RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03267
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080904

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

CI CONTENTION:  The CI requests consideration of all conditions.  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 - 20080519	VARD - 20081107	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Headaches	8045-9304	10%	TBI W/Migraine Headaches	8045-8100	50%	20080922	
PTSD	Not Unfitting	PTSD w/Depression	9411	30%	20080925	
Syncope	Not Unfitting	Tachycardia with Syncope	7011	NSC	20080922	
Asthma	Not Unfitting	Asthma	6602	10%	20080922	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic Headaches.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic headache condition began in late 2005 or early 2006 after exposure to several blasts where he was within 5-10 meters.  Neuroimaging in August 2006 was normal.  Neurological evaluation that began in August 2006 noted the headaches were either post concussive or tension, resulting in possible ocular migraines or possible retinal migraines.  There was no clearly established diagnosis.   The MEB forwarded chronic migraines for PEB adjudication.  
The MEB NARSUM examination on 27 March 2008, 5 months prior to separation, noted complaints of headaches with 6/10 pain on average, which he could work through, but occasionally there was a 10/10 headache during which he could not tolerate light and needed to be in a quiet room and lie down.  These occurred about twice per week.  He also reported intermittent tunnel vision, occurring 1-2 times every other week and occasionally with his 10 headaches.  He was taking 3 medications and had not refilled the last prescription, received October 2007, for one of the medications.  Physical examination in August 2007 was unremarkable and there had been no significant change.  

At the 22 September 2008 VA Compensation and Pension (C&P) evaluation, performed 18 days after separation, the CI reported headaches every other day and lasting for a few hours up to all day long.  Pain was usually in the left side of the head.  He stopped his medication prior to discharge because it was not helping and he was not taking any medication at the time of the VA examination.  He had sensitivity to light and to sound.  Sometimes his vision faded.  Headaches were prostrating in that he had to stop his activities, go home and lie down.  Physical examination was unremarkable.  Diagnoses of mild traumatic brain injury (TBI) and migraine headaches- persistent and refractory, to therapy were rendered.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the chronic headaches condition 10%, coded 8045-9304 (dementia due to trauma).  Code 8045, per the VA Schedule for Rating Disabilities (VASRD) in effect at that time, 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 VA rated the TBI with migraine headaches condition 50% coded 8045-8100 (migraine headaches), based on the VA C&P examination 18 days after separation, citing frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability.  Members discussed whether a pathway to a higher rating existed under the 8100 code for migraine headaches.  There were no follow-up visits to neurologist or to other physicians within 6 months prior to the MEB NARSUM or C&P examinations.  There were no documented visits to the emergency room (ER) that would suggest prostrating attacks.  The Board concluded there was no other pathway to a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends no change in PEB adjudication for the chronic headache condition.  

Contended PEB Conditions:  PTSD, Asthma and Syncope.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  None of the conditions were profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the chronic headache condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended PTSD, asthma, and syncope conditions, 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 20140621, 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), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

17 NOV 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160017169 (PD201403267)

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