RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03357
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060503

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:  Review of all conditions 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 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 - 20060322	VARD - 20070906	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches…	8199-8100	10%	Migraines	8100	30%	20070112	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Migraine Headaches.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s headaches began as early as age 12 but increased in frequency sometime around early 2002.  During a 10 January 2006 neurology follow-up examination, 4 months prior to separation, the CI reported three to four mild headaches per week, with one per week that required him to lie down in a dark room.  The headaches were better controlled with amitriptyline but that medication made him drowsy.  On the day of the examination, he reported having a mild headache.  

The 15 February 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of ongoing headaches occurring almost daily despite medication.  The only medication that improved the headaches made him drowsy.  Physical examination was normal.  The current medication was amitriptyline 25 mg.  The 24 February 2006 commander’s statement noted the CI had not missed any work due to his medical condition [headaches].  

At the 12 January 2007 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported ongoing headaches with pain rated 6-7/10 in severity, occurring 4 times per week.  Physical examination was unremarkable, and neurological exam showed no evidence of focal deficits (nerve, spinal cord or brain function).  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headaches condition 10%, analogously coded 8199-8100 (migraine headaches). The VA rated the headaches condition 30%, coded 8100 code, based on the C&P examination, citing prostrating attacks occurring on average of once a month 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).  The panel carefully considered the frequency and nature of the CI’s headaches including objective evidence and corroborating subjective evidence.  The panel considered the absence of reported impairment secondary to headaches, and the overall functioning of the CI.  The neurology visit noted the headaches required the CI to retire to a dark room once per week.  The commander did not mention the need for environmental manipulation to accommodate the CI during his headaches, such as need a dark room, needing to sleep, etc., and there was no evidence that the CI had to leave work due to headache.  The commander’s statement documented the CI had not missed work due to headaches   and the NARSUM was silent regarding the headache severity.  Panel members concluded that review of the record did not show prostrating headaches occurring on average once a 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 amitriptyline was reported to improve headaches, though it made the CI sleepy.  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 headaches.

BOARD FINDINGS:  In the matter of the migraine headaches and IAW VASRD §4.124, 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:

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03357.

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.