RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00404
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070815

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 “headaches consistent with post-concussive syndrome,” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  His complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the Panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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 conditions at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service connected conditions after separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel 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 - 20070712	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Headaches Consistent with Post-Concussive Syndrome	8045-9304	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Headaches Consistent with Post-Concussive Syndrome.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s headache condition began in November 2006 after a high impact parachute landing.  Radiographic imaging documented a normal brain without evidence of trauma.  

At the 6 March 2007 psychology examination, 5 months before separation, the mental status examination was significant for mild anxiety, and was otherwise normal for memory, speech, and affect as well as logical and goal-directed thinking, and thought content.  Neuropsychological testing did not provide any evidence of cognitive impairment showing high average to superior performance.  At the conclusion of testing, the neuropsychologist suggested a diagnosis of adjustment disorder, with mixed anxiety and chronic depressed mood.  

The 29 May 2007 MEB NARSUM examination, 3 months before separation, noted complaints of “debilitating” headaches occurring “90%” of the time that prevented sustained exercise.  The physical and neurologic examinations were normal.  

The 30 May 2007 commander’s statement noted that “physical and mental stress in this individual results in extreme headaches and pressure in his head.  The headaches make it difficult for him to keep his eyes open, make him moderately tired, and make it hard for him to focus. Since the incident, the soldier’s capabilities have decreased significantly.”  There was no documentation of incapacitating episodes or specific documentation of lost days from work.  

The 12 July 2007 NARSUM addendum addressed the psychiatric/psychological condition by stating that the CI had had interpersonal difficulty and periods of anxiety and depression, which seemed situational in nature, and may have been exacerbated by suboptimal stress management, concluding that “none of his psychological problems were medically disqualifying.”  

There was no VA Compensation and Pension evaluation in evidence as the CI had not submitted a VA claim.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated the headache condition 10%, analogously coded 8045-9304 (residuals of traumatic brain injury (TBI); dementia due to head trauma), citing normal radiographic imaging and neurologic examination.  

Rating guidance under diagnostic code 8100 (migraine headaches) 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 panel considered the results of the psychologic and NARSUM examinations, along with the commander’s statement and STR to accurately assess the overall disability picture (§4.2) at the time of separation.  Review of the STR in the 12 months prior to separation does not show prostrating headaches occurring on an average of once per month or more frequently (8100) to support a rating higher than the 10% adjudicated by the PEB.  

The panel also considered rating the residuals of TBI IAW §4.124a under 8045 (residuals of TBI) using the evaluation of cognitive impairment and other residuals of TBI not otherwise classified, however, none of the facets of cognitive impairment rose higher than a level 1 impairment, and therefore did not support a rating of higher than 10%.  

There was likewise no evidence of occupational or social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to such symptoms as depressed mood, anxiety, suspiciousness, weekly panic attacks, chronic sleep impairment, or mild memory loss that supported a higher rating under analogous coding using the general rating formula for mental disorders (§4.130).  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the headache condition.  

PANEL FINDINGS:  In the matter of the headache consistent with post-concussive syndrome condition and IAW VASRD §4.124a and §4.130, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150601, w/attachments
Exhibit B.  Service Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

07 MAR 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170002980 (PD201500404)

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