RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01735
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060927

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aerospace Control and Warning Systems, medically separated for “migraines headaches controlled on medications,” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  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 -20060814	VARD - 20061213	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches 	8100	10%	Migraine Headaches	8199-8100	10%	20061023	
Syncopal Episodes Resolved	Not Unfitting	Syncopal Episodes due to Hypoglycemia	8099-8045	NSC		
Cerebellar Venous Malformation		Arteriovenous Malformation	8009-8003	NSC		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Migraine Headaches Controlled on Medications.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI reported an episode of dizziness resulting in her falling down a set of stairs on 17 May 2003.  No head injury was reported and the medical evaluation, following the fall, was normal.  In June 2003, the CI reported headaches, nausea, vomiting, blurry vision, and dizziness.  The CI disclosed a history of migraines in grade school that resolved but at the time was experiencing “blackouts” where she was “out of it” for a few seconds without loss of consciousness.  Magnetic Resonance Imaging (MRI) showed an incidental right cerebellar venous malformation and she had multiple follow-up MRIs that were unchanged.  Echocardiogram, holter continuous cardiac monitor, and electroencephalogram were normal.  A 4 hour glucose tolerance test revealed hypoglycemia as the cause of the blackouts.  The CI was able to modify her diet and no further episodes were noted.  The CI was given the diagnosis of vestibulopathy and migraine headaches.  The CI was started on a headache prophylaxis medication which resulted in headache improvement.  The CI continued to experience headaches and dizziness while pregnant which were treated with Tylenol #3 with codeine.  Headaches continued at a frequency of 2 per week and could not be further reduced with prophylactic treatment.  The MEB forwarded “right cerebellar venous malformation and pre-syncopal/syncopal episode” for PEB adjudication.  

The 23 March 2006 MEB NARSUM examination, 6 months prior to separation, noted the CI was breast feeding at the time of her evaluation and therefore not taking her prophylactic medication which is not recommended during pregnancy or while breast feeding.  She reported taking Darvocet for headaches but frequency was not noted.  Neurological examination was normal.  

At the 17 May 2006 neurological evaluation, 4 months prior to separation, the CI reported more frequent headaches since the delivery of her son.  The CI details headaches 3 times per week with associated nausea, vomiting, phono and photophobia that were relieved with oral medication, incapacitation was not addressed.  Physical examination showed normal neurological examination unchanged from previous evaluations.  

At the 23 October 2006 VA Compensation and Pension (C&P) evaluation, performed 1 month after separation, the CI reported restarting the Topamax for headache prophylaxis.  The CI reported episodes of pain in the back of her head with everything becoming blurry and associated vomiting occurring twice per week lasting a few hours up to 4 days.  The CI reported she was on quarters for 6 days for headaches during the time she was in the Air Force.  Physical examination, including neurological was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 10%, coded 8100 (migraine), citing the condition prevented the CI from performing her duties.  The VA also  rated the headache condition 10% coded 8100, based on the VA C&P examination 1 months after separation, citing characteristic prostrating attacks averaging one in two months over the last several months.  

The panel considered whether the CI’s headaches at the time of separation merited a 30% or a 10% disability rating.  The MEB NARSUM, 23 March 2006, 6 months prior to separation, noted headaches but no indication of incapacitating headaches.  On 31 May 2006, the commander details the CI’s performance with no indication that the CI had lost work due to prostrating headaches and her performance report one month prior to separation indicated that she was highly effective and should be promoted ahead of her peers.  A review of all records in evidence revealed only one visit for acute migraine with the only episode of quarters over the 3 years prior to separation.  Although more than 1 severe headache per month was reported, the panel concluded the headaches were not prostrating.  Panel members agreed, the evidence of the record reflected a severity and frequency to support no higher than a rating of 10%.  After due deliberation, considering and 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 headache condition.

Contended PEB Conditions:  Cerebellar Venous Malformation and Syncopal Episodes Resolved.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The panel notes that no symptoms were tied to the venous malformation.  Venous malformation, was an incidental finding while the CI was being worked up for headaches.  No treatment was recommended.  The Board notes the underlying cause of the CI’s syncopal episodes was determined to be hypoglycemia.  The CI was recommended to eat every two to three hours.  Although the syncopal episodes were the original reason for a profile restricting duty and mobility, the CI was able to control her hypoglycemia with diet modification and her episodes resolved.  The CI’s driver’s license was reinstated.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS: In the matter of the headache condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended venous malformation and syncopal episodes resolved conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There are 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 20150630, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01735.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings