RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	caSE:  PD-2014-04283
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040415

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- concussion syndrome with migrainous headaches,” with a disability rating of 10%.

CI CONTENTION:  “The CI contends for a PTSD rating.”  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 - 20040219	VARD - 20040608	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Concussion Syndrome with Migrainous Headaches	8045-9304	10%	Post-Concussive Disorder, manifested by Headaches with Migrainous Quality	8199-8100	30%	20041129	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:  

Post-Concussion Syndrome with Migraine Headaches.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s headache condition began in August 2003 after being shot in the helmet.  He did not suffer a loss of consciousness; however, since that time he experienced daily headaches which limited his daily activities and he was not able to function in his MOS secondary to headaches.  An MRI of the brain in September 2003 was normal.  The CI was assessed with post-concussive disorder, manifested by headaches with migrainous quality, and prescribed both preventive and abortive medications.  Treatment did not result in improvement sufficient to allow continued military service.  The MEB forwarded “prostrating migraine headaches” and “post concussive syndrome” for PEB adjudication.

At the MEB examination (recorded on DD Form 2807 Report of Medical History and DD Form 2808 Report of Medical Examination) dated January 2004, approximately 3 months prior to separation, the CI reported he was taking narcotic pain medication and preventive and abortive medications for treatment of his headaches.  He endorsed frequent headaches and problems with sleep.  He indicated that his symptoms were related to the concussion and migraines.  

At the MEB NARSUM examination on 10 February 2004, 2 months prior to separation, the CI reported his headache frequency and severity had both decreased.  Documentation of missed work or need to manipulate work environment was absent; however, the examiner documented the diagnoses of prostrating migraine headaches and post-concussive syndrome.  The examiner stated, “The soldier’s prostrating migraine headaches have been going on approximately 6 or 7 months.  He is currently unable to do the duties of his MOS, secondary to his prostrating migraine headaches.”

The initial VA Compensation and Pension (C&P) examination scheduled 3 months after separation was cancelled; however, the examination was accomplished 8 months after separation on 19 November 2004.  The CI described three different types of headaches.  He had recently developed a pulsating pain behind his right eye, which responded to medication.  The second type of headaches were the migraines that were reported while in service.  These headaches occurred every other day and lasted up to 1 hour and 20 minutes in length.  The headaches resolved with medication.  The third type of headaches were diagnosed as muscle tension headaches and the CI reported he first noticed these after he got out of the military.  These occurred once a week and resolved in about 20 minutes with medication.  The CI was not working, he was a full-time college student (75%), and there was no indication that he was failing school.  The examiner assessed migraine and tension headaches.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the post-concussive syndrome condition 10% coded analogously 8045-9304 (brain disease due to trauma).  The VA rated the post-concussive disorder, manifested by headaches with migrainous quality at 30%, coded analogously 8199-8100, (migraine) based on the STR.  The rating was increased to 50% based on the 19 November 2004 C&P examination.  

The VASRD in effect at the time of separation captured brain injuries under the generic category of brain disease due to trauma (8045).  There are two different scenarios for rating under this code; analogously with purely neurological deficits, or purely subjective symptoms.  In the absence of associated neurological disabilities (seizures, nerve paralysis, etc.), rating of this condition under 8045-9304 is limited to 10%, and cannot be combined with any other rating for a disability due to brain trauma.  The Board found absence of evidence that would support any neurological disability, and therefore only 10% was supported. 

The Board next considered the 8100 code since the CI was diagnosed with prostrating migraine headaches.  The Board carefully considered the frequency and nature of the CI’s headaches including objective and corroborating subjective evidence, and found insufficient evidence to support a higher than 10% rating under the 8100 code.  The higher rating of 30% requires once monthly over several months of prostrating headache attacks.  The Board could find only one headache potentially meeting the criteria or description of prostrating attacks.  Review of the records demonstrated the CI presented to the ER on one occasion with a headache complaint.  The Commander’s statement did not mention any headache episodes that required him to leave work early or to seek refuge in a dark room.  At the neurology consult, 6 months before separation, it was documented that the CI reported that two tablets of his abortive medication took the headache down to a barely noticeable level.  The Board acknowledged that the CI’s headache condition appeared to have worsened after separation; however, there was little evidence to support the presence of prostrating headaches at separation.  There was no evidence in the C&P examination to support the notion that his headaches were prolonged, completely prostrating, or that he had attacks productive of severe economic inadaptability.  Evidence of completely prostrating attacks were absent in the treatment record before and after separation.  Additionally, there was no indication that the CI missed classes or was failing classes due to his headache condition.  There were no additional applicable codes to consider for rating the condition.

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 adjudication of the post-concussion syndrome condition.

BOARD FINDINGS:  In the matter of the post-concussion syndrome with migrainous headaches 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20141112, 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

08 DEC 2016

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018336 (PD201404283)

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