RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX.	CASE:  PD-2021-00066
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Vehicle Mechanic, medically separated for “pain syndrome” attributed to headaches and PTSD, with a disability rating of 10%.  

CI CONTENTION:  He should have received ratings for his back condition.  Additionally, his medical issues, which were hereditary, genetic, or existed prior to service, are ratable IAW the 8-year rule (10 USC 1207a).  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 - 20080515	VARD - 20081219	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pain Syndrome	9499-9422	10%	Migraine	8100	30%	20080917	
			PTSD	9411	Deferred	20080905	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  80%	

ANALYSIS SUMMARY:  

Pain Syndrome.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI complained of chronic headaches that began after a motor vehicle accident, but later resolved.  However, they reemerged after an improvised explosive device blast in 2003 while deployed to Iraq.   He also had PTSD related symptoms, which were exacerbated after returning from Iraq in February 2004.

At the 13 November 2007 neurology consultation, 8 months prior to separation, the CI reported that following his divorce in 2005, the headaches continued to worsen.  At the time of the examination, he reported daily headaches, rated at 2/10 in intensity, which caused total head throbbing/stabbing pain.  Triggers were standing up too quickly, sunlight, stress, depression, and missing sleep, all of which were relieved by Percocet.  The neurological examination was normal.  

During the 27 December 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI reported constant headaches, dizzy spells, fainting, and forgetting things, but physical findings were unremarkable. The 27 March 2008 MEB NARSUM examination, 4 months before separation, noted complaints of chronic headaches, rated at 10/10, as well as PTSD symptoms.  The CI was prescribed anti-anxiety and narcotic pain medication as needed, as well as propranolol (beta blocker) and a regimen of twice-daily methadone for pain.  PTSD-related symptoms were not described, and the mental status and neurological examinations were both normal.  

At the 5 September 2008 VA Compensation and Pension (C&P) PTSD examination, 2 months after separation, the CI reported suffering from headaches, and was currently taking oxycodone and valium.  There was no indication that medication was being prescribed for PTSD.  The CI reported PTSD related symptoms, however, the origin of his symptoms was not documented, and there was no mention of a direct relationship of his symptoms to combat or childhood trauma.  The mental status examination was normal, and the examiner opined that the CI’s chronic pain syndrome, secondary to degenerative arthritis, contributed to depression and PTSD symptoms.  During the 17 September 2008 VA neurological examination, the CI reported “sparkling lights” as pre-migraine aura, photosensitivity and other symptoms consistent with migraine-type headaches, treated with valium, Percocet and oxycodone as needed.  The examiner opined that less than half of the headaches were prostrating, but did not describe the headaches during the examination or from the treatment records.  Neurological findings were normal and the presence of a headache was not recorded.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB bundled the headache and elements of PTSD as a pain syndrome and applied a single 10% rating, analogously coded 9499-9422 (pain syndrome), citing continuous medications required for control. The VA rated the headaches 30%, coded 8100 (migraine), based on the C&P examination, citing “characteristic prostrating attacks occurring on an average of once a month over the last several months.”  The VA deferred the rating for PTSD “pending medical opinion.”

The panel first considered whether the headaches, having been de-coupled from the combined PEB adjudication, remained separately unfitting.  Panel members noted the headaches were profiled and that the commander indicated that headache medications interfered with duty performance.   The consulting neurologist opined the condition was incapacitating, but provided no description of an incapacitating episode or any information that linked severity of headache to duty performance.  The commander indicated that the CI was unable to drive a vehicle due to the nature of his medications, but noted he was capable of leading a squad.  The neurologist and the STR demonstrated the need for medication to control headaches that were aggravated by stress, medication overuse, and psychological factors.  The panel concluded that there was a preponderance of evidence showing that the headache condition standing alone would have caused the CI to be referred into the disability evaluation system (DES) or be found unfit.  

The panel next proceeded with the rating recommendation for the pain syndrome based on the evidence at the time of separation.  The STR showed the CI had no significant head injury and a normal CT brain scan.  He had multiple medication trials, which were not helpful; however, he experienced relief with narcotic anti-anxiety medications.  Although the neurologist opined that the headaches were incapacitating and failed retention standards, there was no evidence of prostrating headaches, nor did the neurologist diagnose migraine headaches.  The C&P examiner opined there were episodes of prostrating headaches, but the commander made no mention of headaches interfering with duty performance.  Thus, panel members agreed that a higher 30% rating IAW VASRD 4.130 was not justified for occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  In regards to rating under diagnostic code 8100, panel members concluded the STR 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 higher rating.
Elements of PTSD.  Panel members agreed that the PTSD was not unfitting alone or in combination with the headaches.  Although the MEB found the condition to fail retention standards and listed it on the profile, the March-June 2007 NCO evaluation report showed satisfactory duty performance.  Service records documented similar or better NCO reports in 2005 going forward and the commander stated, proximate to separation, that the CI was capable of commanding a squad.  There was no mention of PTSD or any mental health symptoms that significantly interfered with satisfactory duty performance at separation.  The STR indicated the absence of medication or therapy during the 7 months prior to separation, but a history of anti-anxiety medication on an as needed basis, and no psychotropic prescriptions. There was no clinical evidence of occupational or social impairment due to PTSD symptoms, and thus, there was not a preponderance of evidence showing that the PTSD would have caused the CI to be referred into the DES or found unfit.  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 pain syndrome.  

Contended PEB Condition:  Low Back Pain.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the pain syndrome and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  In the matter of the contended back condition, the panel agrees it cannot recommend it for additional disability rating.  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 20210531, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20210017141,XXXXXXXXXXXXXX 

Dear XXXXXXXXXXXX:

	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,