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

IN REPLY REFER TO

1850
CORB:003
12 Feb 20

From: To:

Director, Secretary of the Navy Council of Review Boards 
PD-2017-01515

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 6 Feb 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy of 15 October 2019 for appropriate action.

2.	On 31 January 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.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-01515 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050715

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Military Policeman, medically separated for “chronic constant headache with migrainous features” with a disability rating of 10%.

CI CONTENTION: “The headaches have continued after all these years…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 - 20050412	VARD - 20060711	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Constant Headache with Migrainous Features…	8199-8100	10%	
Post Meningitis Headaches	
8099-8019	
10%	
20060601	
Status-Post Meningitis Probably a Bacterial Type…	Cat II					
Depression and Anger Symptoms	Cat II	Post-Traumatic Stress Disorder (PTSD)	9411	NSC	STR	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	
	
ANALYSIS SUMMARY:

Chronic Constant Headache with Migrainous Feature. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s headache condition began in June 2003 with the onset of a sore throat, which was followed by the “worst headache of his life,” marked

neck stiffness, and a fever. Subsequently, he was diagnosed as having meningitis based on abnormal cerebrospinal fluid findings and a normal CT scan of the head. He underwent antibiotic treatment intravenously for 30 days. The meningitis resolved, but the chronic headaches continued primarily in the mid parietal and occipital areas of the head and were associated with photophobia (light sensitivity). The headache intensity worsened with exertion, concentration, and impact exercises. Treatment with medication resulted in only mild improvement. Depression and anger (see below), which developed subsequent to the meningitis, was treated by mental health with Zoloft (antidepressant) and Ambien (sedative). A brain MRI in February 2004 demonstrated no significant findings. Neurologic examination on 29 December 2004 was unremarkable and the findings were incorporated in the NARSUM.

The 29 December 2004 MEB NARSUM examination, 7 months prior to separation, noted the CI’s inability to tolerate activities, run, or have prolonged exposure to lights. The examiner documented that he was alert, oriented times three, lucid and fluent. Cranial nerves were full and intact and funduscopic findings were normal. Deep tendon reflexes were 2+ and symmetric. Gait and tandem walking were normal as were motor and sensory examinations. No prostrating attacks were reported.

At the 1 June 2006 VA Compensation and Pension (C&P) examination, 11 months after separation, the CI reported headaches occurring on a daily basis and treated with over-the- counter medication that helped with the symptoms, but did not completely alleviate them. He took medications at work when he had a headache, but there was no mention of days lost from work, prostrating attacks, or any incapacitation. Daily headaches continued to be associated with photosensitivity. Physical examination showed normal head, eyes, ears, nose throat; and intact cranial nerves, finger-to-nose-to-finger, and alternating movements.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the headache condition 10%, analogously coded 8199-8100 (migraine headaches). The PEB also listed “depression and anger symptoms” and “status-post meningitis…” as related Category II conditions (contribute to the primary unfitting condition but not separately ratable). The impairment from the meningitis is subsumed under the overall rating for the “chronic constant headache with migrainous features...” IAW VASRD §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA also rated headache condition 10%, analogously coded 8099-8019 (meningitis, cerebrospinal, epidemic) based on the C&P examination, citing ascertainable residuals. Review of the record did not show prostrating headaches occurring on an average of once per month, or more frequently, over the several months prior to separation to support a rating higher than the 10% adjudicated by the PEB. 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.

Contended Category II PEB Condition: Depression and Anger Symptoms. The panel’s main charge is to assess the fairness of the PEB’s implied determination that the contended condition was not separately unfitting. The contended condition was implicated in the commander’s non- medical assessment by reference to his physical and mental condition as well as restrictions from handling firearms due to medication. At a mental health examination on 21 March 2005, 1 month prior to separation, the CI complained of “anger…no sleep…PTSD due to recent disease and deployment to OIF…no memory…always tired…” He attributed most of his symptoms to the residual effects from meningitis and only somewhat to PTSD (since he denied “C” criteria for PTSD). Mental status revealed an alert, cooperative man who appeared his age and was in no acute distress. He was neatly dressed with good military appearance, and maintained appropriate eye contact, posture and attentiveness. His sensorium was clear and cognitive functions were grossly intact, with appropriate speech and word usage. Expressed thoughts were clear, coherent and goal directed.  Mood was typically euthymic with episodes of irritation, and

affect was full, flexible and appropriate. Psychomotor function was neither agitated nor retarded. Insight into his condition appeared partial, and impulsivity, irritability and irrationality were not observed. The CI denied homicidal and suicidal ideation in both passive and active modalities, with no feeling of subtle persecution. He denied overt paranoid ideation, perceptual distortion and referential thinking, and there was no evidence of delusions or for danger to coworkers. He had no episodic difficulties with poor judgment or substantial impulse control problems, and danger to himself appeared unlikely. The Axis I diagnoses were: features of PTSD, resolving; depressive disorder not otherwise specified (NOS); partner relational problem; and caffeine related disorder, NOS. The examiner concluded that the CI was psychiatrically fit for limited duty assignments and was competent and responsible for his own behavior and actions. He was referred back to his treating physician for medication management and psychiatric follow-up, and advised that two pots of coffee per day needed to be scaled back.

There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance. After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the Category II contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the chronic constant headache with migrainous features  and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication. In the matter of the depression and anger symptoms (associated with the headache condition), the panel recommends no change in the PEB adjudication as a Category II condition. 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.