RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03622
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20041027

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Multichannel Transmission Systems Operator/Maintainer), medically separated for “migraine headaches,” with a disability rating of 0%.

CI CONTENTION:  The CI requests the Board consider 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 on 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 - 20040928	VARD - 20041108 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	0%	Migraine Headaches with Residuals	8100	30%	20041019	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDTIONS:  70%	

ANALYSIS SUMMARY:  

Migraine Headaches.  According to the service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first evaluated for headaches in mid-2002 with some entries imply an onset preceding his January 2002 enlistment.  He was referred to Neurology on 2 June 2004 and diagnosed with migraines.  The neurologist documented a twice per week frequency of headaches which “can last hours,” but did not clarify whether they were considered prostrating.  Abortive treatment (Imitrex) was prescribed with moderate success if used early (drowsiness side effect), but prophylactic treatment (Topamax) was of no benefit per the CI.  
There was STR documentation of seven clinical encounters for emergent treatment of headache from the initial visits to separation, with three of these in the last 12 months and two in the last 6 months prior to separation.  There was no indication of any acute treatment events not captured in the STR.  There were no STR entries opining that the headaches were prostrating or describing them as such.  The headaches were not sufficiently controlled with further treatment and the CI was referred for a MEB, which in turn forwarded “migraine headaches” to the PEB.  

The NARSUM examination was conducted 17 August 2004, 2 months prior to separation, by the same neurologist providing the consultation referenced above and documented the same frequency and duration of occurrence as above.  In the NARSUM, the examiner specifically opined that the headaches were not prostrating.  A detailed neurological examination was normal.  The commander’s statement reported that the CI had been performing to standards and was capable of light duty and did not document any duty loss due to headache.  
  
At the 19 October 2004 VA Compensation and Pension (C&P) examination, performed 2 weeks before separation, the CI reported headaches “occurring 2 times per week and lasting for 6-7 hours, has been to the emergency room on 5 different occasions in the past 12 months.”  The examiner did not elaborate further, and did not express an opinion as to whether the headaches were prostrating.  A detailed neurological examination was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the condition 0% (code 8100, migraine), with the DA Form 199 stating “occurring twice weekly, not considered prostrating.”  The VA’s 30% rating under 8100 referenced the above C&P evidence and quoted the 30% criteria of 8100 without elaboration; but specified “There was no evidence that these headaches are completely prostrating in nature and cause severe economic problems (paraphrasing the 50% criteria of 8100).”  The §4.124a rating under code 8100 rests on the presence and frequency of “characteristic prostrating attacks over the last several months.”  The 10% rating is for an average frequency of “one in 2 months;” that for 30% is “once a month;” and, for 0% “less frequent attacks.”  The VASRD does not provide a definition of “prostrating” or quantify the rating window of “last several months.”  A common (court-sanctioned) approach is to apply the clear English definition of prostrating with dictionary examples including “utter physical exhaustion or helplessness” (Webster's) or “extreme exhaustion or powerlessness” (Dorland's); and, members agreed that, at a minimum, ratable headaches should require reasonably convincing evidence that they force the abandonment of work or current activities.  

Members agreed that the above 50% criteria were not supported, especially considering the evidence from the commander that the headaches did not cause severe occupational consequences.  It was next deliberated whether any of the headaches could be reasonably characterized as prostrating, or whether the NARSUM neurologist’s opinion that they were not, was best supported by the evidence.  The lack of documentation of work loss notwithstanding, members agreed that the episodes of emergent treatment verified by the STR would reasonably constitute abandonment of activities and were justifiably conceded as prostrating.  The two such episodes within 6 months of rating were reasonably aligned with the 10% criteria, although not with the once per month average specified by 30% criteria.  Barring this exception, members agreed that the NARSUM opinion by the treating neurologist was more probative than that of the VA rater for concluding that there were no additional prostrating headaches.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a 10% rating for the migraine headache condition under code 8100.

BOARD FINDINGS:  In the matter of the migraine headache condition, the Board unanimously recommends a Service disability rating of 10%, coded 8100, IAW VASRD §4.124a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Migraine Headaches 	8100	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140926, with attachments
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

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXX, AR20160011580 (PD201403622)

1.  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, accept the Board’s recommendation to modify the individual’s disability rating to 10% without re-characterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

			     

CF: 
(  ) DoD PDBR
(  ) DVA