RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03183
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070228

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

CI CONTENTION:  “The most severe is my PTSD and chronic migraines” 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 - 20070220	VARD - 2071212	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Concussive Headaches	8045-9304	10%	Post-Concussion Syndrome With Chronic Headaches	8045-8100	30%	20070510	
PTSD	Not Unfitting	Post-Traumatic Stress Disorder with Depression	9411	30%	20070510	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Post Concussive Headaches.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI headache condition began during the CI’s deployment to Iraq where he was exposed to at least four IED explosions.  During the May 2005 explosion the CI reported being thrown, lost consciousness, awoke feeling disoriented and had ringing in his ears.  He developed recurring headaches with photophobia and phonophobia that increased in frequency depending on the combat environment and with loud noises.  Eventually they occurred daily and lasted 2 to 3 hours.  After re-deployment his headaches persisted and a neurologist diagnosed post-concussion syndrome:  chronic daily headache, with migraines features with analgesic overuse.  The head pain was reproducible with palpation of the occiput, suggesting occipital neuralgia.  Scan of the head was normal.  He received two medications for pain and referred to a pain specialist.  An occipital nerve block and various medications did not bring relief.  Despite treatment, the CI’s headache condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “post-concussion syndrome with chronic headaches” for PEB adjudication.

The commander’s performance statement in November 2006, 3 months before separation, documented the CI worked approximately 30 hours a week performing staff duty while attending appointments for his MEB process.  The CI had severe headaches that are recurrent 3-4 times per week.  He has trouble falling and staying asleep, and difficulty functioning without pain during the day.  Loud noises and bright lights cause severe pain, and he occasionally experiences numbness throughout his body.

During the MEB NARSUM in December 2006, 2 months before separation, the CI reported daily headaches with photophobia, phono phobia nausea and occasional vomiting lasting 2 to 3 hours and generally decrease with rest.  Symptoms were worse with exertional activities or emotional stress so he was not able to perform his military specialty.  He was taking medications for headaches as needed.  A diagnosis of post-concussion syndrome with chronic headaches was rendered.  The CI’s P3 permanent profile (December 2006) precluded him performing all physical fitness test events, did not allow him to drive while on medication, and no overnight duty.

At the VA Compensation and Pension (C&P) examination in May 2007, performed 3 months after separation, the CI reported two attacks daily, each lasting from 2 hours up to a few days.  He stayed in a dark corner in the basement and took medication.  He was searching for employment.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating analogous coded 8045-9304 (residuals of traumatic brain injury – dementia due to head trauma).  The VA assigned a 30% rating analogous coded 8045-8100 (residuals of traumatic brain injury - migraine headaches) based on the VA C&P examination 3 months after separation, citing characteristic prostrating headaches occurring on average of once a month over the last few months.

Board member reviewed code 8045 applied by the VASRD in effect at the time of separation, which stipulates “Purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, will be rated 10 percent and no more under diagnostic code 9304.”  The Board agreed that the 10% rating rendered by the PEB was appropriate based on this VASRD criterion.

The Board considered code 8100 (migraine headaches) has a separate and distinct pathway to a higher rating.  The 8100 rating criteria at the time of separation is as follows:

		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

The VASRD does not clearly 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 Board members agree the evidence was sufficient to determine the CI experienced migraine headaches to render a 0% 8100 rating; however, the STR evidence did not document the CI with characteristic prostrating attacks to render a 10% or higher rating.  The commander did not document the CI’s work stoppage to alleviate headaches but rather the CI had difficulty functioning without pain during the day.  The commander stated the CI worked approximately 30 hours a week performing staff duty while attending appointments for his MEB process.

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 brain disease due to trauma condition.

Contended PEB Condition:  PTSD.  The Board’s main charge is to assess the fairness of the PEB’s determination that PTSD was not unfitting.  The CI was positively screened for PTSD and the MEB NARSUM psychiatric evaluation in December 2006 rendered a PTSD and depression diagnoses.  However, the examiner determined that both mental health conditions met retention standards.  The PTSD condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  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 PTSD and thus no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the post concussive headaches condition and IAW VASRD §4.124, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended PTSD condition, the Board unanimously recommends no change from the PEB determinations 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 20140702, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 

SUBJECT:   Department of Defense Physical Disability Board of Review Recommendation for Mr. 
XXXXXXXXXX, AR20160011128  (PD201403183)

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