meet the physical requirements of the CI’s military specialty and was referred for a Medical Evaluation Board (MEB).  The Neurology MEB Addendum examination on 3 October 2002, approximately 10 months prior to separation, noted that the CI reported an aura that consisted of blurred vision with headaches located on the side and back of her head which lasted several hours to several days.  She had a throbbing pain with nausea, occasional vomiting, photophobia, phonophobia and eye tearing.  The CI also reported that certain foods, smells, foods and menses triggered the onset of her migraines.  The examiner noted that the CI had been tried on various migraine medications however the headaches remained refractory to treatment.  The commander’s statement from November 2002, noted limitations on lifting and frequent medical appointments, but that the CI could perform “many of the functions of her MOS in-garrison.”  At the MEB NARSUM examination on 9 December 2002, approximately 8 months prior to separation, the CI reported that she still had severe onsets of headache and incapacity despite being prescribed migraine medication.  There were normal physical exam findings.  At the VA Compensation and Pension (C&P) examination on 25 March 2003, performed approximately 4 months before separation, the CI reported frequent migraine headaches occurring weekly with characteristic symptoms including photosensitivity and occasional nausea and vomiting for which the CI used  medication to abort the headache.  However the frequency of headaches which were prostrating was not reported.  There were normal physical exam findings.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 0% (code 8100 migraine) citing that the CI’s migraine headaches did not meet the DoDI definition of prostrating, and were exercise induced or tension related.  The VA rated the headache condition 30% (code 8100) citing the history of headaches and frequency of occurrence as recorded in the VA C&P examination describe above.  Rating guidance under diagnostic code 8100 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).  While the CI described frequent migraine headaches, review of service treatment records in the 12 months prior to separation does not show prostrating headaches occurring on average one in 2 months or more frequently to support a rating higher than the 0% adjudicated by the PEB.  The commander’s statement noted a lifting restriction as interfering with performance of all military duties but that the CI was able to perform duties in-garrison that did not require lifting.  The frequency of headaches also appeared to have decreased in the last several months (6 months) prior to separation based on review of the service treatment records.  Although the CI reported frequent headaches at the time of the VA C&P examination, the service treatment record did not support a contention that all her headaches were prostrating attacks.  The objective evidence of record fails to reflect prostrating headaches occurring on average one in 2 months over the last several months prior to separation to support the 10% rating or higher.  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.  

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.  As discussed above, PEB reliance on DoDI 1332.39 for rating migraine headaches was operant in this case and the condition was adjudicated independently of that instruction by the Board.  In the matter of the migraine headaches 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 recharacterization of the CI’s disability and separation determination.   

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency (AHRC-00), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for AR20160004503 (PD201402899)

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 
( ) OVA