RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00086
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051231

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

CI CONTENTION:  Her condition continued to worsen and negatively impact her daily activities.  Her complete submission is at Exhibit A.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  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/Naval 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 - 20051207	VARD - 20061229	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	0%	Migraine Type Headaches	8100	30%	20061220	
RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Migraine Headaches.  According to the service treatment record (STR), the CI reported no history of significant headache problems before undergoing right shoulder surgery in April 2005.  She then developed daily headaches with nausea and vomiting that required treatment with abortive and preventive medication.  Improvement with treatment was insufficient to allow return to unrestricted duty.

At a neurology evaluation on 15 July 2005 (6 months prior to separation) the examiner indicated that although the CI had “chronic daily headaches ever since” her shoulder surgery in April, she had only been receiving abortive and prophylactic medication treatment for headaches for the previous 5 weeks.  The headaches “were a little better” during that interval.  At a neurology clinic follow-up on 8 Aug 2005, the CI reported that headaches were “about 10 to 20% better.”  Very severe headaches associated with nausea and vomiting occurred “about two times per month.”  The CI declined an offer to change the prophylactic medication to one that might be more effective.

The commander’s statement on 18 August 2005 referred to profile restrictions and impact on deployment as reasons for recommending that headaches rendering the CI unfit.  There was no mention of missed duty time due to prostrating headaches.  On the Report of Medical Assessment (DD Form 2697) on 22 August 2005 (4 months prior to separation), the CI indicated that a right arm and shoulder condition interfered with her ability to work in her primary specialty; migraine headaches were not identified in this regard.
 
At the MEB NARSUM examination on 11 Oct 2005 (3 months prior to separation), the CI reported the headaches “tend to last about 5 hour,” rating pain at 9/10 severity.  It was stated that the prophylactic medication had “markedly reduced the frequency of her migraines to about 1 per week.”  However, the prophylactic medication reportedly made her drowsy and caused her to miss work.  The examiner stated that migraine headaches were unacceptable for duty when she “does not take medication” and that the “medications make her unfit.”

On 19 October 2005, the CI presented for acute care of a headache and received an injection of a pain medication.  Review of the STR found two visits for care of an acute headache during the 9 months from the time the condition began until separation.

At the VA Compensation and Pension (C&P) examination on 20 December 2006 (12 months after separation) the CI reported she had headaches prior to and after entering active duty that were relieved with over-the-counter medication; but they worsened following her shoulder surgery.  She was taking the same abortive and prophylactic medication she took in the Service.  It was reported that headaches occurred weekly and usually lasted for hours, and that response to treatment was “fair.”  Regarding headache severity, it was noted that “most attacks are prostrating.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 8100 code (migraine headaches), indicating the medical record did not document any prostrating headaches.  The VA rated the condition at 30% based on an examination 1 year after separation, citing prostrating attacks that occurred on a weekly basis.  A 10% rating requires “characteristic prostrating attacks averaging one in 2 months over the last several months” while the next higher 30% rating stipulates an average frequency of prostrating attacks of once a month.  When rating headaches under the diagnostic code 8100, VA guidance uses the clear English definition of prostrating.  The standard dictionary definition of “prostration” is “utter physical exhaustion or helplessness.”  In deliberating the frequency of prostrating attacks leading up to the time of separation, the Board considered that the CI’s report of severe headache frequency was somewhat inconsistent (twice per month at the neurology examination on 8 August 2005, but “markedly reduced…frequency…to about 1 per week” at the later NARUM exam).  The frequency of prostrating events was also examined in the context of a reported headache duration of 5 hours and pain severity of 9/10 (per the NARSUM), but a lack of willingness to reduce this described severity by trying a different medication.  Although the CI reported to the VA examiner 1 year after separation that prostrating headaches were occurring once per week, prior to separation the commander made no reference to missed duty time due to migraines and the CI did not indicate that headaches were an impediment to performance of her duties on the Report of Medical Assessment.  The Board ultimately agreed that the described clinical picture most closely approximated the 10% criteria (“characteristic prostrating attacks averaging one in 2 months over last several months”).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the chronic migraine headaches condition, coded 8100. 

BOARD FINDINGS: In the matter of the chronic migraine headaches condition, the Board unanimously recommends a 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 the prior to medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Migraine Headaches	8100	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150123, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXX AR20160013803 (PD201500086)

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.

 BY ORDER OF THE SECRETARY OF THE ARMY:

CF: 
(  ) DoD PDBR
(  ) DVA