RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00111
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050826

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Tactical Aircraft Maintenance, medically separated for “post concussive chronic migraine headaches…,” with a disability rating of 10%.  

CI CONTENTION:  “TBI Diagnosis.”  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 - 20050708	VARD - 20060301	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Concussive Chronic Migraine Headaches…	8100	10%	Headaches, Residuals, Post Concussive Syndrome	8100	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Post Concussive Chronic Migraine Headaches.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the migraine headache condition began after 4 head injuries between October 2003 and January 2004.  Post-concussive syndrome with chronic headaches, dizziness, memory changes and decreased concentration began after the last injury in January 2004.  At a March 2004 neurological evaluation, 17 months prior to separation, the CI reported 2-3 headaches per week with sensitivity to light, sound, and smells.  Electrophysiologic testing (electroencephalogram [EEG]) in February 2004 and radiographic imaging (MRI) in April 2004 were within normal limits.  At an April 2004 primary care visit, 16 months prior to separation, the CI reported “no migraines on [medication]” with improved sleep and only “mild headache pressure.”  At a May 2004 neuropsychology evaluation, the CI reported that medications had helped but the headaches were “constantly pulsing all the time,” and worsened after 1 hour of computer work, causing him to have to put his head down.  At a September 2004 primary care visit, 11 months prior to separation, the CI reported that the headaches were “still there,” and his memory and concentration were improving with therapy.  The September 2004 MEB NARSUM was updated in February 2005 and June 2005, without any significant changes.  The CI had reported recurrent daily headaches, with no real improvement on medication, however there was improvement in night awakenings due to headaches.  He additionally reported dizziness, inability to focus, visual abnormalities, memory problems; and a depressed mood with improved memory and concentration after behavioral therapy.  There was no further STR documentation for treatment of headaches in the 11 months prior to separation.  In an undated commander’s statement, the chronic migraine headache caused the CI to “not function well enough to perform his military duties.”  It also reported that the CI had daily headaches requiring medical care, at least twice a week.  There was no VA examination in evidence proximate to separation.

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 10% for the headache condition, coded 8100 (migraine), citing lack of incapacitation.  The VA rated 0% for the headache condition, coded 8100, citing the absence of current medical evidence of ongoing treatment for post-concussion syndrome.  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 STR 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 that adjudicated by the PEB.  After due deliberation, considering 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 migraine headache condition.

BOARD FINDINGS:  In the matter of the post concussive chronic migraine headache condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20150819, w/attachments
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-2016-00111.

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.  The Board recommended no re-characterization or modification of your separation.

I 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.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings