RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03646
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20070430

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

CI CONTENTION:  No specific contention was 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 - 20070111	VARD - 20070514	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Concussive Headaches	8045-9304	10%	Post-Concussive Migraine Headaches, Status Post Head Trauma	8100	30%	20070207	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Post Concussive Headaches.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was hit by an IED in December 2003, and another in January 2004, resulting in post concussive headaches.  A third concussive event took place on 12 April 2005 when he struck his head during a parachute landing.  The CI was subsequently placed on quarters for migraines in October 2005 for 48 hours, January 2006 for 24 hours, February 2006 for 48 hours, and May 2006 for 48 hours.  

At a 31 July 2006 neurology evaluation, the provider instructed the CI to rest and avoid working or operating a vehicle when taking his prescribed muscle relaxant; and regularly follow-up with his primary care doctor.  The October 2006 profile called for a 30-minute rest period every 4 hours at work and “no working greater than 4 hours continuously.”  The commander’s statement (undated but referenced a November 2006 MEB review), noted the CI could not withstand “extensive physical hardships.”  

During the 2 December 2006 MEB NARSUM examination, 5 months prior to separation, the CI reported headaches that were triggered by intense physical training or working extended hours, and required him to miss work or go on quarters for more than 24 hours.   He was unable to run or do push-ups or sit-ups, and could not work greater than 4 hours.  Physical and mental status examinations were essentially unremarkable, and the medication profile documented the last order for narcotic pain medication on 22 December 2006.

At the 7 February 2007 VA Compensation and Pension (C&P) examination, 3 months before separation, the CI reported severe, right-sided headaches every 1 to 2 months which lasted 2-3 days and required complete bedrest.  He had been taking an anti-convulsion medication daily for the past year which decreased the frequency of the headaches to the present level, and he also took a muscle relaxant as needed.  He was able to perform all the activities of daily living but avoided cooking, gardening or pushing a lawnmower which triggered his headaches.  Physical and mental status examinations were essentially unremarkable.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the post concussive headaches condition 10%, coded 8045-9304 (residuals of traumatic brain injury and dementia due to head trauma), citing VASRD instructions for code 8045 code.  The VA rated the post concussive headaches condition 30%, coded 8100 (migraine headaches), based on the C&P examination, citing characteristic prostrating attacks occurring on an average of once a month over the last several months.  Members noted that per the VASRD in effect at the time of the PEB adjudication, code 8045 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.”  The panel considered recommending a rating under code 8100, but found insufficient evidence of “characteristic prostrating attacks” that would justify a rating higher than 10%.  The VASRD describes “prostrating” as the need to stop what one is doing “and seek medical attention.”  Members agreed that placement on quarters would indicate evidence of a prostrating attack, however, a review of the STR showed that the CI was last placed on quarters on 8 May 2006, 7 months prior to the NARSUM examination, and 9 months prior to the C&P examination, which did not meet the criteria for prostrating attacks “over the last several months” to support a 30% rating.  Additionally, the commander did not document the CI’s work stoppage to alleviate headaches, but rather noted he had difficulty functioning with extended hours.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the post concussive headaches condition.  

BOARD FINDINGS:  In the matter of the post concussive 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. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170509, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180010037, 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.

Sincerely,					      
Enclosure