RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00824
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040122

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Ground Surveillance Systems Operator, medically separated for “recurrent post-concussion headaches with migraine features” with a disability rating of 10%.  

CI CONTENTION:  Review of all conditions requested.  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 - 20031121	VARD - 20040218	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Post-Concussion Headaches with Migraine Features	8045-9304	10%	Post-Concussion Headaches with Migraine Features	8100	50%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 60%	

ANALYSIS SUMMARY:  

Recurrent Post-Concussion Headaches with Migraine Features.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s headache condition began in August 2002 after falling and hitting the back of his head, resulting in brief loss of consciousness.  An MRI and CT scan of the brain were negative for intracranial abnormality.  During the 20 June 2003 MEB examination (recorded on DD Forms 2807-1 and 2808), 7 months prior to separation, the CI reported migraine headaches with blackouts.  Physical examination noted complaints of headaches occurring two to three times per week.  Physical examination was normal.

The 3 November 2003 MEB NARSUM addendum examination, 2 months prior to separation, noted complaints of both chronic daily headaches as well as episodic exacerbations of his headache disorder.  He reported nausea, dizziness, eye tearing, and photophobia with severe headaches.  The CI claimed to be experiencing two prostrating headaches per week, missing approximately 2 to 3 days per week of work due to these headaches.  The headaches on occasion caused him to seek treatment in the emergency room (ER) and reportedly were only partially responsive to migraine prophylaxis and abortive therapy.  Physical examination showed normal cognitive function, and unremarkable neurological and physical examinations.  The examiner opined that the CI had headache, without aura, likely consistent with migraine headache versus post-concussive headache disorder and chronic daily headache with a possible analgesic-rebound headache component.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 10%, dual coded 8045-9304 (residuals of traumatic brain injury - dementia due to head trauma).  The VA rated the headache condition 50%, coded 8100 (migraine), based on the STR, citing very frequent, completely prostrating, and prolonged attacks productive of severe economic inadaptability.  The VASRD in effect at the time of separation captured brain injuries under the generic category of brain disease due to trauma coded 8045.  There are two different scenarios for rating under this code: analogously with purely neurological deficits, or based on purely subjective symptoms.  In the absence of associated neurological disabilities (seizures, nerve paralysis, etc.), rating of this condition under 8045-9304 is limited to 10%, and cannot be combined with any other rating for a disability due to brain trauma.  Therefore, a higher rating is not possible under this code.  

The panel also considered a rating under the 8100 code for migraine headaches.  The rating options under 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 NARSUM addendum noted that the CI reported migraine headaches that occurred twice a week, and at times, caused him to seek relief in the ER.  The STR documented only one visit to the ER for headache treatment.  

The CI noted that he lost time from work due to his headaches.  The commander’s statement (CS) noted the migraine headaches were present 2-3 times per week.  However, the CS was silent regarding any loss of time from work due to headaches.  The CS stated, “during a migraine attack, [the CI] is completely disabled from accomplishing any soldier’s skill task or MOS specific task.  When an attack occurs in a garrison environment, he must take medication that impairs his abilities to function at any task.”  The panel noted the lack of clarity in the statement, and panel members agreed, the CS lacked probative value for determining if the CI suffered prostrating attacks since it was not clear whether the headaches rendered the CI disabled or the medication caused him to be disabled.  The CS also noted that duty performance was satisfactory.  Panel members concluded, rating under the 8100 code was not of benefit to the CI since there was no evidence to support higher rating for characteristic prostrating attacks occurring on an average once a month over last several months.  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 headache condition 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. 

AR20190008875, 

Dear XXXXXXXXXXXXXXXXX

	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.