RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX.	CASE:  PD-2015-00625
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040401

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Armament Repairer, medically separated for “tension 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 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 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 determinations 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 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 - 20040106	VARD - 20050209	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Tension Headaches	8199-8100	10%	Tension Headaches with Dizziness	8100	0%	20040724	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Tension Headaches.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s headache began in July 2002 after a viral syndrome.  The CI visited the emergency department on 7 occasions (3 times in June and July 2002; twice in in January 2003; and once each in July and October 2003) for symptoms related to headaches (that included fatigue, dizziness, light headedness, near syncope and syncope).  Multiple documents throughout the CI’s records show constant daily headaches without any significant neurologic or pathologic abnormalities.  The CI took abortive medications (Topomax and Imitrex) without relief of his symptoms.  Treatment did not result in improvement sufficient to allow unrestricted duty and the CI was referred for MEB.  The MEB forwarded “chronic tension-type headaches” for PEB adjudication.  

At the MEB NARSUM, dated 7 November 2003, 5 months prior to separation, the CI reported constant headaches with some light sensitivity, and denied nausea, vomiting or noise sensitivity.  The headaches varied in intensity, but were “severe and prostrating” at least once per day.  

At the 25 November 2003 MEB examination (recorded on DD Forms 2807 and 2808), 4 months prior to separation, the CI reported daily headaches, intermittent weakness and dizziness, and visual changes.  The physical and neurologic examinations were checked as “normal.”  The 2 December 2003 commander’s statement, 3 months prior to separation, reported that the CI’s neurological symptoms prevented satisfactory performance in the CI’s primary MOS “due to safety concerns” and prevented him from performing soldier readiness tasks.   

At the 24 July 2004 VA Compensation and Pension (C&P) examination, performed 7 months after separation, the CI reported constant daily low intensity headaches without nausea or vomiting.  The headaches worsened 3-4 times a week and improved after using abortive medication.  Brief spells of dizziness occurred with exacerbations.  The neurologic examination showed normal reflexes, sensation, strength, and gait with no evidence of pathology.  The examiner diagnosed “mild tension-type headache” disorder.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the headache condition, analogously coded 8199-8100 (migraine).  The VA rated 0% for the headache condition, coded 8100, citing daily headaches with no evidence of prostrating attacks.  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).  

After reviewing the evidence, the panel unanimously agreed that the CI’s headache condition most closely matched the criteria for a 10% rating at the time of separation.  The 30% rating criteria stipulates “characteristic prostrating attacks occurring on an average once a month over last several months,” and the panel concluded there was no evidence to support a rating higher than the 10% rating adjudicated by the PEB.  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 tension headache condition.  

BOARD FINDINGS:  In the matter of the tension headaches condition and IAW VASRD §4.124a, 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 20150602, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170007486, XXXXXXXXXXXXXXXXXX. 

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,