RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2016-00271
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20070704

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Human Resources Specialist, medically separated for “migraine headaches with syncope” with a disability rating of 10%.

CI CONTENTION: The CI made no specific 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 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 - 20070419	VARD - 20160102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches with Syncope	8100	10%	Migraine Headaches	8100	0%	STR	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Migraine Headaches with Syncope. According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s migraine headache condition began in March 2006 when the CI started experiencing headaches with episodes of syncope (fainting or a sudden loss of temporary consciousness), which were thought to be related to stress. On 24 July 2006, the CI reported recurrent syncopal episodes (four times in the prior 30 days) in very hot environments which were preceded by severe headaches accompanied by photo/audiophobia and nausea.

During the 15 September 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 10 months prior to separation, the CI reported she took Tylenol (acetaminophen, a pain reliever) and oxycodone (a narcotic for migraines).  Fainting resolved after a profile limited exposure   to

heat, outside, and exercise. She noted headaches three times a week, however, the CI reported “I can function” with headaches. The neurologic portion of this examination, performed by a neurologist, was normal.  The examiner specifically noted “HA’s not prostrating.”

Sumatriptan (a migraine headache abortive medication) was listed as an active medication on   9 November 2006. She underwent a cardiac work-up to include an echocardiogram which was normal  and  magnetic  resonance  imaging  of  the  brain  which  was  negative.   A  note  dated 9 February 2007 indicated the CI did not have any episodes of syncope since August 2006 and the four episodes she did have all occurred during March to August 2006. There was no post- ictal state (after epileptic seizure), no abnormal movements, no loss of bladder or bowel control, and no significant injuries from a fall. She stated that she felt well and wanted to deploy with her unit. The examiner noted “syncope may be considered pseudoseizure” and the CI “may qualify for 1 year trial of duty.” A 22 February 2007 neurologic evaluation revealed headaches which were associated with “a severity, nausea, but have not gone to vomiting.” She had blurred vision, photophobia and phonophobia. She looked for a quiet, dark room, and if she slept, it helped. The neurologist indicated “Her last syncopal episodes, however, were in November [2006], and she is doing somewhat better with the syncope issue.” The neurological examination was essentially normal. The diagnosis was familial migraine headaches with the syncopal episodes likely secondary to migraines. Medication for the migraines was changed to Topamax since the Sumatriptan, which helped in the past, but subsequently was not helpful.

The 16 March 2007 MEB NARSUM examination, 4 months prior to separation, noted complaints of headaches occurring about every 1½ weeks. The CI reported that despite the headaches, which at the time she had them, they were incapacitating; however, she went to work. She reported she was placed on quarters in January 2007 and noted one episode after she was seen by a neurologist. The examiner referred to the DD Forms 2807-1 and 2808 for the physical examination and noted the neurologic examination was normal. There was no VA examination proximate to separation for this panel to review.

The 27 March 2007 neurology visit noted the CI had negative laboratory tests for urinalysis, CBC (complete blood count), and CMP (comprehensive medical panel). An electroencephalogram to rule out seizures was normal and orthostatic blood pressures were likewise normal. She had done somewhat better since she eliminated caffeine, but she was not getting 7 hours of sleep. However, she reported no recent syncopal-like episodes with her migraines. Topamax was discontinued since it made her too sleepy. In its place amitriptyline (for nerve pain) was prescribed.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the migraine headache with syncope condition 10%, coded 8100 (migraines), citing “2x/month April through November, none since.” The VA rated the migraine headache condition 0%, also coded 8100, citing the CI did not attend her C&P Headaches examination.

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 determined that the STR did not reflect occurrence of prostrating attacks to support a rating of 30% rather than the 10% adjudicated by the PEB since there was no evidence of “characteristic prostrating attacks occurring on an average once a month over last several months” proximate to separation. 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 migraine headache condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication. There were 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.

AR20190011838, 

Dear XXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.