RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02213
BRANCH OF SERVICE:  army	SEPARATION DATE:  20081001

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Concrete and Asphalt Equipment Operator, medically separated for “migraine” with a disability rating of 10%.

CI CONTENTION:  Condition continues to worsen.  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 - 20080716	VARD - 20081231	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine	8100	10%	Migraine Headaches	8100	10%	20081113	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:

Migraine.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI had a history of migraine headaches since August 2006.  He developed the headaches after a spinal tap to rule out viral meningitis prior to deployment to Iraq.  While deployed he was exposed to two explosive devices.  Neurology prescribed Topamax and Imitrex, but neither medication offered relief so the CI used Tylenol with 30%-40% relief.  Neuroimaging of the brain showed a brain anomaly in the frontal lobe of no clinical significance and another lesion in the white matter of unknown significance per radiologist.

Review of the STR revealed six encounters for headache care during the 12 months before separation.  Of these, none were for acute headaches.  At the 29 April 2008 MEB NARSUM, 5 months prior to separation, the CI complained of daily and constant headaches.  He reported light and noise increased the pain, but were relieved 90% of the time by going into a dark room.  The CI stated he did not leave work due to his headaches because “they make me stay.”  He maintained a driver’s license.  The 7 May 2008 commander’s statement documented the CI worked an 8-hour duty day, but was unable to perform his duties without constant rest periods, which were not unreasonable in number or duration.

During the 20 June 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported severe migraines, but the neurologic evaluation was normal.  There were no further headache care STRs from June 2008 to separation.

At the 13 November 2008 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported weekly migraine headaches that were not treated with continuous medication because Fioricet and Imitrex made him dizzy and drowsy.  The CI found some relief with Tylenol, which he took twice daily.  He reported his response to treatment was fair and that most of his migraine attacks were prostrating and usually lasted longer than 2 days.  He was working part-time and had lost less than 1 week from work.  Physical examination was normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 10%, coded 8100 (migraine) citing “one prostrating headache in two months.”  The VA rated the headache condition 10%, also coded 8100, citing characteristic prostrating attacks averaging one in two months 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."  DoDI 1332.39 defines prostrating attacks as “the CI must stop what he or she is doing and seek medical attention.”

The panel carefully considered the frequency and nature of the CI’s headaches including objective evidence and corroborating subjective evidence.  The MEB NARSUM and the commander’s statement noted the CI did not have to leave work to seek medical care and he was allowed rest periods of a reasonable nature.  The STR did not document frequent visits to the emergency room or to the neurologist.  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 to support a rating higher than the 10% adjudicated by the PEB.  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 migraines.

BOARD FINDINGS:  In the matter of the migraines 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.  The panel, therefore, recommends that there be 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 20170402, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008217, 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