RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxxxx	CASE:  PD-2017-05498
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aerospace Medical Service Independent Duty Medical Technician, medically separated for “post-concussion migraine syndrome” with a disability rating of 10%.

CI CONTENTION:  Review of all conditions requested.  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 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 - 20060509	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post-Concussion Migraine Syndrome	8199-8100	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Post-Concussion Migraine Syndrome.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI struck his head in March 2005 and began having daily headaches.  He had a history of about 25 other closed head trauma incidents since high school; some involved loss of consciousness.  A brain MRI and CT scan in April 2005 were negative.  The CI was diagnosed with post-concussive migraine syndrome.

The 27 February 2006 MEB NARSUM examination, 4 months prior to separation, noted occasional monthly episodes of cephalgia (cluster headaches) that were incapacitating.  The headaches were of mixed migraine/tension-type.  Physical examination was unremarkable.  The examiner noted that the CI still had severe episodes of cephalgia despite being on migraine medication.  The 9 March 2006 commander’s statement noted the CI was still working in his primary military specialty but was limited to on-base, office-type functions “in an effort to minimize the [CI’s] risk of further head injuries and aggravating the condition.”  The CI missed 4 to 6 hours of work per month due to medical appointments and had difficulty concentrating whenever he had a headache.  There was no mention of the CI having the need for rest, to leave work or requiring a dark or quiet room due to his headache condition.

During the 14 March 2006 neurology follow-up appointment, the CI reported that the week prior he experienced an episode of nausea, neck tightness, numbness at the left side of his face, left shoulder and arm, and left facial drooping.  The CI also experienced a severe headache several hours later that faded with time.  This single episode was assessed as a complicated migraine.  During the 13 April 2006 MEB NARSUM addendum, 3 months prior to separation, the same examiner stated the CI had done well since the 27 February 2006 MEB NARSUM examination and now had occasional headaches that were not as problematic as before.  No physical examination was conducted.  A flight medicine examination on 19 April 2006 documented the CI had approximately four headaches per month and usually only had to take one tablet (Zomig) to treat or prevent headaches.  There was no indication these were prostrating headaches.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the migraine syndrome 10%, analogously coded 8199-8100 (migraine headaches).  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).  There was no VA Compensation and Pension examination proximate to separation in evidence.

The panel deliberated whether the CI had prostrating headaches.  The commander’s statement recorded the CI’s headache medication could make the CI drowsy and inattentive.  However, there was no documentation of the CI’s requirement for a dark or quiet room, the need for rest, or having to leave work due to his headache condition.  The MEB NARSUM addendum noted the CI’s headache condition had improved, he had occasional headaches that were not as problematic as before.  The flight medicine examination documented the CI had monthly headaches requiring one tablet (Zomig) to treat or prevent these headaches.  There was no indication these were prostrating headaches.  Panel members agreed that the STR evidence did not reflect prostrating headaches occurring on average once a month, or more frequently, over the last several months, prior to separation, to support a rating higher than the 10% adjudicated by the PEB.  

Additionally, the panel considered a higher rating utilizing code 8045 (traumatic brain injury) IAW VASRD 2006 in effect at the time of separation.  Members agreed there was no rating advantage as there was no STR evidence of epileptiform seizures, or hemiplegia (muscle weakness or partial paralysis on one side of the body that can affect the arms, legs, and facial muscles) proximate to separation to warrant a higher rating.  Code 8045 also limits purely subjective complaints such as headaches, dizziness, or insomnia at 10%.  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 migraine syndrome condition.

BOARD FINDINGS:  In the matter of the migraine syndrome 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.

SAF/MRB

Dear XXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05498.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.