RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  pd-2017-01577
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20080501

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E6, Multiple Launch Rocket System Crewmember, medically separated for “post concussive migraine headaches” with a disability rating of 10%.  

CI CONTENTION:  Review all combat injuries.  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 - 20080310	VARD - 20070104	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Concussive Migraine Headaches	8045-8100	10%	Migraine Headaches	8100	30%	20061121	
Shoulder Instability	Not Unfitting	Status Post Arthroscopic Bankart Repair, Left Shoulder	5099-5010	10%		
Tinnitus		Tinnitus Bilateral	6260	10%		
PTSD		Post-Traumatic Stress Disorder 	9411	30%	20061129	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70% 	

ANALYSIS SUMMARY:  

Post Concussive Migraine Headaches.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s vehicle was attacked by a car bomber in Iraq on 30 March 2005.  The vehicle rolled several times and the CI was able to escape.  There was no loss of consciousness.  

At the 21 November 2006 VA Compensation and Pension (C&P) examination, 17 months before separation, the CI reported bilateral headaches in frontal and occipital areas.  His symptoms included:  nausea, emesis, photophobia, and dizziness without syncope.  The CI stated he “would get a headache once or twice a month”.  Headaches were usually aggravated by lack of sleep and stress.  There was no evidence in the STR for treatment of migraine headaches from the VA C&P examination in November 2006 until October 2007.  

The 29 October 2007 neurology examination, 6 months prior to separation, included reports of headaches with dizziness along with memory and concentration problems.  The CI’s headaches occurred about once every 6 to 8 weeks and could last for several hours.  The headaches were not preceded by aura, throbbing, nausea, photophobia, or phonophobia.  They were associated with spots and blurred vision.  Aggravating factors included:  light, noisy environment, and sleep deprivation.  The CI’s headaches were relieved by a darkened room, lying down, rest, and medication.  An MRI and CT scan of the brain were normal.  The neurologist’s assessment was headache, primary, most likely triggered by the head injury.  He opined most-post-concussion headaches are known to have resolved within a year, but may last longer and develop into a migraine-like headache.  The headaches were infrequent.  Prophylactic treatment was not prescribed.  The CI was prescribed Zomig (non-narcotic migraine medication) and Fioricet (non-narcotic tension headache medication).  

At the 19 December 2007 MEB NARSUM, 4 months prior to separation, the CI reported subjective complaints of migraine headaches every 4 to 6 weeks.  Additionally, he reported that he experienced eight to twelve headaches per year.  Treatment included retreating to a darkened room, along with avoidance of light and sound.  The CI reported the he would leave work approximately once every 6 months due to his migraines and saw a neurologist every 6 months.  His medications include zolmitriptan (non-narcotic migraine medication).  The commander’s statement, on 10 July 2007, reported “no limitations that would impair his ability to do his duties.”  There was no report of missed work due to prostrating attacks.  An additional commander’s statement on 19 December 2007 reported no limitations or report of missed work due to prostrating attacks.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 10%, coded 8045-8100 (residuals of traumatic brain injury-migraine), citing one prostrating headache each 6 weeks.  The VA rated the headache condition 30%, coded 8100, based on the C&P examination, citing prostrating attacks occurring an average of once a month over the last several months.  

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 panel carefully considered the frequency and nature of the CI’s headaches including objective evidence and corroborating subjective evidence.  The results of the neurology examination were contemplated, which reported the headaches were infrequent and there was no need to prescribe prophylactic medication.  Also considered was the evidence of the treatment records to accurately assess the overall disability picture (§4.2) at the time of separation.  The panel noted that review of the STR found no clinic encounters for acute exacerbation of headache during the several months prior to separation.  Although the CI reported headaches occurred every 4 to 6 weeks, the panel concluded the headaches were not prostrating.  Review of the record did not show prostrating headaches occurring on average once per month, or more frequently, over the last several months prior to separation. After reviewing the evidence, the panel agreed that the CI’s migraine headache condition most closely matched the criteria for a 10% rating under VA code 8100 at the time of separation.  There was no objective evidence of treatment of recurrent migraine headaches for 4 months after his release from active duty.  Furthermore, the CI reported missing work only once every 6 months.  There was no reasonable doubt in the CI’s favor and no justification for the panel to recommend other than the 10% rating assigned by the PEB for the headache condition.  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 concussive migraine headaches condition.  

Contended PEB Conditions:  Shoulder Instability, PTSD, and Tinnitus.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  The PTSD was profiled as an S2, was determined to meet retention standards, and was determined to be not unfitting by the PEB.  The shoulder instability and tinnitus conditions were not profiled.  None of the conditions were implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the post concussive migraine headaches condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended shoulder instability, PTSD, and tinnitus conditions, the panel recommends no change from the PEB determinations as not unfitting.  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 20170213, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180004893, 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