RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXX	CASE: PD-2017-05478
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20051109

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Linguist, medically separated for “intractable disabling migraine headaches” with a disability rating of 10%.

CI CONTENTION: In addition to the headache condition, the CI requested review of additional conditions 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 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 - 20050809	VARD - 20060724	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	10%	Migraine Headaches	8100	10%	STR	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Migraine Headaches. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI had a history of migraine headaches since age 12. Beginning in approximately July 2002, the CI experienced worsening headaches occurring on average once a week. Radiograph studies (MRI and CT) were normal. Abortive medications such as Imitrex caused the headaches to significantly worsen.

The 24 May 2005 MEB NARSUM, 6 months prior to separation, noted 10/10 painful headaches associated with nausea, vomiting, photophobia, phonophobia, and tunnel vision. “She typically misse[d] three to four days of work per month due to headaches.” She had gone to the ER approximately 10 times in the past 2 years, but denied hospitalizations. Preventative and abortive medications failed to mitigate her headaches. The CI was prescribed Depakote (used for seizures) as a preventative, Phenergan for nausea, and Vicodin for pain. On physical examination, she was noted to be “in no apparent distress.”

During the 20 July 2005 MEB examination (recorded on DD Forms 2807-1 and 2808), 4 months prior to separation, the CI reported frequent and severe headaches. The examiner recorded a normal neurologic evaluation. Review of the STR revealed seven encounters of care for headaches during the 12 months before separation, of which the evidence reflected six were prostrating. The STR fell silent with regard to care for headaches between July 2005 and the time of separation, 4 months later. The non-medical assessment, on 4 August 2005, recorded the CI missed 8 hours of work each week for her condition. There was no VA examination proximate to separation in evidence.

Panel members directed attention to their rating recommendation based on the above evidence. The PEB and VA both rated the migraines 10%, coded 8100 (migraine). The PEB cited intractable disabling migraine headaches while the VA based the rating on the STR, citing “characteristic prostrating attacks averaging one in 2 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 carefully considered the frequency and nature of the CI’s headaches including objective and corroborating subjective evidence. Review of the record did not show prostrating headaches occurring on average once per month, 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 migraines.

BOARD FINDINGS: In the matter of the migraines 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-2017-05478

DEPARTMENT OF THE NAVY
SECRETARY OF TIIB NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO:
1850
CORB: 003
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:	XXXXXXXXXXXXXXX

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.