RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00555
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20041115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Aviation Maintenance Administration, medically separated for “post-traumatic migrainous headaches” with a disability rating of 10%.  

CI CONTENTION:  Review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) requested.  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the MEB, but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.   

RATING COMPARISON:  

SERVICE PEB - 20040923	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Traumatic Migrainous Headaches	8045-9304	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA 	

ANALYSIS SUMMARY:  

Post-Traumatic Migrainous Headaches.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s headache condition began in December 2002 after suffering a traumatic closed head injury involving a motor vehicle accident.  X-ray studies of the C-spine on 8 December 2002 were normal.  MRI studies of the C-spine on 10 February 2003 were normal.  

X-ray studies on 19 March 2003 showed a normal curvature, alignment and preservation of the vertebral body heights without evidence for anterolisthesis with positioning.  There was no significant prevertebral soft tissue swelling.  A CT scan of the head on 8 April 2003 showed no areas of abnormal density.  There were no masses or extra axial fluid collections.  Soft tissues were unremarkable.  A neurologist report on 23 April 2004 noted the post traumatic headaches which had been refractory to standard headache therapies.  There had been little response to acute therapy.  The CI now required the use of oral fentanyl lozenges after being involved with another motor vehicle accident.  The physician’s assessment was that the CI would be limited functioning at an efficient level in the Navy.  

The 3 August 2004 MEB NARSUM examination, 3 months prior to separation, noted complaints of severe migraines due to repeated head trauma.  The examiner noted frequent emergency room (ER) visits requiring use of a narcotic agent and increased treatment using fentanyl lozenges.  The examiner also noted one severe headache per week requiring narcotic analgesia with 12-24 hours of incapacitation.  Physical examination showed the CI had been involved in two motor vehicle accidents where he had been struck by a vehicle as a pedestrian.  These traumatic events happened in December 2002 and again in April 2004.  The CI was prescribed Amitriptyline, Fentanyl, Depakote, Trazodone and Connate to assist in relieving the symptoms.  The physician’s assessment was post-traumatic migraine headaches with exacerbation due to repeat trauma and necessitating the use the narcotic agents for significant control.  The 16 August 2004 MEB examination (recorded on DD Form 2808) noted debilitating migraines.  The 18 August non-medical assessment noted the member’s condition required him to be away an average of 8-16 hours per week for treatment, evaluation/or recuperation.  There was neither a profile nor a VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 10%, coded 8045-9304 (analogous to residuals of traumatic brain injury).  Code 8045, per the VA Schedule for Rating Disabilities (VASRD) in effect, stipulates, “Purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, will be rated 10 percent and no more under diagnostic code 9304.”  

Members discussed whether a higher rating under the 8100 code for migraine headaches would be applicable.  The NARSUM examination noted the presence of one severe headache per week requiring narcotic analgesia with 12-24 hours of incapacitation as well as frequent ER visits.  These visits to the ER/neurologists suggest prostrating attacks.  The medication record confirmed the frequent visits to neurologist and to other physicians within 6 months prior to the MEB NARSUM.  After reviewing the evidence, the panel unanimously agreed the CI’s migraine headache condition at the time of separation most closely matched the criteria for a 30% rating under VASRD code 8100.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the headache condition.  

BOARD FINDINGS:  In the matter of the post-traumatic migrainous headaches condition the panel recommends a disability rating of 30%, coded 8100 IAW and 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; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Post-Traumatic Migrainous Headaches	8100	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161112, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND	
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:  (a) DoDI 6040.44
	(b) PDBR ltr dtd 13 Apr 18 ICO XXXXXXXXXXXXXXXXXX  
	(c) PDBR ltr dtd 13 Mar 18 ICO XXXXXXXXXXXXXXXXXX
	(d) PDBR ltr dtd 19 Apr 18 ICO XXXXXXXXXXXXXXXXXX
	(e) PDBR ltr dtd 20 Apr 18 ICO XXXXXXXXXXXXXXXXXX

1.  Pursuant to reference (a), the recommendations of the Physical Disability Board of Review set forth in references (b) through (e) are approved.  The official records of the following individuals are to be corrected as follows:

     a. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 10 percent disability rating (increased from 0 percent) effective date of discharge.       

     b. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.

     c. XXXXXXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a 30 percent rating (increased from 10 percent) effective date of discharge.  

     d. XXXXXXXXXXXXXXXXXX, former USN: Entitlement to disability separation pay with a 20 percent disability rating (increased from 10 percent) effective date of discharge.
 
3.  Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.