RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05823
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20041115

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Medical Specialist, medically separated for “chronic muscle tension headaches” with a disability rating of 10%.

CI CONTENTION:  “No VA Rating.”  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 - 20041015	VARD - 20050520	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Muscle Tension Headaches	5399-5323	10%	Tension Headaches	8199-8100	10%	20050411	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Muscle Tension Headaches.  According to the MEB narrative summary (NARSUM), the CI reported that headaches began in 1997; however, the first mention in the service treatment record was 2 March 2004 while deployed to Iraq.  She previously had two brain MRIs for an unrelated condition and a repeat MRI after being aeromedically evacuated from to Germany.  All showed a microadenoma of the pituitary gland and no identifiable source of headaches.  

During the 17 May 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, the CI reported daily headaches that worsened as the day progressed.  Neurological examination was normal.  The 29 July 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of chronic intractable headaches.  Physical examination showed no evidence of increased intracranial pressure.  

At the 11 April 2005 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI reported daily headaches which were usually present upon arising in the morning.  The headaches were described as a dull pain in the posterior scalp and neck that waxed and waned throughout the day.  Treatment consisted of a muscle relaxer at bedtime which provided good relief.  She complained of being incapacitated, requiring 6 to 8 hours of bedrest 1 or 2 days per month.  Physical examination showed gait and balance were normal.  Her neck demonstrated full range of motion.  A normal neurological examination was reported.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headache condition 10%, coded analogous to 5323 (muscle injuries, group XXIII function: muscles of the side and back of the neck).  The VA also rated the headache condition 10%, coded analogously to 8100 (migraine), based on the C&P examination, citing characteristic prostrating attacks averaging one in two months over the last several months.  

The VASRD §4.56 states when one or more cardinal signs and symptoms of muscle disability such as loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination and uncertainty of movement are present, a moderate level of disability for the muscle group is to be assigned.  In this case, fatigue-pain was present for a 10% rating as adjudicated by the PEB.  The panel also considered the rating formula for migraine headaches but noted that prior to separation there was no evidence for characteristic prostrating attacks to support even a minimal rating.  After due deliberation, considering all of 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 headache condition.  

BOARD FINDINGS:  In the matter of the headache condition and IAW VASRD §4.73 and 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:

Exhibit A.  DD Form 294, dated 20170821, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008244, XXXXXXXXXXXXXXXXXX 

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.

Sincerely,					      
Enclosure