RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX 	CASE:  PD-2017-02187
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080707

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Personnel Administration Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “migraine headaches” with a disability rating of 0%.   

CI CONTENTION:  In addition to the migraines, the CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20080616	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	0%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  0%	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’s headaches began in February 2003 after an episode of syncope.  The CI was separated and placed on TDRL on 6 May 2004.  During the 3 March 2008 primary care clinic (PCC) appointment, 4 months prior to TDRL removal, the CI reported that his migraine headache “[would not] let up” despite treatment with Flexeril (muscle relaxant) and Cafergot (headache preventive and abortive medication).  The CI reported the injection usually took care of the headache.  Physical examination showed the CI was alert and oriented to person, time and place.  The examiner treated the headache with Phenergan (pain, nausea and vomiting medication) and Tramadol (synthetic narcotic pain medication)

The 25 March 2008 TDRL re-examination, 3 months prior to TDRL removal, noted complaints of poorly controlled migraine headaches associated with visual problems, nausea, dizziness, photophobia and phono-phobia.  The headaches occurred three or four times per month.  He also had one or two bi-frontal headaches per week. Physical examination showed normal neurologic functioning and normal cognition, speech and memory.  No mention or discussion of prostrating attacks was evident in the examination.

At the 30 April 2008 PCC appointment the CI reported “no decrease in the amount of headache that he [had].”  He also indicated that the recent addition of Reglan (anti-nausea and vomiting) “really [helped] when he [had] a headache.” Physical examination showed the CI to be alert and oriented to person, time and place.  The examiner increased the prescription of Elavil (pain medication) to see if that would prevent future headaches.  The examination record contained no discussion of prostrating attacks.  The 6 September 2008 PCC examination recorded complaints of continued migraine headaches, but the CI was “doing well.”  Medications of Cafergot and Lortab (anti-migraine) were continued by the examiner.  The examiner noted the CI was taking 15 hours of classes and working two jobs while under a good bit of stress.

At the 19 December 2008 PCC visit, 5 months after TDRL removal, the CI complained of an acute migraine and requested injectable medication (Toradol) because his abortive medication, the last of which he had just used, had dulled but not eliminated the headache.  He was alert and oriented, and the examiner treated the headache with Toradol and Benadryl (an antihistamine).  The examiner recorded that the CI was going to go home and go to sleep.  There was no VA Compensation and Pension examination proximate to TDRL removal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the migraines 0%, coded 8100 (migraine), citing no documentation of ER/acute care visits and no use of medication for migraines.  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.  There was no evidence of frequent visits to the emergency room or to the neurologist.  The CI reported a Toradol injection was of great help and he was “doing well” and was able to attend school and work.  Review of the record did not show prostrating headaches occurring on average once every 2 months, or more frequently, over the last several months prior to TDRL removal to support a rating higher than the 0% 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 migraine headache condition.  

BOARD FINDINGS:  In the matter of the migraine headaches and IAW VASRD §4.124, 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 20170305, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20190008892, 

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.

Sincerely,					      

Enclosure