RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01093
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20080327

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Trainee, medically separated for “non-epileptic seizures” and “migraine headaches,” rated 20% and 0%, respectively, 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 - 20080206	VARD - 20081105	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Non-Epileptic Seizures	8999-8911	20%	Non-Epileptic Seizure Disorder with Conversion Disorder	8199-8103	10%	20081017	
Migraine Headaches	8100	0%	Migraine Headaches	8100	30%	20081017	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Non-Epileptic Seizures.  According to the service treatment record (STR), the CI’s non-epileptic seizure condition was first suspected in December 2005 when she had an electroencephalogram (EEG) as part of her headache work-up.  The neurologist felt the study demonstrated epilepsy at the right temporo-occipital area.  The same study was reviewed by another neurologist on 7 February 2006 who did not appreciate any clear-cut epileptiform abnormalities.  In early 2006 she reported daily episodes of staring spells where she did not respond to others around her.  She was admitted in March 2006 for four days of video and EEG monitoring.  She reported the sensation of one of her spells three times during that admission and no EEG or video abnormalities were noted.  

At the 10 April 2007 neurological examination, 11 months prior to separation, the CI complained of spells where she felt herself fading and friends reported she stared blankly, occurring approximately once per week.  Physical examination demonstrated a normal neurological evaluation.  During the 16 January 2008 psychiatry evaluation for the MEB, 2 months prior to separation, the CI reported spells of a “deja vu” type experience, during which she saw lights moving and experienced a ringing in her ears along with a brief, momentary “blackout” lasting a few seconds in which other people witnessed her staring.  These spells were immediately followed by a headache.  The examiner documented normal psychological and neurological examinations.  

At the 29 September 2008 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported she had been having spells 3-4 times per week but they had decreased to approximately once per month.  With the exception of an anxious mood, the psychological and neurological examinations were normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the non-epileptic seizure condition 20%, coded 8999-8911 (analogous to epilepsy, petit mal), citing at least two episodes in the last six months but averaging less than five episodes weekly.  The VA rated the non-epileptic seizure condition 10%, coded 8199-8103 (analogous to tic, convulsive), based on the C&P examination, citing tics, which are moderate in severity, and no evidence of epilepsy.  

The panel agreed there was no evidence of 5 to 8 minor seizures (spells) per week to satisfy the requirements for the next higher 40% rating under the General Rating Formula for Major and Minor Epileptic Seizures.  The panel also considered a rating under code 8103 and agreed the spells were not characterized as severe to support a 30% rating.  There are no other applicable codes.  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 non-epileptic seizure condition.  

Migraine Headaches.  According to the STR, the CI’s migraine headache condition began in 2005.  She underwent an extensive work-up and multiple medications were tried to decrease the frequency and severity of headaches with little effect.  During the 16 April 2007 neurology examination, 11 months prior to separation, the CI reported bi-temporal headaches that lasted from a few hours to 2 days and occurred 2 or 3 times per week.  When the headaches were severe, the CI was unable to function in class and would go to bed for relief.  There was no indication of the frequency of the severe attacks.  Physical examination showed a normal neurological evaluation.  Review of the entire STR found one visit in the 12 months prior to separation for an acute headache.  

At the 17 October 2008 VA C&P examination, 7 months after separation, the CI reported headaches that occurred 4-5 days per week that began in both temples and radiated to the top and back of her head.  Headaches usually began in the afternoon and lasted 4-5 hours.  The CI reported she was not taking any medications for her headaches.  Physical examination showed a normal neurological examination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the migraine headache condition 0%, coded 8100 (migraines), citing an average of less than one prostrating attack in two months over the last several months.  The VA rated the migraine headache condition 30%, also coded 8100, based on the C&P examination, citing migraine headaches occurring 2 to 3 times a month and most are prostrating.  
Rating guidance under diagnostic code 8100 is based on the frequency of “prostrating attacks” over the “last several months.”  The VASRD does not further define prostrating attacks; however commonly accepted definitions include “utter physical exhaustion or helplessness” (Webster's New World Dictionary of American English), “complete physical or mental exhaustion” or “extreme exhaustion or powerlessness” (Dorland's Illustrated Medical Dictionary).  The evidence only shows one visit in the 12 months prior to separation for an acute migraine.  Although the CI complained of headaches multiple times per week, there was no evidence of prostrating attacks averaging one in 2 months over the several months prior to separation.  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.  

BOARD FINDINGS:  In the matter of the non-epileptic seizure condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the migraine 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.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004769, 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