RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01493
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040107

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee, medically separated for “chronic headaches,” with a disability rating of 10%.

CI CONTENTION:  The CI contends his condition has worsened.  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 - 20031125	VARD - 20040728	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Headaches	8045-9304	10%	Headaches…	8199-8100	10%	20040301	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Headaches.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s headache condition began in April 2003 after hitting his head while in Basic Training.  He had no loss of consciousness nor amnesia. Examination revealed a scalp hematoma (a swelling of clotted blood within local tissue). Radiographic imaging of the skull was normal.  Despite various inpatient and outpatient treatment protocols, the CI’s headache symptoms remained as to not allow unrestricted duty and he was referred for an MEB.  The MEB forwarded “chronic headaches with migrainous features, mixed in type” for PEB adjudication.

A total of three examinations by neurology during June and July 2003 indicated the CI as having “daily headaches” further described as “24 hours a day” escalating to include symptoms of altered vision, hearing, and gastrointestinal upset.  The provider’s history included that the CI’s symptoms were “…resolved by resting completely still.”  The CI’s physical examinations (PE) were noted as normal throughout this time period except for a notation regarding superficial scarring in the back of his head from a prior dog bite at age 3. 

At the 29 September 2003 MEB NARSUM examination, 4 months prior to separation, the CI continued to complain of headaches as described above as well as decreased concentration and short-term memory loss.  His PE, including the neurological evaluation, was unremarkable.  The examiner stated, “The [CI’s] condition currently limits him secondary to the chronicity in nature of prostrating frontal or cephalic headaches with exacerbations with increased activity, being relieved solely by rest.”  The headaches were refractory to medication.

At the 1 March 2004 VA Compensation and Pension (C&P) neurological disorders evaluation, 2 months after separation, the CI reported headaches two to three times daily, precipitated by anxiety, stress, leaning over, noise or bright lights,  and lasting for up to 2 hours.  The CI stated the pain was located in the back of the head, described as “throbbing,” and he was still unemployed due to his headache condition.  The provider documented that the CI “…will go and lay down in a dark, quiet place” as a way to relieve head pain.  His mental status and neurologic examinations were normal.  The CI’s diagnosis was listed as headaches secondary to stress, tension, and trauma.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic headache condition at 10%, dual coded as 8045-9304 (residuals of traumatic brain injury-dementia due to head trauma), citing trauma to the head and normal radiographic studies.  The VA rated the headaches secondary to stress, tension and trauma condition at 10%, analogously coded 8199-8100 (migraine headache), based on the C&P examination 2 months after separation, citing  characteristic prostrating attacks averaging one in 2 months over the last several months.

The VARSD in effect at the time of separation captured brain injuries under the generic category of brain disease due to trauma (8045).  There are two different scenarios for rating under this code; analogously with purely neurological deficits, or purely subjective symptoms.  In the absence of associated neurological disabilities (seizures, nerve paralysis, etc.), rating of this condition under 8045-9304 is limited to 10%, and cannot be combined with any other rating for a disability due to brain trauma.  The Board found absence of evidence that would support any neurological disability, and therefore, only 10% was supported under that rating scheme.  

The Board also considered the 8100 code based upon pre- and post-separation examinations that indicated characteristic prostrating attacks by noting symptom relief ”solely by rest” and “…lay[ing] down in a dark quiet place.”   The Board agreed that a 30% rating, but no higher, was justified for the headache condition under code 8100, based on the criteria for characteristic prostrating attacks occurring on an average of once a month over the last several months.  There were no additional applicable codes to consider for rating the condition.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the chronic headache condition, coded 8199-8100. 

BOARD FINDINGS:  In the matter of the chronic headache condition, the Board unanimously recommends a disability rating of 30%, coded 8199-8100 IAW VASRD §4.124a.  There were no other conditions within the Board’s scope of review for consideration.  The Board 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	
Chronic Headaches	8199-8100	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150618, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006355, XXXXXXXXXXXXXXXXXX.

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,