SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02278.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

						Sincerely,

		

								

Attachment:
Record of Proceedings 

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02278
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20030822

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Munitions Systems Craftsman, medically separated for “migraine headaches” with a disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 - 20030701	VARD - 20040428	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	10%	Migraine Headaches	8100	30%	20031217	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Migraine Headaches.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s migraine headaches condition began in 1996 with no trauma or injury.  Symptoms were reported two to three times a week.  There were several neurologist visits and multiple medications tried.  A Doppler resonance angiogram showed no findings of hemodynamically significant lesion of the carotid arteries.  An MRI of the brain was normal with and without contrast as were the intracranial vessels reviewed by MRI.  These assessments showed a lack of signals seen in the left vertebral artery that might be due to diminutive size or possible congenital non-development.

The 9 June 2003 MEB NARSUM examination, 2 months prior to separation, noted complaints of continued migraines headaches, two to three times a week despite preventative therapy.  Physical examination showed a normal gait.  Cranial nerves II through XII were intact.  Deep tendon reflexes were within normal limits.  There were no focal motor or sensory deficits.  

At the 17 December 2003 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported migraine headaches, one to two times a week with visual aura occurring 10% to 20% of the time.  Headaches consisted of pounding, nausea, and vomiting that could last up to several days.  Maxalt medication aborted the headaches about 60% of the time.  Beta-blockers, calcium channel blockers and antidepressants were used without improvement.  Physical examination showed no acute distress at the time of examination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and the VA rated the migraine headaches condition 10% and 30%, respectively, coded 8100 (migraine headaches). The PEB cited that the headaches prevented the CI from reasonably performing the full spectrum of her duties.  The VA based the rating on the C&P examination, citing prostrating attacks occurring on an average of once a month over the last several months.  

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.  The commander detailed the CI was restricted from night shift by profile however, she was able to complete her normal duty shift.  There was no discussion of prostrating attacks or lost work days except for the NARSUM which detailed “the only time the CI requested quarters for missed work was when she woke up with the migraine headache and at that time only requested quarters for missed work the night before.”  Although there were notes regarding frequency of migraine headaches, there was no specific information on the number of times the headaches were prostrating over what period of time.  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 headache condition and IAW VASRD §4.12, 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 20180203, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record