RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04157
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070918

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Information Systems Operations-Analyst, medically separated for “migraine headaches” with a disability rating of 10%.  

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 - 20070717	VARD - 20080221	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	10%	Migraine Headaches	8100	10%	20070906	
Hallux Limitus	Not Unfitting	Bunionectomy, Left Great Toe	7805	0%	20070906	
Major Depression, Single Episode	Not Unfitting	Depressive Disorder, Not Otherwise Specified (NOS)	9434	10%	20070906	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Migraine Headaches.  According to the service treatment record and MEB narrative summary (NARSUM), the CI complained of an 8-year history of migraine headaches.  At a neurology examination in October 2006, the CI reported approximately two severe headaches per week that could last up to 3 days.  The headaches were characterized as throbbing, explosive pain and were associated with neck pain, unsteadiness, scintillating scotoma, narrowing of visual fields, nausea, photophobia, phonophobia and irritability.  Onset was preceded by clouding of attention, difficulties with concentration and reduction of memory, and usually occurred approximately 2 weeks prior to migraine.  The examiner described the headaches as prostrating.  The physical examination was normal.

On 1 February and 2 March 2007, the CI was treated with intramuscular pain medication and placed on quarters.  At the 9 March 2007 neurology evaluation, the CI reported severe migraines associated with neck pain, unsteadiness, paresthesia of the upper and lower extremities, scintillating scotoma and clouding of attention days preceding the headache. The headache frequency was noted as two times per month. The examiner noted the headaches were prostrating.  The neurologic examination was normal except for decreased upper and lower extremity reflexes.  

During the 26 April 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported frequent and severe headaches once per week accompanied with dizziness and feeling faint.  She reported that she experienced chest pain and an abnormal heart beat before, during and after her headaches.  The examiner noted the CI was currently undergoing an MEB for severe, intractable migraines with many days of missed work.  At the family practice clinic on the same day, the CI complained of 5/10 migraine pain to the left side of her head that radiated from the frontal area to the occipital area.  She had no sensitivity to light and stated the headache was preceded by aura and a dizzy spell.  Although the examiner noted the CI was in no acute distress, Toradol was administered via injection and the CI was placed on quarters.  The MEB NARSUM neurology addendum noted the CI was currently undergoing her first Botox treatment and Fioricet was added for increased abortive therapy to the existing prescriptions of Imitrex and Reglan.  

During the 6 September 2007 VA Compensation and Pension (C&P) examination, 12 days before separation, the CI reported having headaches since 1998 that occurred two or three times per month and lasted 3-4 days.  Her headache pain was characterized as dull and throbbing and was aggravated by lack of rest and relieved by rest and medication (Fioricet).  She also reported having an aura of decreased concentration and visual disturbance.  Her migraines were associated with nausea and sometimes vomiting.  She reported having migraines “about” twice a month.  She was able to drive but not at night when she has a headache.  Neurological examination showed her vision and motor systems were within normal limits. The examiner noted the CI was “prostrated about twice per month” for these headaches.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 10%, coded 8100 (migraine) citing “prostrating headaches requiring unscheduled clinic visits  for analgesic injections, occurring an average of once every 2 months over the last several months.  The VA also rated the headache condition 10%, coded 8100, citing “characteristic prostrating attacks averaging one in two months 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 noted six visits during the 9-month period from November 2006 to July 2007 which required intramuscular treatment with pain medications and quarters.  This frequency averages to approximately (.67) headaches a month.  Despite the PEB and VA ratings of 10% for the headaches, the panel majority agreed that the evidence more nearly supported a 30% rating for characteristic prostrating attacks occurring on an average once a month over last several months.  

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

Contended PEB Conditions:  Hallux Limitus and Major Depression, Single Episode.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Although the hallux limitus was profiled, implicated in the commander’s statement and judged to fail retention standards, there was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  The major depression was not profiled or judged to fail retention standards, but was implicated in the commander’s statement.  However, there was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for either of the contended conditions so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the migraine headache condition, the panel majority recommends a disability rating of 30%, coded 8100 IAW VASRD §4.124.  The single voter for dissent recommended no change but did not elect to submit a minority opinion.  In the matter of the contended hallux limitus and major depression, the panel recommends no change from the PEB determinations as not unfitting.  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:

AR20190010066, 

Dear XXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a permanent 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 permanent 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), 
	A copy of this decision has also been provided to the Department of Veterans Affairs.