RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXX	CASE: PD-2017-03562
BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20060829

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Infantryman, medically separated from the Temporary Disability Retired List (TDRL) for “migraine headaches, occurring four times/week” with a disability rating of 0%.

CI CONTENTION:  “Review all conditions.”  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 - 20060728	VARD - 20051219	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	0%	Migraine Headaches	8100	50%	20051201	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Migraine Headaches. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s headaches began in August 2004 after returning from deployment, and became so severe and recalcitrant to multiple medications that he was separated with the disability description of “intractable prostrating migraine headaches with chronic daily headaches” and placed on the TDRL in April 2005.

At the 1 December 2005 VA Compensation and Pension (C&P) examination, 9 months before TDRL removal, the CI reported severe headaches with nausea and vomiting about two times a week, which rendered him totally debilitated. Physical examination recorded sitting and standing

blood pressure at 137/75 and 132/97, pulse 90 beats/minute, respirations 20/minute, height 69 inches, and weight 289 pounds. Gait, cardiovascular, and neurological findings were normal. The 30 May 2006 TDRL neurological evaluation, 3 months prior to separation, noted CI complaints of up to four headaches per week with photophobia, blurry vision, and nausea occasionally and vomiting rarely. He treated the headaches with over-the-counter analgesics and he had just “learned to live and work with them.” Physical examination showed him to be awake, alert, oriented to time, place, and person, and well-developed, well-nourished, and in no distress. A detailed neurological examination of the cranial nerves, motor and sensory status, coordination, and reflexes was normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the migraine headaches 0%, coded 8100 (migraine headaches), citing migraine headaches occurring 4 times/week. The VA rated the headaches 50%, coded 8100, based on the C&P examination, citing very frequent, completely prostrating, and prolonged attacks productive of severe economic inadaptability. Panel members noted that rating 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 considered the results of the VA and TDRL examinations along with the evidence of the treatment records to accurately assess the overall disability picture (VASRD §4.2) at the time of TDRL removal. Review of the record did not show prostrating headaches occurring on average once every 2 months, or more frequently, over the last several months prior to separation to support a rating higher than the 0% adjudicated by the PEB. 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 condition.

BOARD FINDINGS: In the matter of the migraine headaches 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.

2	PD-2017-03562

AR20190008465, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.