RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW 

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00346
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20080929

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

CI CONTENTION:  “Review 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 - 20080729	VARD - 20090519	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intractable Headache Disorder	8199-8100	0%	Tension Headaches	8199-8100	0%	20090227	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Intractable Headache Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a history of headaches since recruit training in 2007.  Headaches were primarily tied to exertional activities or wearing Kevlar.  Beginning in Infantry School, the CI experienced worsening headaches occurring 4 to 5 times a week.  Diagnostic imaging of the brain was normal.  He was evaluated by Neurology and tried on numerous headache/migraine medications which did not provide relief.  The MEB forwarded “headache” and “intractable headache disorder” for PEB adjudication.  

At the neurology clinic appointment on 30 April 2008 the CI reported that once a headache stated he had to stop what he was doing and put his head down.  At the neurology clinic appointment on 14 May 2008 the CI reported that the headaches lasted 1 to 2 hours and forced him to stop what he was doing.  

The NMA, dated 3 June 2008, reported that the CI was away from work 4 to 6 hours per week due to his migraine headaches.  The commander further noted that the CI was “constantly taken away from productive time with complaints of headache and sitting at medical.”  Review of the STR revealed 18 encounters of care for unrelenting headaches in the 12 months before separation for follow-up and medication trials by Primary Care and Neurology.  

The MEB NARSUM Neurology addendum examination on 14 May 2008, approximately 4 months prior to separation, noted complaints of headaches that started with an aura of pressure and then a transition into a headache rated at 9/10 in the frontal area and climaxing in a half hour.  The headaches lasted 1 to 1.5 hours and occurred 3 to 6 times per week.  “They affect him most because they limit his ability to train or perform tasks like exercising.”  He was treated with multiple abortive and prophylactic medications over the prior 3 months without any benefit.  The headaches were exacerbated by Kevlar and worsened when palpating his head.  There were functional limitations of an inability to perform any physically exertional activities or wear his Kevlar.  The physical examination showed tenderness of the scalp and was otherwise unremarkable.  Under “present condition” the neurologist stated that the CI “currently has been getting approximately three headaches per week which incapacitate him.”  

At the 5 March 2009 VA Compensation and Pension (C&P) evaluation, performed approximately 6 months after separation, the CI reported headaches 4 to 5 times a week with pressure feeling in the entire head which lasted for a couple of hours.  He required rest for headache relief when they occurred at home, but at work he continued with his duties.  The physical examination was unremarkable.  The examiner stated “Headache Severity:  Attacks are not prostrating; ordinary activity is possible.”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 0%, coded analogous to 8100 (Migraine).  The VA also rated the headache condition 0%, coded analogous to 8100, citing that the headaches were not prostrating.  

Rating guidance under diagnostic code 8100 is based on the frequency of “prostrating attacks” over the “last several months.”  The VASRD does not further 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 considered the results of the NARSUM, neurology and VA examinations along with the evidence of the treatment records to accurately assess the overall disability picture (§4.2) at the time of separation.  The Board deliberated on if the CI’s headaches were prostrating.  The clinical treatment notes did not describe the CI as being prostrated and indicated the disability was principally an inability to continue training and exercise tasks when headaches occurred.  The neurologist indicated the headaches as incapacitating, but did not further describe any prostrating features, while the VA examiner indicated there were no prostrating headaches.  The Board adjudged that the record did not show prostrating headaches occurring on average once every two months, or more frequently, over the last several months prior to separation to support a rating higher than the 0% adjudicated by the PEB.  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 headache condition.  

BOARD FINDINGS:  In the matter of the headache condition 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 20150529, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 15 Nov 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

						  XXXXXXXXXXXXXXXXXXX
	     				  Assistant General Counsel
						  (Manpower & Reserve Affairs)