RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00413
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060415

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, UH-60 Helicopter Repairman, medically separated for “chronic occipital headaches,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  The 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 condition(s) at the time of separation.  The panel 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 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 - 20060127	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Occipital Headaches	5399-5323	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Chronic Occipital Headaches.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic occipital headaches condition began in September 2004 after a motor vehicle accident.  At the time of the accident the CI loss of consciousness for 45 minutes.  The CI was diagnosed with a concussion and subsequently post-concussive headache.  The CI was evaluated by neurology over the course of 6-9 months.  He was treated with Nortriptyline (antidepressant and nerve pain medication) twice a day and Midrin (pain reliever) and his occipital headache frequency diminished.  A neurology note dated 27 April 2005 documented that the CI was without his headache medications and was having daily headaches with only 6 hours a day of relief.  The headaches were relieved by lying down.
The MEB NARSUM dated 25 August 2005 documented increased headache frequency with Blackhawk mechanic military specialty performance and wearing a Kevlar helmet for more than a 30-minute period.  His unit move the CI out of his military specialty at least 2-3 times a week.  A neurology noted dated 1 November 2005, 5 months prior to separation, documented diagnoses of tension-type headache and headache syndromes.  At that time the CI reported headache flares with most of his duties.  The commander’s statement, 17 November 2005, reported since the time of the accident (approximately 11 months) the CI served as the unit mail clerk and NCOIC of Hangar Guard Duty with satisfactory performance.  The commander did not address missed duty due to headache or acute treatment.

The December 2005 neurology NARSUM, 4 months prior to separation, documented recurrent, 7/10 headaches occurring approximately every 4 hours.  The headache improved with lying down for at least an hour.  The headache was exacerbated by strenuous physical activities and wearing a Kevlar helmet.  The physical examination was normal.  There was no VA Compensation and Pension examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 10%, analogously coded 5323 (Group XXIII. Function), citing chronic muscle contraction tension headaches 2-3 times per week.  The panel considered rating options analogous to 8100 (migraine headaches) which rely on the frequency of “prostrating attacks” over the “last several months.”  The DoDI 1332.39 (in effect at separation, but since rescinded) required that “the Service member must stop what he or she is doing and seek medical attention.”  However, VASRD §4.124a does not require seeking medical attention for an attack to be considered prostrating, and a common approach is to apply the clear English definition of prostrating.

The panel carefully considered the frequency and nature of the CI’s headaches including objective evidence and corroborating subjective evidence.  The panel noted that the CI’s headaches were controlled by medication until 12 months prior to separation.  Although the STR documented prostrating (requiring him to lie down for at least an hour) headaches, the frequency of prostrating headaches were not documented for prolonged reading, exposure to loud noises or bright lights, and strenuous activity, the frequency of these prostrating headaches.  Panel members agreed that a rating based on the frequency of the STR prostrating attack evidence would be speculative.  The panel noted that the PEB rated the headache condition using a muscle injury code.  The STR documented daily, non-prostrating, headaches every 4 hours which resulted in removal from the CI’s primary military specialty 2-3 times per week.  The panel noted that the CI was able to satisfactorily perform the duties of a mail clerk and hanger guard.  The panel determined that daily tension (muscular) headaches did not rise to the level of moderately severe muscular dysfunction for a 20% rating analogous to 5323.  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 chronic occipital headache condition.

BOARD FINDINGS:  In the matter of the chronic occipital headache condition and IAW VASRD §4.73, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’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 20150530, w/atchs
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

17 Apr 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170005969 (PD-2015-00413)

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