RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01782
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20040422

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “chronic daily headaches” with a disability rating of 0%.  

CI CONTENTION:  Review requested of an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). 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 - 20040226	VARD - 20040506	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Daily Headaches	8199-8100	0%	Chronic headaches	8199-8100	10%	20040224	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Daily Headaches.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s headache condition began in April 2003 while he was deployed to Iraq.  HIs headaches increased with coughing, sneezing, yelling, driving, running, and doing sit-ups, as well as wearing a Kevlar helmet; and the pain could not be controlled by medication.  He was aeromedically evacuated on 23 June 2003, when he reported chronic “daily” headaches, but neurological evaluation was normal.  

During a neurologic consult on 14 November 2003, 5 months prior to separation, the CI reported daily headaches originating at the right apex and worsened by wearing a Kevlar helmet.  Physical examination showed no skull or neck area tenderness, and the examiner assessed “headache not otherwise specified.”  At a follow-up neurology visit on 29 December 2003, 4 months before separation, the CI reported daily headaches, rated at 5-6/10, and that increased to 9-10/10 with stress or tension, and with wearing Kevlar or driving.  Physical examination showed right occipital nuchal junction tenderness, but was otherwise unremarkable.  During a 7 January 2004 neurologic examination, the CI reported daily headaches that required him to stop work and sit or lie down.  Medications were not helpful and considered refractory to treatment.  

The commander’s statement on 8 January 2004 noted that the CI’s chronic migraines and inability to wear a Kevlar helmet rendered him incapable of performing his military duties, however associated work stoppage or missed work was note documented.  

The 20 February 2004 MEB NARSUM examination, 2 months prior to separation, noted complaints of moderate to severe daily headaches exacerbated by physical activity and wearing Kevlar.  The headaches occasionally resulted in downtime from work and frequently scheduled medical appointments.  Physical examination was unremarkable and the examiner diagnosed “headaches,” noting a normal head CT scan and no history of acute or emergency room care. 

At the 24 February 2004 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported daily headaches which were significantly worsened by wearing a Kevlar helmet and not controlled by medication.  Physical examination showed no head tenderness, and that the head was normocephalic (head size and brain were normal).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 0%, analogously coded 8199-8100 (migraine), citing headaches exacerbated by physical activity and Kevlar wear, but not considered prostrating.  The VA rated the headache condition 10%, also coded 8199-8100, based on the C&P examination, citing recurrent daily headache pain causing impairment to military duty function.  The rating options under 8100 for migraine headaches rely on the frequency of “prostrating” attacks, but is not defined by VASRD §4.124a; thus the panel’s precedence has relied on the English definition of prostrating (extreme exhaustion, or powerlessness, reduced to extreme weakness).  A 0% rating stipulates less frequent attacks, a 10% rating requires on average one prostrating headache in 2 months over past several months, and a 30% rating requires on average one prostrating headache monthly over several months.  The panel carefully considered the frequency and nature of the CI’s headaches and determined that objective and corroborating subjective evidence from the STR, neurology and MEB NARSUM examination did not characterize the CI’s headache condition as prostrating.  There was no evidence of emergency room visits, unscheduled medical appointments, modification of the CI’s work schedule or environment, or placement on quarters due to the headaches.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the headache condition.  

BOARD FINDINGS:  In the matter of the chronic daily headaches and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20161120, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20180014202, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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.

Sincerely,					       

Enclosure