RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00993
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20060329

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O5, Allergist (Physician), medically separated from the Temporary Disability Retired List (TDRL) for “migraine headaches” and “post-operative pain complicated by post herpetic neuralgia, chronic,” rated 10% each, with a  combined disability rating of 20%.  

CI CONTENTION:  “Review all conditions.”  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 - 20060213	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	10%	No VA Examination Proximate to Separation in Evidence	
Post-Operative Thoracic Pain Complicated by Post-Herpetic Neuralgia	5099-5003	10%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Migraine Headaches.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI had a history of headaches since 1992, but beginning in 1999 and despite treatment, she experienced worsening headaches that eventually prevented working a full duty day.  She was separated and placed on TDRL on 29 August 2001. 

The 2 September 2005 TDRL re-evaluation NARSUM examination, 7 months prior to TDRL removal, noted complaints of headaches twice a week which were mitigated within an hour with an abortant medication.  The CI was also treated with Botox for the headaches.  Neurological examination was normal, but incapacitation was not recorded.  The examiner assessed that she remained medically disqualified and recommended continuation on the TDRL.  On 13 December 2005, the Informal PEB (IPEB) determined the CI’s conditions (see below for thoracic pain analysis) had improved to the point that there was no functional impairment and she was found fit for duty.  The CI non-concurred and requested a Formal PEB (FPEB).  In her rebuttal, she reported incapacitation from headaches 2-3 times a week lasting 1-2 days, and the FPEB determined the headache condition was unfit.  Following the FPEB adjudication, the CI was seen in neurology on 15 February 2006 for rebound headaches (occur with “withdrawal” from an excessive use of an analgesic).  The examiner did not document incapacitating episodes and recommended continued medical management with use of Botox and an abortant medication.  On 29 March 2006, the US Army Physical Disability Agency (USAPDA) upheld the FPEB adjudication.  A primary care entry on 1 September 2006 noted the CI’s migraines were controlled with Botox injections.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The CI was removed from TDRL with a permanent disability disposition of separation with severance pay at 20%, of which 10% was for the headaches, coded 8100 (migraine headaches).  The PEB cited pharmacy records which did not support usage of an abortant (Imitrex) at a frequency indicating more than occasional (less than per month) use.  A higher 30% rating would be justified by the presence of prostrating headaches at a frequency of once a month or greater for the past several months.  A review of the record did not show evidence of this level of severity.  After due deliberation, considering all of 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 migraine headache condition.  

Post-Operative Thoracic Pain Complicated by Chronic Post Herpetic Neuralgia.  According to the STR and MEB NARSUM, the CI’s thoracic pain condition began in early 2000 following surgery to remove a lung mass.  As mentioned above, the CI was separated and placed on TDRL on 29 August 2001.  This condition was also found as fit for duty by the IPEB in 2005, but ultimately changed to unfit when adjudicated by the FPEB, and upheld by the USAPDA.   

During the 2 September 2005 TDRL re-evaluation NARSUM examination, 7 months prior to TDRL removal, the CI reported thoracic pain which was attributed to the thoracotomy and complicated by post-herpetic neuralgia.  On examination, she was noted to be in no acute distress.  In her 8 January 2006 rebuttal, the CI reported chronic thoracic pain and was seen in neurology on 16 February 2006.  The provider documented that she was in no acute distress, had a normal respiratory rate, and made no comment pertaining to skin (rash) or tenderness to touch.  

The panel directed attention to its rating recommendation based on the above evidence.  The CI was removed from the TDRL with a permanent disability disposition of separation with severance pay at 20%, of which 10% was for the post-operative thoracic pain condition, coded analogously as 5003 (degenerative arthritis), citing the USAPDA pain policy.  Members noted that while there was pain from two separate conditions, there was insufficient evidence to separately measure the pain from each condition.  The panel also noted the respiratory rate was normal.  Initial post-operative pulmonary testing was abnormal, but still in the recovery period.  No rash was recorded in the months leading up to separation and no pulmonary testing proximate to TDRL removal was in evidence.  After due deliberation, considering all of 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-operative thoracic pain condition.  

BOARD FINDINGS:  In the matter of the migraine headache condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the thoracic pain condition and IAW VASRD §4.71a, 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 20170217, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180006631, 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