SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear Applicant:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00374.

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.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay

I have 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 (210) 565-2273 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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-00374
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20080321

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Security Forces Apprentice, medically separated for “migraine headaches” with a disability rating of 10%.  

CI CONTENTION:  “Military initially awarded me with 40% but took away 30% and said my refusal to take medications aggravated my symptoms.  I refused to take antidepressant medication given to me for 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 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 - 20080117	VARD - 20080805	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	10%	Migraine Headaches	8100	30%	20080516	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Migraine Headaches.  According to the service treatment record (STR), the CI’s migraine headaches began in July 2007 after wisdom tooth removal.  During the 18 July 2007 personnel readiness program (PRP) evaluation, 8 months before separation, the CI reported experiencing a headache for the past 7 days.  The headache throbbed; became worse with exertion, light or noise and caused nausea, blurred vision, chest pain and dizziness.  He received a muscle relaxant from a previous-undocumented emergency room visit for tremors in his extremities during this same 7-day period.  An MRI of the head was normal.  
During the 17 October 2007 PRP medical summary, 5 months prior to separation, the CI was diagnosed with intractable migraine headaches, which did not responded to any medical treatment.  Headaches occurred 2-3 times per week.  The CI stated he did not like his career field which contributed to his headaches; as long as he remained in his career field the headaches would never resolve.  The CI declined any further medication to control the headaches.  The 23 October 2007 commander’s statement documented the CI’s illness significantly impacted his ability to complete his assigned duties.  The commander also stated the CI’s current profiles precluded his ability to perform almost 100% of his prescribed duties.

At the 9 January 2008 family practice evaluation, 2 months prior to separation, the CI reported trying multiple medications without significant relief of his migraine headaches.  He reported migraine headaches twice per week which he treated with over-the-counter medication and sleep.  There was no neurological consultation or MEB narrative summary (NARSUM) examination in evidence for this panel to review.

At the 16 May 2008 VA Compensation and Pension (C&P) neurological disorder evaluation, 2 months after separation, the CI reported headaches that occurred 2 to 3 times per week mostly in the evenings.  He reported photophobia, noise sensitivity, nausea and dizziness.  He took over-the-counter pain relievers, went into a dark room and laid down for about 45 minutes before feeling better.  He could not work through his headaches.  Physical examination did not address headaches.  The CI was diagnosed with migraine headaches, mild to moderate.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the migraine headaches 50%, coded 8100 (migraine headaches), and then applied a 40% deduction for aggregating/contributory factors.  The VA rated the migraine headaches 30%, also coded 8100, based on the C&P evaluation, citing prostrating attacks occurring on an average of once a month over the last several months.  The panel first considered if the PEB’s 40% deduction for “aggregating/contributory factor” was reasonable.  The PRP evaluation, 5 months before separation, diagnosed the CI with intractable migraine headaches, indicating the CI did not want to try any more or different medications, and did not want to go to the field.  The family practice evaluation, 2 months prior to separation and the last headache-related STR in evidence, recorded the CI tried multiple medications without significant relief of his migraine headaches.  The panel majority agreed, due to the documented intractable nature of the CI’s migraine headaches and lack of MEB examination evidence, that the 40% deduction was not reasonable.  The panel noted that the PEB’s 50% rating was the highest rating allowed under code 8100.  Per DoDI 6040.44, the panel is not allowed to lower the PEB’s rating.  Therefore 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 headaches, coded 8100.

BOARD FINDINGS: In the matter of the migraine headaches, 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 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 20170209, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record