RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00653
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040106

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

CI CONTENTION:  The CI contended for: tinnitus, anxiety, depression, GERD, fibromyalgia, sleep apnea and migraines.  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 - 20031029	VARD - 20120815	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Headaches Mixed Type	8100-8199	10%	Migraines	8100	0%	STR	
Depression Existed Prior to Service (EPTS)	Category II	Depression	9434	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Chronic Headaches Mixed Type.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s chronic headaches began in September 2002 after the birth of her son.  Inpatient hospitalization (5 days), neurologic consultation (spring 2003) and radiographic imaging (March 2003, normal) resulted in the diagnosis of chronic headaches.  Spinal fluid removal and analysis (in February and March 2003), in addition to multiple medication trials (through October 2003), did not result in sustained improvement.  

There were eight entries documenting the acute care and treatment of headaches in June, July, August, September, October, and November of 2003.  Symptoms varied but included blurry vision, light and sound sensitivity, nausea or emesis, and dizziness.  The MEB NARSUM examination on 3 September 2003, 4 months prior to separation, noted that the headaches interfered or prevented her from doing normal activities.  The neurologic examination was within normal limits or noncontributory.  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 the chronic headaches condition 10%, analogously coded 8100-8199 (migraines).  The rating options under 8100 for migraine headaches rely on the frequency of “prostrating attacks” over the “last several months.”  The DoDI 1332.39 (in effect at separation but since rescinded) required that “the Service member must stop what he or she is doing and seek medical attention.”  However, VASRD §4.124a does not require seeking medical attention for an attack to be considered prostrating.  The panel carefully reviewed the STR to accurately assess the overall disability picture (§4.2) at the time of separation.  During the several months prior to separation, the evidence supports a 30% rating for characteristic prostrating attacks occurring on an average of once a month over the last several months.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a separation rating of 30% for the chronic headache condition coded 8100.  

Contended PEB Conditions:  Depression.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chronic headache condition, the panel majority recommends a disability rating of 30%, coded 8100 IAW VASRD §4.124a.  The single voter for dissent recommended a rating modification to 10% and did not elect to submit a minority opinion.  In the matter of the contended depression condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  

The panel recommends that 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 as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Headache Mixed Type	8100	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160915, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00653.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  The Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at XXXXXXXXXXXXXXXXXX to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,

Attachment:
Record of Proceedings