RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02678
BRANCH OF SERVICE:  army	SEPARATION DATE:  20080711

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E7, Recruiter, medically separated from the Temporary Disability Retirement List (TDRL) for “migraine headaches” with a disability rating of 10%.

CI CONTENTION:  My service and VA migraine ratings are too low considering the negative impact on my life.  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 Physical Evaluation Board (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 - 20080609	VARD - 20090106	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	10%	Complicated Migraines	8100	30%	20081106	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:

Migraine Headaches.  According to the service treatment record (STR), the CI was placed on the TDRL in 2004 due to prostrating migraine headaches two to three times per week.  The CI reported missing 1 to 2 days of work due to headaches while employed as a recruiting company researcher.  Neurologists documented the CI had tried several medications for headache relief with Depakote (divalproex) providing him “mild” headache help/relief. 

At the 2 June 2008 TDRL re-evaluation, 1 month prior to TDRL removal, the CI reported one to three “moderate” headaches per week, and two to four “severe” headaches per month.  He also noted he was unemployed.  The examiner noted the CI had tried numerous medications to “little avail,” and his current medications for migraine relief included Depakote, Zomig (zolmitriptan), promethazine (for nausea) and Ambien (zolpidem for sleep).  The neurologic examination showed the cranial nerves were not impaired.  In an undated memorandum to the PEB, the CI stated, “I still have regular migraines.” He also noted that he had “lost his job due to reasons related to [his] illness” and “with limited resources, [he] refrained from purchasing medication that proved little to no benefit for the relief of [his] ailment.”  

At the 12 September 2008 VA Compensation and Pension (C&P) neurology examination, 4 months after separation, the CI reported having “intractable, incapacitating” headaches about twice a month, which lasted a couple of days.  Some were associated with right facial drooping.  Current medications were Depakote, Zomig, promethazine and Ambien.  Cranial nerves, motor, reflexes, and sensory testing were all normal.  The neurologist’s diagnosis was complicated migraine headaches manifesting as severe headaches mainly on the left side with nausea, vomiting and photophobia and often with right-sided symptoms.  The examiner opined that the CI had “mild” headaches one to two times per week and “incapacitating” headaches twice a month. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the migraine headaches 10%, coded 8100 (migraine headache), citing headaches were not considered prostrating IAW DoDI 1332.39.  The VA rated the migraine headaches 30%, coded 8100, based on the C&P examination, citing characteristic prostrating attacks occurring on average of once a month over the last several months.

Although the CI did not provide evidence of emergency, acute care or civilian neurological treatment during the TDRL period, the panel recommends a 30% rating for prostrating headache attacks occurring on an average of once a month over last several months based on the following reasons.  The panel considered the CI’s headache condition as his “illness” and his “ailment” since the headache condition was the only condition the PEB adjudicated.  The panel then determined the CI’s prostrating headaches disability at TDRL placement still existed at the time of TDRL removal, and of interest, the same examiner performed the TDRL placement and TDRL removal examinations.  The CI reported “severe” and “intractable-incapacitating” headaches at least twice monthly, was not able to work, lost his job and received only “mild” to “little avail” relief from headache medications, all at the time of TDRL placement and proximate to TDRL removal as reported in the STR, the final TDRL re-evaluation, the CI’s memorandum and the VA examination.

After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the migraine headaches, coded 8100.

BOARD FINDINGS:  In the matter of the migraine headaches, the panel recommends a disability rating of 30%, coded 8100 IAW VASRD §4.121a.  There are no other conditions within the panel’s scope of review for consideration. 
 
The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Migraine Headaches	8100	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170331, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190008402, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiries concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs.