RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00260
BRANCH OF SERVICE:  Army 	
DATE PLACED ON TDRL:  20040527
DATE REMOVED FROM TDRL:  20070129	

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E4, Light Wheeled Vehicle Mechanic, medically separated from the Temporary Disability Retired List (TDRL) for “cluster headaches [HA] with migraine features” with a disability rating of 0%.  

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 – 20040426/20070111	VARD – 20040927	
Condition	Code	Rating	Condition	Code	Rating
Proximate	
		TDRL
Placement	TDRL Removal			TDRL
Placement	TDRL
Removal	
Cluster HA with 
Migraine Features	8100	30%	0%	Migraine HA	8100	50%	--	
COMBINED RATING:  30% → 0%	COMBINED RATING OF ALL VA CONDITIONS:  50%/NA	

ANALYSIS SUMMARY:  

Cluster HA with Migraine Features.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI began experiencing HAs in the summer of 2003 while deployed overseas.  His HAs would worsen in hot temperatures, from lack of sleep, or in environments with excess particulate in the air.  The CI was diagnosed with migraine headaches and started on preventative and abortive medications.  The PEB rated the migraine HA condition 30%, coded 8100 (migraine) and placed the CI on the TDRL, citing weekly prostrating headaches.  

At the 6 June 2005 neurology clinic evaluation, the CI reported migraine headaches occurring 3 to 4 times a week during exacerbations, but that he could go a full month without a HA when not experiencing aggravations.  The CI reported severe headaches in hot weather which were relieved by lying in a dark room and occasionally applying ice to his head.  He receive little help from the prescribed medications (Imitrex and Topiramate).  

At the 6 May 2006 follow-up neurology evaluation the CI reported two HAs over the last 5 months that required the use of injectable Imitrex; the last HA occurred in March 2006.  At that time, the CI was a full-time student and reported his quality of life was good.  

At the 2 October 2006 neurology appointment, the CI reported increased HAs (3 to 4 times a week) lasting a couple of hours to several days.  The headaches were associated with photophobia (light sensitivity), phonophobia (sound sensitivity), nausea, neck soreness and tinnitus (ringing in the ear).  During severe HAs, the CI needed to lay down, forcing him to miss school and work.  The CI reported that he presented to the emergency department for prostrating headache twice in the last 2 years.  

A 9 January 2007 supervisor’s letter noted that over a 6-month period (June – November 2006) the CI missed 9 full days and left his shift early 7 days.  The document did not specify the reason the CI missed or left work.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the cluster HA with migraine condition 0%, coded 8100, at TDRL removal, citing HAs averaging less than one prostrating episode every 2 months.  The VA rated the migraine HA condition 50%, coded 8100, citing frequent prostrating HAs causing severe economic inadaptability.  

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 panel carefully considered the frequency and nature of the CI’s HA condition including objective evidence and corroborating subjective evidence.  

The panel noted reports of 3-4 times per week; however, the CI differentiated weekly headaches from severe headaches at multiple evaluations and did not address the frequency.  Although the CI’s supervisor noted missed or early departure from work, migraine headaches were not identified as the medical condition impacting the CI’s work schedule.  Review of the record supported the conclusion that, during the several months prior to separation, the CI experienced prostrating headaches occurring on average once every 2 months.  A rating of 10% was therefore justified.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a separation rating of 10% for the cluster HA with migraine features condition coded 8100.  

BOARD FINDINGS:  In the matter of the cluster HA with migraine features condition, the panel unanimously recommends a disability rating of 10%, coded 8100, for TDRL removal, IAW VASRD §4.124a.  There are no other conditions within the panel’s scope of review for consideration.  
The panel recommends the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Cluster HA with Migraine Features	8100	30%	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160427, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170015226, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure