RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04276
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060421

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, M1 Armor Crewman, medically separated for “post-concussive headaches” with a disability rating of 10%.  

CI CONTENTION:  The CI continues to have basilar artery migraines impacting his personal and professional life.  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 - 20060310	VARD - 20060815	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-concussive Headaches	8045-9304	10%	Post-Concussion Syndrome with Headaches 	8045-9304	10%	20060320	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Post-concussive Headaches.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s post-concussive headaches began in January 2005 after being hit in the head (helmeted) with a tank hatch.  He had about a 1-2 minutes loss of consciousness, and was admitted to the hospital.  CT and MRI scans of the brain were normal.  The 16 February 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of two types  of headaches occurring 2-3 times per week.  The CI had parietal-occipital “pounding” headaches with nausea, photophobia and mild diplopia and right-sided retro-orbital headaches that were triggered by reading.   Physical examination showed intact cranial nerves.  

At the 20 March 2006 VA Compensation and Pension (C&P) examination, 1 month prior to separation, the CI reported severe headaches following head trauma.  The headaches occurred 2-3 times per week and lasted all day at times, but typically lasted 2-3 hours, and medication usually helped.  Physical and neurological examinations were unremarkable. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the post-concussive headaches 10%, analogously coded 8045-9304 (residuals of traumatic brain injury (TBI)-dementia due to head trauma), citing paragraph 2 under VASRD Code 8045.  The VA also rated the post-concussive headaches 10%, analogously coded 8045-9304, based on the C&P examination, citing subjective complaints of headaches, in the absence of a diagnosis of multi-infarct dementia associated with brain trauma.  The VARSD in effect at the time, captured brain injuries under the generic category of brain disease due to trauma coded 8045.  There are two different scenarios for rating under this code; analogously with purely neurological deficits, or based on purely subjective symptoms.   In the absence of associated neurological disabilities (seizures, nerve paralysis, etc.), rating of this condition under 8045-9304 is limited to 10%, and cannot be combined with any other rating for a disability due to brain trauma.  Therefore, a higher rating is not possible under this code. 

The panel also considered if a higher rating could be obtained under the 8100 code for migraine headaches. The rating options under 8100 for migraine headaches rely on the frequency of ‘prostrating’ attacks, and VASRD §4.124a does not define ‘prostrating.’  Precedence has relied on the English definition of prostrating (extreme exhaustion, or powerlessness, reduced to extreme weakness).  The panel carefully considered the frequency and nature of the CI’s headaches including objective and corroborating subjective evidence, and agreed that the review of the record did not show prostrating headaches occurring on average once monthly, or more frequently, over the last several months prior to separation to support a rating higher than the 10% 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 post-concussive headaches.  

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:

AR20190007285, 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.