RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01910
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20030606

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Operation Resource Manager, medically separated for “chronic migraine headaches,” with a disability rating of 10%.  

CI CONTENTION:  The CI contends that he received medical care from a civilian provider and that those records were not included in the case file sent to the Physical Evaluation Board (PEB).  Those records are now included in his case file.  The CI’s 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 - 20030207	VARD - 20040322	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Migraine Headaches	8100-8199	10%	Migraine Headaches	8100	30%	20040607	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

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 May 1994 treated with a variety of medications both for prophylaxis and symptom control.  Despite treatment and reclassification, he remained on limited duty (avoidance of excessive heat) and was not world-wide qualified even though his duty performance in garrison was exceptional.  He was therefore referred for MEB.  The MEB forwarded chronic migraine headaches for PEB adjudication.  Review of the medical records shows that in the 16 months prior to separation, the CI was placed on quarters twice for headaches, each time for 48 hours.  Both times he also had a viral infection.  The closer to separation of the two was still 8 months prior to separation.  At the MEB NARSUM, dated 10 January 2003, 5 months prior to separation, the CI reported that he was averaging four migraines per week.  He was restricted from working in environments with an ambient temperature greater than 85 degrees Fahrenheit.  The neurological examination was normal as it had been on numerous previous examinations.  The squadron commander’s statement, dated 14 January 2003, 5 months prior to separation and prior to the Informal PEB, reported that environmental triggers in the work place triggered mild migraine attacks.  He also reported that the CI’s migraines had “not caused any interruptions of duties” and had not caused him to miss any work.  The CI requested an exception to remain on active duty until retirement.  Two additional letters of support from his change of command noted that he performed his duties well in-garrison.  The squadron commander’s updated statement, dated 27 February 2003, 3 months prior to separation, reported that despite environmental factors at work that trigger migraines, the CI was “able to function and perform his primary duties.”  The operation officer’s statement, dated 3 March 2003, 3 months prior to separation reported that the CI’s condition did “not affect his primary job” and that he had “not missed work due to his condition.”  He recommended that the CI be placed in a non-deployable status.  The group commander’s statement, dated 24 March 2003, reported that the CI’s migraines had “not caused any interruptions of duties” and that despite his condition, he was “still able to function and perform his primary duties.”  He recommended that the CI be placed in a non-deployable status.  The enlisted performance report, dated 31 March 2003, 2 months prior to separation, reflected exceptional duty performance.  At the 7 June 2004 VA Compensation and Pension (C&P) examination, performed 12 months after separation, the CI reported that he got “headaches about four times a week…last[ing] about half a day.”  He “had to go home two to three days over the past five months because of headaches.”  The neurological examination was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 10% coded 8199-8100 (analogous to migraine).  The VA rated the headache condition 30% coded 8100, citing the VA C&P examination.  The Board noted that the history provided on the C&P was not consistent with that reported by multiple members of the CI’s chain of command and that these were within 3 months of separation.  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 Board considered the results of the NARSUM and VA C&P examinations along with the evidence of the treatment records to accurately assess the overall disability picture (§4.2) at the time of separation.  Although the VA rated the CI’s migraine headaches at 30%, review of the record did not show prostrating headaches occurring on average once per month, or more frequently, over the last several months prior to separation to support a rating higher than the 10% adjudicated by the PEB.  Rather, the evidence proximate to separation indicates that the CI did not have prostrating headaches at all at that time.  The Board concluded there was no evidence to support a rating higher than the rating adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the migraine headache condition.  

BOARD FINDINGS:  In the matter of the migraine headache condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, 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 20150601, 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-2015-01910.

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