RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01660
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aviation Operations Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “non-prostrating migraine headaches,” with a disability rating of 0%.  

CI CONTENTION:  The CI contended both migraine headaches and Meniere’s disease.  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 - 20051110	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Non-Prostrating Migraine Headaches	8100	0%	
No VA Exam in Evidence	
Meniere’s Disease	Not Unfitting		
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Migraines.  The CI was placed on the TDRL on 12 May 2001 for weekly prostrating migraine headaches.  A 28 March 2003 treatment note stated the CI had no active medications other than prenatal vitamins as she was 13 weeks pregnant at the time.  In January 2004, the CI submitted her medication profile for a TDRL re-evaluation and stated she was unable to take medication due to her pregnancy from January 2003 until September 2003 and then for another 6 months due to breastfeeding.  At the 28 October 2003 TDRL evaluation the CI reported two headaches per month with a 75% reduction in the overall intensity of her headaches after taking Cafergot (a combination medication with two vasoconstrictors) 75% of the time.  The CI denied seeking emergency room treatment for headaches.  The examiner noted the CI had not been treated for her migraine headaches and thus her current monthly headache frequency reflected the natural untreated headaches process.  

An outpatient treatment note for an office visit on 29 March 2004 indicated the CI presented for a refill of her migraine medication that she wanted to resume since she was no longer breast feeding her 6-month-old daughter.  The CI reported her migraines receded some during pregnancy, but never entirely went away.  She reported at that time experiencing migraines every 2 weeks that responded to Cafergot.  The provider noted Cafergot, Maxzide, amitriptyline and meclizine would be resumed as before.  The medication profile showed those medications were filled the same day (90 day supply).  The STR records fell silent with regard to care for headaches except as noted above.  

Prior to the August 2005 TDRL re-evaluation the CI was asked to submit a current medication profile listing all of her medications.  The 28 August 2005 VA medication profile showed that the CI had received a 90 day prescription for Cafergot 29 March 2004 (17 months earlier) and that she had not requested the authorized refills.  At the 31 August 2005 TDRL NARSUM examination, 3 months prior to TDRL removal, the CI reported suffering from headaches that occurred approximately twice per month, each lasting 2-3 hours.  The CI reported using Cafergot or Excedrin for relief if she was able to take them immediately after the onset of the headache.  If not, only sleep in a dark room relieved the headache.  Physical examination showed a normal neurologic evaluation.  

The panel directed attention to its rating recommendation based on the above evidence.  At TDRL removal, the PEB rated the migraine condition 0%, coded 8100 (migraines), citing the headaches were non-prostrating and were relieved either by Caffergot, Excedrin, or sleep.  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).  Review of the service treatment record in the 12 months prior to separation does not show prostrating headaches occurring on average one in 2 months or more frequently to support a rating higher than the 0% adjudicated by the PEB.  Although she did complain of migraines twice per month, the CI reported these headaches impacted her for 2-3 hours and were relieved with Cafergot or Excedrine if taken at the onset.  This was consistently reported while on TDRL.  The panel also considered the most recent medication profile and that the CI received 30 tablets of Cafergot at a time and that her prescription had expired without being renewed in March of 2005.  Given how she reported she took Cafergot, 2 tablets at onset of headache and then 2 tablets every 30 minutes until headache was resolved, for her medication to last until the August 2005 visit the headaches must have resolved within 30 minutes of taking the first dose most of the time.  The panel felt that the majority of these headaches did not raise to the level of “prostrating” for the purposes of disability rating.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the migraine headache condition.  

Contended PEB Condition: Meniere’s Disease.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting at the time of TDRL removal.  At the 31 August 2005 TDRL re-evaluation, the CI reported continued improvement, stable, now with one episode every 3 months lasting no more than 1 day.  She was taking no medication and had not seen an Otolaryngologist except for TDRL evaluations in the last 3 years for her Meniere symptoms.  The examiner stated the CI had maintained a relatively normal quality of life without medical intervention for at least 3 years and met medical retention standards.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the migraine headache condition and IAW VASRD §4.124a, the panel majority recommends no change in the PEB adjudication.  The single voter for dissent recommended modification to 10% and did not elect to submit a minority opinion.  In the matter of the contended Meniere’s Disease, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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, dated 20150626, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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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,