RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE: PD-2017-05995 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20050119

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

CI CONTENTION:  Review all conditions.  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 - 20041102	VARD - 20050616	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Post Concussive Headaches	8045-9304	10%	Post Traumatic Headaches	8045-9304	10%	20050307	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Post Concussive Headaches. According to the service treatment (STR) record and MEB narrative summary (NARSUM), the CI’s post concussive headaches began in June 2000 after two minor head injuries. He subsequently suffered head injuries in March 2002 during an airborne jump, and in April 2002 after a motor vehicle accident. In April 2004, he was diagnosed with post concussive syndrome, and was seen several times in the emergency room (ER) for headache symptoms and treated with multiple medications. Multiple CT scans from 2000 to 2004 were normal and inconclusive for brain injury.

The 5 October 2004 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of posttraumatic headaches and migraine syncope.  The examiner noted that he had

been seen once in June 2004 and twice in July for headaches. He was diagnosed with posttraumatic headaches by neurologist in August 2004, and was prescribed prophylactic medication.   Physical examination, including neurological tests, was unremarkable.

At the 7 March 2005 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported a history of headaches and preventative medication use. However, there was no mention of recent headaches or frequency, and physical findings were normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the post concussive headaches 10%, coded 8045-9304 (residuals of traumatic brain injury (TBI)-dementia due to head trauma). The VA also rated the post concussive headaches 10%, using the same code, based on the STR and C&P examinations. Panel members noted that the VARSD in effect at the time of separation captured brain injuries under the generic category of brain disease due to trauma coded 8045. There are two different scenarios for rating under this code: analogously with purely neurological deficits, or based on purely subjective symptoms. In the absence of associated neurological disabilities (seizures, nerve paralysis, etc.), rating of this condition under 8045-9304 is limited to 10%, and cannot be combined with any other rating for a disability due to brain trauma.  Therefore, a higher rating is not possible under this code.

The panel also deliberated over whether a higher rating could be obtained under code 8100 (migraine), and carefully considered the frequency and nature of the CI’s headaches including objective and corroborating subjective evidence. The 10% rating under this code stipulates one prostrating headaches in two months over past several months, and a 30% requires attacks once monthly over several months. Panel members agreed that there was no documentation showing prostrating headaches occurring on average once monthly, 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 post concussive headaches.

BOARD FINDINGS: In the matter of the post concussive 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.

2	PD-2017-05995

AR20190008488, 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.