RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-01367
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20060213

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

CI CONTENTION: The CI indicated he continues to suffer from migraines and neck pain. 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 Medical Evaluation Board (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 - 20051107	VARD - 20060524	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-traumatic Migraine HA	8100	0%	Post-Traumatic Migraine HA	8100	50%	20060406	
Low Back Pain	Cat II	Right Thoracic Muscle Spasm	5299-5237	40%		
Neck Pain		No VA Placement	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 80%	
	
ANALYSIS SUMMARY:

Post-Traumatic Migraine Headaches. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was involved in a motor vehicle accident (MVA) in February 2004 without loss of consciousness or head trauma. He went to the emergency room (ER) and was evaluated, treated and released. He began having neck pain with radicular symptoms into his right arm, as well as headaches emanating from the back of the neck. He also reported localized low back pain.

At the 29 August 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported back and neck problems. His back pain improved with treatment, but he had headaches two or three times a week. Physical examination showed decreased range of motion (ROM) of the cervical spine and lower back due to discomfort. The 29 September 2005 MEB NARSUM examination, noted complaints of headaches that were sharp and stabbing and located in the right temporal and retro-orbital areas. The headaches were triggered by right-sided neck and shoulder pain. At times the headaches lasted up to 4 hours, and were occasionally accompanied by light sensitivity and nausea. The CI reported that on multiple occasions he had to leave work due to the incapacitating nature of the headaches. The headaches were occurring about 4-5 times per month. The CI reported significant relief in his back pain with botox injections, but he was unable to perform daily exercises because of the exacerbation of his neck and back pain. Physical examination showed the CI was not in apparent distress, had normal motor and sensory exams, was able to heel, toe and tandem walk, but appeared to be in pain when walking. The examiner noted the CI expressed a wish to remain on active duty, but was found not fit for flight duty because of recurrent migraines and inability to complete the physical readiness test.

The 12 October 2005 non-medical assessment (NMA) stated, “his ability to learn and his attention to detail have enabled him to become a lead travel claim processor. He processes an average of 37 claims daily with minimal error rate. His medical condition does not effect, or limit his ability to complete his daily work assignment.” The NMA recommended a conversion to a clerical rating since the CI was fit for duty for clerical ratings, but not for aircrew duty.

At the 6 April 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported the headaches were triggered by pain in the neck muscles and relieved by medication taken 10 minutes after headache onset. The CI reported his headaches were accompanied by blurred vision, photophobia, phonophobia and generalized weakness. About once a month he had headaches with nausea, and every 3 months his headaches presented with vomiting. The CI reportedly stated his headaches had prevented him “totally from working at a computer which was necessary during his service in the military.” Physical examination was unremarkable.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the post-traumatic migraine headaches 0%, coded 8100 (migraine). The PEB listed the back and neck pain as related diagnoses (Category II) contributing to the disability in this case. The STR demonstrates that the CI suffered headaches that emanated from the cervical region, and were triggered by right-sided neck and shoulder pain. Tension type headaches were described. Panel members agreed, the neck pain was the underlying diagnosis associated with the headaches and is not a separate condition for which a rating may be assigned (4.14, avoidance of pyramiding). Thus, it is appropriately subsumed in the same rating. The panel considered the back pain condition separately below. The VA rated the post-traumatic headaches 50%, coded 8100, based on the C&P examination, citing very frequent exacerbations and associated claim of inability to work.
The rating options under code 8100 rely on the frequency of ‘prostrating’ attacks, and VASRD
§4.124a does not define ‘prostrating.’ The panel’s precedence has relied on the English definition of prostrating (extreme exhaustion, or powerlessness, reduced to extreme weakness). The panel carefully considered the frequency and nature of the CI’s headaches including objective and corroborating subjective evidence. The panel noted that the headaches were reportedly triggered by right-sided neck and shoulder pain, and lasted up to 4 hours in duration. The NARSUM examiner stated the headaches occurred about four or five times per month. Although the CI reported that these headaches caused him to leave work on multiple occasions due to the incapacitating nature of the headaches, and that the headaches prevented him “totally from working at a computer,” there was no corroboration that the CI’s headaches caused him to miss

work or seek treatment in the emergency room. The non-medical assessment noted the condition did not affect or limit his ability to complete his daily military duties. There was no mention of headaches occurring at work. There was no evidence of manipulation of the environment to accommodate the CI (dark room). Panel members agreed there was no evidence of characteristic prostrating headaches in the STR. 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 post-traumatic headache condition.

As noted above, the PEB listed the chronic musculoskeletal low back pain condition as a Category II condition, a condition that is related to and contributes to the primary unfitting condition. The panel’s charge for this Category II condition is to assess whether it can be reasonably justified as separately unfitting for rating consideration. The panel’s threshold for such a determinations is reasonably unfitting and remains adherent to the DoDI 6040.44 “fair and equitable” standard. The back condition was listed on the LIMDU that expired 6 months before separation. There was no evidence that an extension of the profile was made or warranted. The NARSUM demonstrated the condition was well managed with Botox. X-rays and MRI of the lumbar spine were normal and without evidence of degenerative changes. The back was not implicated in the NMA, there were no objective findings of a lumbar spine condition and the NARSUM showed a normal physical examination with the exception of pain when walking despite a normal gait. The panel concluded that the back condition alone was not unfitting. 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 back condition and therefore no additional rating is recommended.

BOARD  FINDINGS:       In the matter of the post-traumatic migraine headaches and  IAW VASRD
§4.124a, the panel recommends no change in the PEB adjudication. In the matter of the category II back and neck conditions, the panel agrees it cannot recommend them for additional disability rating. 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.

DEPARTMENT OF THE NAVY
SECRETARY OF TI-IE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY  REFER  TO a
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL  DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 21 Apr 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate  action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.