RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05803
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060308

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Military Police, medically separated from the Temporary Disability Retired List (TDRL) for “migraine headaches” with a disability rating of 0%.  

CI CONTENTION:  “Accuracy & Fairness.”  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 - 20060210	VARD - 20011220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	0%	Migraine Headaches	8100	30%	STR	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Migraine Headaches.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a history of migraine headaches since being injured in a motor vehicle accident in 1999.  She was initially treated with Imitrex.  The initial PEB placed her on the TDRL in July 2001 stating her severe headaches were occurring approximately twice per month, with mild headaches reported daily.  A second TDRL evaluation and subsequent PEB found her headache condition was not sufficiently stabilized and she remained on TDRL until her final PEB dated 10 February 2006 determined that she had only one headache severe enough for abortive therapy in the previous year.  

At the 9 September 2005 neurology TDRL re-evaluation, approximately 6 months prior to separation, the CI reported that her headaches were nearly constant and present most days with variable intensity.  Her usual pain was “bilateral posterior, tender to touch, no shooting/tingling electric pain, often associated with neck tightness.”  She was able to function normally.  Nausea, vomiting, light and sound sensitivity were not present.  Despite the headaches, the CI noted that she continued with her daily tasks without the use of abortive medication.  She was not taking any medications and had not used abortive medication since March 2005 (6 months prior).

The CI reported that she had to take a shot of toradol in February 2005 but had had no other acute interventions in the year prior.  She was working 8-10 hours a day, 5 days a week in a church office.  She was also attending college classes 12 hours a week, working towards her Bachelor of Arts degree in accounting.  Physical examination revealed she was in no apparent distress, and there were no remarkable physical findings.  Neurological examination demonstrated intact cranial nerves and motor and sensory function, with the exception of tenderness to light pressure towards the back of the head.  The examiner opined the CI had classic migraine headaches (with aura) that were now more consistent with a tension-type headache.  The examiner noted the CI had mild headaches most days, moderate headaches two times per week, and severe headaches infrequently in that she had come for acute parenteral medication only once in the past year.  He noted that “overall her headaches have improved since her last TDRL.”  The examiner also noted that the CI refused abortive or prophylactic medication; however, she agreed to a prophylactic procedure carried out during the examination.  The neurology clinic entry dated 28 December 2005, 3 months after TDRL examination, and 3 months prior to TDRL removal, noted that the CI had a prostrating headache on 22 September 2005 that required acute care with medication.  It was also noted that prophylactic medication was initiated. 

The panel directed attention to its rating recommendation based on the above evidence.  The final PEB rated the headache condition 0%, coded 8100 (migraine) citing “last abortive therapy March 2005, acute parenteral medication required once in last year.”  The VA rated the headache condition 30%, also coded 8100, 5 months after the CI’s placement on the TDRL and not proximal to her final separation.  The panel noted the only medical examination in the CI’s record remotely close to her date of final removal from the TDRL was her TDRL re-evaluation.  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 considered the results of the very limited examinations along with the evidence of the treatment records at the time of her removal from the TDRL to accurately assess the overall disability picture (§4.2) at the time of separation.  The panel also considered the absence of reported impairment and overall functioning of the CI secondary to headaches.  Panel members concluded the review of the record did not show prostrating headaches occurring on average once every 2 months, or more frequently, over the last several months prior to separation to support a rating higher than the 0% adjudicated by the PEB.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the migraine headache condition.

BOARD FINDINGS:  In the matter of the migraine headache condition 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.  

ARXXXXXXXXXXX, XXXXXXXXXXXXX 

Dear XXXXXXXXX:

	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.

Sincerely,					      

Enclosure