RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01437
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20061204

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Infantryman, medically separated for “migraine headaches” with a disability rating of 0%.

CI CONTENTION:  The migraine condition warrants a higher rating.  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 - 20061023	VARD - 20070416	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8199-8100	0%	Migraine Type Headache Secondary to Lasik Surgery & Chronic Pain Syndrome	8100	10%	20061115	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Migraine Headaches.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI underwent unsuccessful LASIK surgery in November 2004 and developed light sensitivity that caused severe headaches which were later diagnosed as migraine in nature.  In the 12 months preceding separation, the CI had 24 documented ER and primary care visits specifically for an active headache which required narcotics for control.  

The 1 January 2006 commander’s statement, 11 months prior to separation, noted the CI suffered from daily headaches which caused him difficulty performing any of his daily duties.  The 16 August 2006 MEB NARSUM, 4 months prior to separation, noted ongoing chronic headaches.  A referenced neurophthalmologist consult from July 2006 noted a normal examination which was limited due to light sensitivity.  The examiner concluded that the CI had been experiencing migraines after eye surgery.  

At the 15 November 2006 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported daily headaches that he woke up with and went to bed with which were characterized as a sharp pounding pain in the back of the head.  Physical examination showed the CI’s pupils were equal at 4 mm and his pupils were weakly reactive to light.  The extraocular muscles were normal.  With left gaze there was very brief nystagmus (dancing eyes) and then return to normal.  Accommodation was normal.  Throughout the testing, the CI was bothered by the light, not just the penlight, but the room light.  A fundoscopy examination was not done because he could not keep his eyes open due to the glare.  Neurological examination was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 0%, coded 8100 (migraine) citing headaches were associated with severe photosensitivity and dry eyes, daily headaches with constant pain of an intensity of 8-10/10 which has required numerous emergency room and sick call visits for which he takes opioid medications with minimal relief.  Neurological examination was unremarkable.  The VA rated the headache condition 10%, also coded 8100, citing headaches were daily and required continuing medication with functional impairment.  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).  Per DoDI 1332.39, paragraph E2.A1.4.1.4, "prostrating" means that the service member must stop what he or she is doing and seek medical attention.  The number of prostrating attacks per time period (day, week, month) should be recorded by a neurologist for diagnostic confirmation.  Estimation of the social and industrial impairment due to migranious attacks should be made.  

The panel noted there were 24 emergency room and urgent care encounters for acute exacerbation of headaches requiring abortive medication during the nine month period from December 2005 to September 2006.  The abortive medication caused the CI to fall asleep, which reduced his capacity to function.  The commander’s statement also noted the CI “suffered from daily headaches which caused him difficulty performing any of his daily duties.”  After reviewing the evidence from the treatment records, the panel unanimously agreed that the CI’s headache condition most closely approximated the, “very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability,” criteria for a 50% rating under VA Code 8100 at the time of separation.  The panel noted that the underlying cause of the CI’s migraine headaches was the result of complications from a failed LASIK eye surgery.  The diagnosis of complications from the surgery was not specifically identified as unfitting and therefore not within the Board’s scope of review.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 50% for the migraine headache condition, coded 8100.

BOARD FINDINGS:  In the matter of the migraine headache condition, the panel unanimously recommends a disability rating of 50%, coded 8100 IAW VASRD §4.124a.  There are 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	
Migraine Headaches	8100	50%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20161005, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180001951, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 50% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

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