RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-02357
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080130

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aircraft Loadmaster Journeyman, medically separated for “headache syndrome” with a disability rating of 10%. 

CI CONTENTION: Review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) requested.  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 – 20071207	VARD - 20090922	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Headache Syndrome	8100	10%	Migraine Headaches	8100	0%	20080916	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Headache (HA) Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced a severe HA on 6 November 2006 requiring treatment in the emergency room.  A head CT was normal and he was referred to neurology where an extensive neurological workup was essentially negative.  The HA syndrome was treated with an antidepressant (Lexapro).  At the neurology clinic appointment on 22 October 2007, the CI’s medication was changed to a different antidepressant (Paxil) and the CI reported doing very well with complete abolition of the HAs.  

The 29 October 2007 MEB NARSUM examination, 3 months prior to separation, summarized the neurologic consultation and results of the MRI, MRA [magnetic resonance angiogram] and sleep study.  The CI was taking Paxil 20 mg daily which was “doing an excellent job for his headaches.”  The diagnosis was HA syndrome controlled with medication.  

At the 16 September 2008 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported constant daily HAs with no nausea or vomiting, vision changes or photophobia.  The CI reported taking Paxil in the past which did help.  Currently he was taking no medications.  He was working part-time and was a full-time student and missed no days related to HAs.  An addendum stated “when he has headaches, he tries to rest in a quiet room when possible; sometimes this is not possible as the headaches are mostly constant.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the HA syndrome condition 10%, coded 8100 (migraine), citing the VA Schedule for Rating Disabilities guidelines.  The VA rated the migraine HAs condition 0%, coded 8100, based on the C&P examination, citing the evidence failed to show there were characteristic prostrating attacks averaging one in 2 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” (Webster's New World Dictionary of American English), “complete physical or mental exhaustion” or “extreme exhaustion or powerlessness” (Dorland's Illustrated Medical Dictionary).  At the time of separation, the CI’s HAs were under excellent control with medication and there was no evidence of prostrating HAs at the MEB NARSUM examination.  At the C&P examination several months after separation, the CI had not been taking any medication and complained of daily HAs.  He had missed no days of work despite the daily HAs and was also a full-time student.  He reported he would try to rest with a HA but that was not always possible.  The panel consensus was although the CI’s headaches returned after separation (off medication), they nonetheless did not meet the threshold of being “prostrating attacks” and no higher than a 0% rating was supported under 8100 at separation.  However, the panel may not recommend a rating lower than that of the PEB IAW DoDI 6040.44.  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 HA syndrome condition.  

BOARD FINDINGS:  In the matter of the HA syndrome condition 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.  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 20170302, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02357.

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