RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02582
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20070514

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

CI CONTENTION:  The Chiari malformation was not rated properly based on head 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 - 20070328	VARD - 20080205	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	10%	Migraine Headaches	8100	30%	20071115	
Chiari Malformation Type I	Category II	Cervical Spine Residuals, Status Post Surgery for Chiari Malformation	5243	30%	20071115	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60% 	

ANALYSIS SUMMARY:

Migraine Headaches.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s headache condition began in April 2006 when she went to the emergency room (ER) for headaches, sensitivity to light (photophobia), double vision (diplopia), blurred vision, and abnormal position sense (proprioception).  An MRI showed a Chiari malformation (an abnormal protrusion of part of the brain into the spinal canal) which was treated surgically with decompression in May 2006.  Following surgery the CI had residual headaches.

An ER visit on 13 July 2006 for headaches returned the CI to duty the same day, but an ER visit on 7 September 2006 for headaches placed the CI on quarters for 48 hours.  A neurosurgery examination on 16 October 2006 noted complaints of headaches with visual problems.  The examiner noted a recent CT scan was near normal and the headaches were thought to be tension headaches.  During a neurologist evaluation on 30 November 2006, the CI reported daily throbbing headaches that caused nausea, photophobia and decreased functioning in the right ear, but the physical examination was unremarkable.  

At the 20 December 2006 MEB NARSUM examination, 6 months prior to separation, the CI reported her headaches were not improving.  The neurological examination was normal.  The examiner recorded no headache relief with recent medication changes.  The commander’s statement on 19 January 2007, 4 months prior to separation, noted the CI worked light duty.  She missed 54 days of work after the May 2006 surgery, and occasionally missed a few hours of work to attend medical appointments.

At the 15 November 2007 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported headaches twice a week which she treated by lying down in a dark room.  She missed work about 3 days a month.  She worked part-time tending bar, was a college student and mother of three children.  She reported missing classes (presumably due to the headaches, but not specifically stated).  She was in no acute distress and her neurological 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).  The VA rated the headache condition 30%, also coded 8100, based on the C&P examination, citing prostrating attacks occurring on an average of once a month over the last several months.  The panel considered whether the CI’s headaches at the time of separation merited a 30% or a 10% disability rating.  Although the C&P examination history supports a 30% rating for “prostrating attacks averaging once a month over the last several months,” the preponderance of STR evidence, during the several months prior to separation, does not support a rating higher than the 10% rating adjudicated by the PEB; characteristic prostrating attacks averaging once in 2 months over last several months.  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 headache condition.

Contended Category II Condition:  Chiari Malformation Type I, Status Post Attempted Surgical Alleviation, with Persistent Symptoms.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was determined to be a condition, which can be unfitting but was not currently compensable or ratable.  The profile was non-specific as to etiology, but the CI was restricted from lifting over 10 pounds and limited to light duty.  The Chiari I malformation was the only condition forwarded by the MEB.  At the 30 November 2006 neurology evaluation, the CI reported daily headaches as well as hearing changes, visual blurring, and fatigue.  However, the physical examination was unremarkable.  An optometry evaluation on 13 July 2006 had noted an unremarkable examination with resolution of previously present edema of the optic disc (due to the Chiari before decompression).  A formal hearing test was not performed, but adequate function was noted by both the neurologist and C&P examiners.  The fatigue was not quantified and, regardless, the commander noted that the CI worked a full duty day.  Any contribution from the Chiari malformation to headaches is subsumed under the headache condition and cannot be used for an addition rating without pyramiding (VASRD §4.14).  The panel observed that the VA actually rated the Chiari malformation for limitation of motion of the cervical spine.  This was not considered by either the MEB or PEB and is therefore outside the scope of the panel.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the headache condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the contended Chiari malformation Type I condition, the panel agrees it cannot recommend it for additional disability rating.  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 20170315, 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-2017-02582.

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,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings