SAF/MRBD (PDBR)
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

MEMORANDUM FOR THE DIRECTOR, ARMY REVIEW BOARDS AGENCY

SUBJECT:  Physical Disability Board of Review Recommendation on XXXXXXXXXXXXX
	Case Number PD-2018-00266

	In accordance with Title 10 § 1554a and in compliance with DoDI 6040.44, the Physical Disability Board of Review (PDBR) adjudicated the disability rating accompanying the medical separation of the covered individual (CI) from the United States Army.  After carefully reviewing the application and medical separation case file, the PDBR recommended no re-characterization of the separation or modification of the disability rating previously assigned.  I recommend you accept this proposed decision.

The CI was an active duty E5, Unit Supply Specialist, medically separated for “history of recurrent episodes of loss of vision lasting seconds associated with headaches and dizziness” with a disability rating of 10%.  The PEB rated the vision loss associated with headaches and dizziness 10%, dual coded 8045-9304 (residuals of traumatic brain injury (TBI)-dementia due to head trauma), citing VASRD code 8045 instructions.  The VA also rated the condition 10%, but coded 8100 (migraines), based on the STR. specifically referencing the September 2003 neurology consultation, which cited characteristic prostrating attacks averaging 1 in 2 months over the last several months. 

The 2004 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:  rate the condition analogously with purely neurological deficits, or rate purely subjective symptoms.  Because there was no STR evidence associated with neurological disabilities (seizures, nerve paralysis, etc.), rating under 8045-9304 was limited to a 10% rating, and could not be combined with any other rating for a disability due to brain trauma.  Therefore, a higher rating was not possible under code 8045.

Under code 8100, rating options depened on the frequency of “prostrating” attacks, which is not defined by VASRD §4.124a.  However, precedence has relied on the English definition of prostrating (extreme exhaustion, or powerlessness, reduced to extreme weakness), and the neurological examinations in evidence documented vision loss with associated headaches occurring daily to 4 times per week.  The MEB narrative summary (NARSUM) noted that the CI reported migraine headaches that occurred approximately 4 times a week, and that episodes could last from 30-70 minutes.  The examiner opined that the CI was unable to drive due to the unpredictability of symptom occurrence, and this negatively impacted duties of his military specialty.  However, there was no indication that any of the headaches met the definition of prostrating.  The CI did not described severe headache pains that caused him to leave work or seek urgent medical attention, and the commander’s statement did not mention headaches requiring rest in a quiet room, leaving work, or seeking urgent medical attention.  The commander specified that due to episodes of blindness, the CI was not allowed to operate a tactical vehicle under combat conditions, or carry/fire a weapon in accordance with his physical profile.  Evidence of prostrating or debilitating headaches was not addressed.  Thus, there was no documentation of “characteristic prostrating attacks (headaches) occurring on an average once a month over last several months” to support a higher 30% rating.  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 vision loss associated with headaches and dizziness.  

	Sincerely,

AR20200004727, 

	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.

	A copy of this letter has also been provided to the counsel you listed on your application, Ms. Rosalind D. Jordan, 420 North James Road, Columbus. OH 43219.