RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01000
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20041020

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Aircraft Guidance and Control Technician, medically separated for “vertigo associated with migraine headache,” with a disability rating of 10%. 

CI CONTENTION: The CI contends debilitating migraines and frequent bouts of vertigo.  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 - 20040727	VARD - 20050411	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vertigo Associated with Migraine Headache	6204-6299	10%	Basilar Migraine Headaches (includes claim for Vertigo and Tinnitus) 	8100	30%	20050126	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:  

Vertigo Associated with Migraine Headache.  The PEB combined the vertigo, and migraine headache conditions under a single disability rating analogous to 6204 (peripheral vestibular disorder) and rated 10%.  This approach by the PEB not uncommonly reflected its judgment that the constellation of conditions was unfitting, and there was no need for separate fitness adjudications.  The panel’s initial charge in this case was therefore directed at determining if combining conditions under a single rating was justified in lieu of separate ratings.  When considering a separate rating for each condition, the panel considers each bundled condition to be reasonably justified as separately unfitting unless a preponderance of evidence indicates the condition would not cause the member to be referred into the DES or be found unfit because of physical disability.  When the panel recommends separate fitness recommendations in this circumstance, its recommendations may not produce a lower combined rating than that of the PEB.  

According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated by ENT in January 2004 for complaints of fullness sensation in both ears, ringing, vertigo and peripheral vision blurring which reportedly had worsened over the last few years.  Auditory symptoms were consistent with Meniere Disease, but the visual symptoms were inconsistent and the CI was referred to Neurology which was also consistent with Meniere Disease with characteristics of migraine headaches.  At a 19 February 2004 neurology evaluation the CI reported ringing in the right ear followed by a spinning sensation 3 times per week and lasting 30 seconds.  She also reported migraines every 2 months that were not associated with vertigo.  The physical examination was normal.  

The 14 June 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of vertigo 1-2 times weekly, which lasted 30-60 seconds.  There were no reported episodes of falling or episodes while driving.  The NARSUM stated a brain MRI and EEG were both normal.  Physical examination was normal.

At the 26 January 2005 neurologic VA Compensation and Pension (C&P) evaluation, 3 months after separation, episodes of vertigo 1-2 times per seek which lasted 30-60 seconds.  Physical neurologic examination was normal

The panel directed attention to its rating recommendation based on the above evidence.  The PEB combined the vertigo and migraine headache conditions as a single unfitting condition coded 6204-6299 (peripheral vestibular disorders) and rated 10%. The VA rated basilar migraine headaches (which included claims for vertigo and tinnitus) 30%, coded 8100 (migraine headaches), based on the C&P examination 3 months after separation, citing characteristic prostrating attacks occurring on an average of once a month over that last several months

The panel’s initial charge in this case was therefore directed at determining if the PEB’s approach of combining conditions under a single rating was justified in lieu of separate ratings.  The panel noted that the preponderance of treatment records addressed vertigo.  Dizziness was profiled. Panel members agreed that the vertigo condition could be reasonably justified as separately unfitting.  Migraines headaches were reported as occurring every 2 months or infrequent.  There was no evidence of emergency room visits or quarters for migraine headaches.  Panel members agreed that the migraine headache condition could not be reasonably justified as separately unfitting.  

The panel then considered it rating recommendation for the vertigo condition.  There no evidence of occasional staggering for a 30% rating under diagnostic code 6204.  The panel also considered a rating analogous to 6205 (Meniere’s syndrome); however, there was no evidence of hearing impairment for at least a minimum rating under this code.  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 vertigo associated with migraine headaches condition.  

BOARD FINDINGS:  In the matter of the vertigo with migraine headache condition and IAW VASRD §4.87, 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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160918, w/atchs
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-2016-01000.

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