RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04494
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051012

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty W3, Attack Pilot, medically separated for “posttraumatic headaches” with a disability rating of 10%.  

CI CONTENTION:  In addition to the headaches, the CI requested review of an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20050810	VARD - 20070613	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Posttraumatic Headaches 	8045-9304	10%	Post Traumatic Migraine Headaches	8045-8207	10%	20060504	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Posttraumatic Headaches.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s headache condition began in July 2004 following a loss of consciousness which resulted in the CI hitting her face and head on a tiled bathroom floor, breaking her nose.  The loss of consciousness was determined to be a vasovagal syncope episode secondary to abdominal pain.  A CT scan was determined normal.  On 2 March 2005, a neurologist stated the CI had severe migraine headaches that were proving to be resistant to therapy and could cause visual impairment.  
During the 2 August 2005 MEB NARSUM examination, 2 months prior to separation, the CI reported two or three prostrating headaches a week which affected her ability to walk or move and required her to lay down in a dark room and take hydrocodone.  The headaches had lessened in frequency and were somewhat relieved with medication.  Physical examination showed pupils equally round and reactive to light and intact cranial nerves II-XII.  The 3 August 2005 commander’s statement indicated the CI reported to work on time every day except for required medical appointments.  She normally worked a half day, except when her physical disability required her to go home early.  

The 4 May 2006 VA Compensation and Pension (C&P) examination, 7 months after separation, showed no frontal tenderness.  The head was normal.  Visual fields were full by confrontation, extraocular movements were intact and full and no nystagmus was present.  At the 16 May 2006 C&P mental health evaluation, 7 months after separation, the mental status examination showed that the CI answered questions and tended to isolate herself frequently.  She was hyper-alert, with increased startle response every now and then.  Mood was nervous and depressed frequently.  Affect was constricted.  Thought processes were intact and she was able to communicate.  She denied hallucinations, suicidal or homicidal thoughts.  Orientation and memory were preserved.  Insight and judgment were intact.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the posttraumatic headaches 10%, dual coded 8045-9304 (residuals of traumatic brain injury & dementia due to head trauma), citing inability to perform her duties.  The VA also rated the posttraumatic headaches 10%, dual coded 8045-8207 (residuals of traumatic brain injury-paralysis of the seventh (facial) cranial nerve), based on the C&P examination, citing subjective complaints of headaches, dizziness, and insomnia, recognized as symptomatic of brain trauma.  

The panel noted there were four medical encounters referencing six severe headaches in the 14- month period from August 2004 to October 2005.  In August 2005 the neurologist noted the CI’s headaches were resistant to pharmacotherapy.  After reviewing the treatment records, the panel agreed the CI’s headache condition most closely matched the characteristic prostrating attacks averaging one in 2 months over last several months for a 10% rating under code 8100 at the time of separation.  There was no clear evidence of characteristic prostrating attacks occurring on average of once a month over the last several months to justify a 30% rating.  The panel also considered a rating under the traumatic brain injury criteria, but based on the STR and VA mental health examination, there was no available higher rating 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 posttraumatic headaches.  

BOARD FINDINGS:  In the matter of the posttraumatic 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:

AR20180016691, 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.