RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01095
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E6, Network Switching Systems Operator Maintainer, medically separated for “post-concussion syndrome with headaches,” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention but listed some of his symptoms.  The 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 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 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 - 20060409	VARD - 20070810	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Concussion Syndrome with Headaches…	8045- 9304	10%	Residuals of Skull Fracture with Post-Concussion Syndrome Migraine Headaches	8045-8100	30%	20060925	
			Posterior Scalp Scar, Status Post Skull Fracture	7805	0%	20060925	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Post-Concussion Syndrome with Headaches.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s post-concussion syndrome began in November 2004 after being hit in the back of the head with a solid object during an assault.  The CI self-reported unconsciousness for several hours.  Subsequent symptoms of headaches, dizziness, and memory loss continued as to not allow the CI unrestricted duty and he was referred to MEB.  The MEB forwarded “migraine headaches” for PEB adjudication.  The 7 December 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of bi-frontal (left greater than right) throbbing headaches associated with nausea as well as photophobia and phonophobia (pain sensitive to both light and sound).  “Severe” headaches occurred approximately “2-4 times per week.”  The CI additionally reported not missing any work due to the headaches.  He reported the need to lie down and sleep during a headache.  His medications remained were an “as needed” abortive compound for headache pain and a daily maintenance drug to assist in sleep as well as to prevent nocturnal head pain.  His physical examination (PE), to include a detailed neurologic examination, was completely normal.  A recent brain MRI was also normal.  The CI’s final diagnosis was ‘migraine headaches.”  A clarification addendum to the NARSUM dated 10 February 2006 documented, “[The CI] was seen by both neuropsychology and psychiatry. They report that he does not have any significant problems that warrant disposition through the Physical Evaluation Board.”  His diagnosis on the addendum remained unchanged.

At the 25 September 2006 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported migraine headaches associated with nausea and sight/sound phobia averaging about 12 times per month with a duration of 3 hours per attack.  The CI reported an inability to function, concentrate, or focus during a headache flare-up.  Specifically, “He is unable to vacuum, drive a car, cook, climb stairs, take out trash, walk, shop, or perform gardening activities and push a lawn mower.” Also noted was, “The [CI’s] usual occupation was heavy equipment operator, which he has performed for 24 years; he is currently employed in the same job.”  He continued on two separate prescription medications.  His general PE was completely normal.  During a mental status examination, the provider noted normal behavior and comprehension, appropriate affect, and an intact memory.  The migraine headache diagnosis remained and the provider documented, “The objective factors are headache three times per week controlled on prescription medications.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the post-concussion syndrome at 10%, coded analogous to TBI, 8045-9304 (dementia due to head trauma), citing a brain MRI and neurological examinations which were unremarkable with no neurological deficit, and that the CI had not lost work time due to the headaches but required accommodation for being late.  The VA rated the same condition at 30%, coded analogous to TBI, 8045-8100 (migraine headaches), based on the C&P examination 4 months after separation, citing characteristic prostrating attacks occurring on an average of once a month over the last several months.  The Board is directed to comply with applicable VA disability rating policy changes issued via “FAST” or Training Letters (TL) effective at the time of separation.  TL06-03 (13 February 2006 - 30 August 2007), specifically addressed the complexity of TBI. Rather than the maximum rating of 10% under the 8045 (or 8045-9304) code, recommends coding “outside” of 8045 when a more favorable rating could be achieved under an alternate code; e.g., analogous rating for a headache (migraine) component under 8045-8100, if there is support for a higher rating under the corresponding 8100 criteria.  Any subsequent TBI VASRD criteria policy changes are not applicable in this case for the CI’s separation occurred prior to additional policy recommendations.

Code 8100 criteria hinges on the frequency of ‘prostrating’ attacks; and, it is incumbent on the Board to apply DoDI 6040.44-compliant and uniform criteria which would define a recurrent migraine episode as ‘prostrating’ and ratable.  Under DoDI 6040.44, the Board is directed to “Use the VASRD in arriving at its recommendations, along with all applicable statutes, and any directives in effect at the time of the contested separation (to the extent they do not conflict with the VASRD in effect at the time of the contested separation).”  Since the VASRD does not provide a definition of ‘prostrating’, it can be argued that the Board is directed to apply the DoDI 1332.39 definition which requires evidence that medical treatment is sought for each rated episode.  The Board, by precedence, has not required rigid proof of medical attention for each and every episode to characterize it as prostrating; but, does require reasonably convincing evidence that rated attacks force the abandonment of work or current activity to treat the migraine; although, self-management (medication and/or sleep) has been accommodated within this threshold.

The Board deliberated on the parameters of meeting the “prostrating” definition in relation to this condition.  Members carefully considered the nature and frequency of the CI’s headaches including subjective reports and comparative objective evidence.  Although the CI’s headache frequency was well supported under code 8100, Board members agreed that the additional criteria of the headaches being “prostrating” in nature was not met.  The CI did not have lost work time due to the condition and he maintained the ability to continue in his occupation as a heavy equipment operator despite reporting the inability to perform minimal activities as documented in the VA examination.  Such findings would not support any impairment rating under VASRD code 8100.  Therefore, 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’s adjudication for the post-concussion syndrome condition.

BOARD FINDINGS:  In the matter of the post-concussion syndrome with headaches 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 modification or re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, 20151010, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170005805, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
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,