RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01748
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040928

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

CI CONTENTION:  The CI makes no contention.  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 panel 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 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 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 - 20040707	VARD - None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	9100	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

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 2001 treated with various medications.  Despite treatment, the migraine headache condition could not be adequately treated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “migraine headaches” for PEB adjudication.  

At the neurologic consultation on 20 May 2004 (4 months prior to separation), the examiner indicated the migraine headaches were occurring approximately once per week, with some lasting as long as a day or two and requiring an injection for relief (the last one of this severity had occurred approximately 6 months prior to this examination).  The CI indicated he could go as long as 2 months without a headache, and they were never more frequent than 2 per week.  Headaches were predominantly in the early morning.  The CI was given a prescription for Topamax (a seizure, or anti-convulsant drug also used to prevent migraines) in addition to the Imitrex nasal spray (a migraine headache preventive/relief drug) that he was already using.  

Two weeks later (2 June 2004) the MEB NARSUM noted migraine headaches 1-2 times per week that would last 3-4 hours.  The CI indicated he would either miss work or arrive late due to headaches approximately 2 times per week that would often incapacitate him, and a previous Air Force Profile (AF Form 422) had excused him from work as necessary due to headaches (the Profile current at the time of the NARSUM did not excuse him from work).  The examiner noted the CI was still using Topamax, Imitrex, and Motrin.  

The commander’s statement dated 15 June 2004, reported the CI missed either partial or whole days of work due to his migraine condition depending upon severity, but did not detail the frequency or number of missed days.  

From June 2004 (NARSUM date and commander direction to be seen at clinic with any migraine) through September 2004 (separation date), there were 10 clinic visits for headaches, although most visits were following decrease in headache severity, and most headaches were not indicated as incapacitating.  The PEB was July 2004 and the STR fell silent with regard to care for headaches between 9 August 2004 and the time of separation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 10% (code 8100 migraine), citing incompatibility with military service and potential deployment/remote assignment inequities.  No VA rating information was available for review by the Board.  

DoDI 1332.39 (in effect at the time/rescinded) required seeking medical attention for a headache to be considered prostrating, but that is not a VASRD rating requirement.  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).  There was no evidence of very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability to support a 50% rating and the Board deliberated if the CI’s disability picture more nearly represented the 30% criteria of “characteristic prostrating attacks occurring on an average once a month over last several months,” or the 10% criteria (awarded by the PEB) of “characteristic prostrating attacks averaging one in 2 months over last several months.”  

The Board considered the results of the neurology and NARSUM examinations along with the evidence of the profiles, commander’s statements and treatment records to accurately assess the overall disability picture (§4.2) at the time of separation.  The CI’s headaches were described as often incapacitating and the CI missed some work on average of twice a week through June 2004 (NARSUM and commander’s statement dates).  The Board deliberated if the more scant STR evidence of incapacitating headaches following the NARSUM and PEB represented improvement of the condition, or no requirement for medical treatment following PEB processing.  Board consensus was that the record supported a conclusion that, during the several months prior to separation, the CI experienced prostrating headaches occurring on average once per month.  A rating of 30% was therefore justified.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority recommends a disability rating of 30% for the migraine headaches, coded 8100.  

BOARD FINDINGS:  In the matter of the migraine headaches, the Board majority recommends a disability rating of 30%, coded 8100 IAW VASRD §4.124a.  The single voter for dissent recommended no change and did not elect to submit a minority opinion.  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	
Migraine Headaches	8100	30%	
COMBINED	30%	

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-2015-01748.

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,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings 

cc:
SAF/MRBR