RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01253
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20050712

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Information Management Journeyman, medically separated for “common migraine headaches, moderate severity” with a disability rating of 10%.

CI CONTENTION:  “I am 100% disabled.”  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 - 20050531	VARD - 20070615	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Common Migraine Headaches, Moderate Severity	8100	10%	Chronic Migraine Headaches	8100	30%	20060209	
Pseudotumor, Cerebri…	8003-8099	Cat II	Pseudo Tumor Cerebri…	8099-8007	0%	20060209	
Bilateral Patellofemoral Syndrome	5003-5099	Cat II	Right Knee, S/P Retropatellar Pain Syndrome	5099-5014	10%	20060209	
			Left Knee, S/P Retropatellar Pain Syndrome	5099-5014	10%	20060209	
Depression	9434	Cat II	Adjustment Disorder…	9440	10%	20060209	
Bilateral Bunions	5280	Cat II	Right Foot, Hallux Valgus…	5280	0%	20060209	
			Left Foot, Hallux Valgus…	5280	0%	20060209	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  100%	

ANALYSIS SUMMARY:  

Migraine Headaches.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a history of migraine headaches since her early 20’s while stationed in Germany.  She reported having “occasional migraine-like” headaches until February 2005 at which time she experienced a period of stress which caused her headaches to worsen.

The CI was sent to a civilian hospital on 26 March 2005 for further evaluation and management of her prolonged (4+ day) headache.  She had an intermittent common migraine headache characterized as being slowly progressive bi-frontal and throbbing.  She developed photophobia and nausea with a pain level of 10/10.  She was discharged after 23 hours of treatment and observation.  She was again hospitalized from 28 March 2005 until 5 April 2005 for further evaluation and treatment.  During this hospital stay, a fluoroscopic guided lumbar puncture was performed (removal of cerebrospinal fluid [CSF]) which revealed elevated CSF pressure; supported the diagnosis of pseudotumor cerebri.

A therapeutic spinal tap was performed on 20 April 2005 with only mild improvement in her headaches.  The CI underwent numerous brain CT and MRI evaluations over the previous 5 years which were normal.

Review of the STR revealed 35 encounters of care for headache during the several months before separation; 30 were for acute headaches with 16 resulting in visits to the Emergency Department (ED).  She was hospitalized on two occasions for her persistent headaches.

The MEB NARSUM, dated 4 May 2005, 2 months prior to separation, provided a brief history of the CI’s migraine condition and referred to the MEB Neurology Addendum examination dated 29  April 2009.  This examination noted the CI reported intermittent migraine headaches for several years, but in February 2005, while experiencing increased stress, her headaches worsened and occurred to 1-2 times per month, often lasting from 2-4 days.  She was hospitalized 2 times in the 6 months leading up to her separation (see above) for prolonged headaches.  Her headaches were mild, but increased to a pain level of 8-10/10, characterized as throbbing with associated nausea, vomiting,  photophobia (light sensitivity), and sonophobia (sound sensitivity) when severe.  She tried multiple abortive medications without prolonged relief.  The examiner noted a long history of common migraine headaches refractory to most oral headache therapies and a recent history of elevated intracranial pressure.  The examiner opined that the CI was at increased risk of intracranial hypertension and that her condition quite possibly morphed from straight migraine headaches to a mix of migraines and elevated pressure headaches during the winter months of 2005.  He mentioned that she “missed a significant amount of work in the last 6 months, and especially in the last 2 months, due to refractory headaches.”  The 10 May 2005 commander’s statement reported that she was absent for approximately 100 days between June 2004 and May 2005, due to her “illnesses.”

At the 9 February 2006 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported a long history of migraine headaches refractory to medications and treatment.  She stated headaches almost constant for the previous 2 months at a pain level of 8/10 at the time of the examination.  The examination noted her extensive history as outlined in her STR but did not elaborate further.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 10%, coded 8100 (migraine headaches), citing that the condition “prevents you from reasonably performing the duties of your office, grade, rank or rating,” and the application of VASRD and DoD guidelines.  The VA rated the headache condition 30%, also coded 8100, based on the C&P examination 7 months after separation, citing “characteristic prostrating attacks occurring on an average of once a month over the past several months.”

The panel noted 15 June 2007 decision review officer decision rated the migraine headaches and pseudotumor cerebri as a single disabling condition at 100% retroactive to the date of separation, analogously coded 8100-8020 (migraine headache-brain abscess).  The pseudotumor cerebri condition is addressed as a “Contented PEB Condition” below.

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 panel noted evidence of 12 ED visits from March-June 2005 for migraine headache care; two visits resulted in hospitalization (March, April 2005); two resulted in quarters (March, May 2005); and one requiring rest in a dark, quiet environment.  Panel members agreed that the evidence supports a 30% rating for prostrating attacks occurring on average once per month over the last several months.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a separation rating of 30% for the migraine headache condition coded 8100.

BOARD FINDINGS:  In the matter of the migraine headache condition, the panel unanimously recommends a disability rating of 30%, coded 8100 IAW VASRD §4.124a.  

The panel recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Common Migraine Headaches	8100	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150615, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01253.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at XXXXXXXXXXXXXXXXXXX to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

Attachment:
Record of Proceedings