RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03397
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070420

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Motor Transport Operator, medically separated “post concussive headache with migraine features” with a disability rating of 10%.  

CI CONTENTION:  No specific contention 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 - 20070309	VARD - 20070517	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Concussive Headache with Migraine Features	8045-9304	10%	Migraine Headaches Associated with Post Concussive Injury	8045-8100	50%	20070417	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  90%	

ANALYSIS SUMMARY:  

Post Concussive Headaches with Migraine Features.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI‘s headaches began in 2002 after another soldier fell on top of him, resulting in a head injury.  The headaches resolved.  He re-injured his head in October 2005 while deployed to Afghanistan when he was bounced against the top of his military vehicle and hit his head, causing concussion and loss of consciousness for several minutes.  The injury resulted in him being medically evacuated.  Review of the STR revealed 15 encounters of care for headache during the 12 months before separation.  Of these, 8 were for acute headaches evidenced by visits to the emergency room (ER) for care.  

The 11 January 2007 MEB NARSUM, 3 months prior to separation, noted the CI had headaches at a constant 6/10 pain level with migraine features to include photophobia, nausea, and vomiting.  He reported that on more than one occasion he had lost consciousness due to pain. His neurologic work-up was complete to include examination and neuroimaging.  He continued to have chronic daily headaches that waxed and waned in severity.  He had been treated with abortive medication over the previous year to include100 mg of Imitrex, Midrin, Percocet, and 5 mg Zomig.  He failed preventive therapy to include a month trial of Topamax 100 mg once per day, and was currently taking Propranolol 80 mg twice daily, which he had been taking daily for 6 months with no change in headaches, Phenergan (25 mg) every 4-6 hours as needed when headaches occurred, and 800 mg Motrin as needed.  He also reported doing biofeedback for treatment.  The headaches caused him extreme difficulty when completing tasks.  He was unable to do physical training and reported missing 3-4 days per month due to headaches.  The NARSUM physical examination noted the CI was in no acute distress at the time of the examination.  His brain MRI was normal and his diagnoses were post concussive headache with migraine features and depression.  The commander’s statement on 18 December 2006 reported the CI suffered from “constant severe migraine and memory loss to due to post concussive syndrome that happened during deployment,” further stating the CI was unable to perform physical training and was “missing 1-2 days of work in any given week due to his condition.”  

At the 19 April 2007 VA Compensation and Pension (C&P) examination, 1 day before separation, the CI reported constant headaches which he described as dull and aching with a pressure sensation, occurring daily.  He had more severe headaches every 2-3 days associated with throbbing pain and some photophobia and acoustic phobia usually lasting 24-48 hours.  These headaches were usually treated with Percocet and sleep for resolution.  He also reported a third, more severe type of headache associated with severe photo and acoustophobia, nausea, and vomiting, leading to occasional syncopal episodes.  These headaches occurred once per month.  There were documented ER visits where he received injections of narcotic analgesia and anti-nausea medication and was sent home for bed rest for 24 hours (his report).  His CT scan of the brain was normal.  At the physical examination the CI appeared to be in no acute distress.  Neurologically his cranial nerves, motor, sensory, and deep tendon reflexes were intact, as was his cerebellar system.  His diagnosis was post concussive headache with migraine features.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 10%, coded 8045-9304 (residuals of traumatic brain injury-dementia due to head trauma).  The VA rated the headache condition 50%, coded 8045-8100 (residuals of traumatic brain injury-migraine headaches), citing very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability.  

Code 8045, per the VASRD in effect at the time, stipulates “Purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, will be rated 10 percent and no more under diagnostic code 9304.”  Members discussed whether a higher rating option existed under the 8100 code for migraine headaches.  The NARSUM examination noted the CI’s headaches with migraine features caused severe limitations to his duty and he was unable to do his job as an NCO.  He missed 3-4 days a month from either sick call visits or quarters due to his headaches.  The C&P examination noted he had made 2-3 ER visits per month on several occasions for injections of narcotic analgesia and was prescribed bed rest for 24 hours.  The STR noted 15 visits to the ER/neurologist in the past year.  These frequent visits to the ER/neurologists suggest prostrating attacks.  The commander noted he was missing 1-2 days of work per week due to his condition.  The medication record confirmed frequent visits to the neurologist and to other physicians within 12 months prior to the MEB NARSUM.  

After reviewing the evidence, the panel agreed the CI’s migraine headache condition most closely matched the criteria for a 30% rating (15 visits in 12 months) under VA code 8100 at the time of separation.  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 headache condition, coded 8045-8100.  

BOARD FINDINGS:  In the matter of the post concussive headache with migraine features condition, the panel recommends a disability rating of 30%, coded 8045 8100 IAW VASRD §4.124.  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	
Post Concussive Headache with Migraine Features	8045-8100	30%	

AR20180015339, 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. Inquiry 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.