RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD1200687
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20130910
SEPARATION DATE:  20030808

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (4A171/Medical Material Craftsman) medically separated for migraine headaches.  The CI had a 10-year history of migraine headaches which could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty.  She was issued a permanent P4 profile and referred for a Medical Evaluation Board (MEB).  Migraine headaches requiring prophylactic medications and recent increase in abortive medications were forwarded to the Informal Physical Evaluation Board (IPEB) IAW AFI 48-123.  No other conditions were submitted by the MEB.  The IPEB adjudicated “migraine headaches” as unfitting, rated 10%, referencing Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI appealed to the Formal PEB, but withdrew her appeal, and was medically separated.

CI CONTENTION:  “Was discharged at 10%, while upgraded by VA to 30% for migraines.  Believe was to avoid retiring me 50% total disability.”

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting migraine headache condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records (BCMR).

The Board acknowledges the CI’s assertions that her disability disposition was biased.  It is noted for the record that the Board has no jurisdiction to investigate or render opinions in reference to such allegations.  These issues may be addressed by the BCMR and/or the United States judiciary system.

RATING COMPARISON:

Service IPEB – Dated 20030507	VA - (~2 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Migraine Headaches	8100	10%	Migraine Headaches	8100	30%	20030923	
No Additional MEB/PEB Entries	Other x 9	20030923 	
Combined:  10%	Combined:  50%	

ANALYSIS SUMMARY:

Migraine Headaches.  CI had a 10-year history of migraine headaches.  She presented to the clinic in May 2002 with a month long history of increasing frequency headaches to once per week.  At this time she was taking only abortive medication and was referred to neurology.  On neurology evaluation, the CI reported headaches 2 to 4 times a week each lasting several days.  Neurologic exam was normal.  A diagnosis of “common migraine headaches” was made and treatment initiated with two prophylactic medications and continuation of the previous abortive medication.  The CI was advised to return in 3 to 4 months for reevaluation or sooner if needed.  On reevaluation, the CI reported no improvement in frequency of headaches.  Neurologic exam was normal.  The examiner opined that increasing the current prophylactic medication would result in better control, but was wary to do so as CI was attempting pregnancy at time and that medicine might be unsafe.  New prophylactic and abortive medications were begun.  On 16 December 2002, the CI noted her headaches to be improved on medication.  There are no further entries in the treatment record until 6 February 2003, 2 months prior to the narrative summary (NARSUM) and 6 months prior to separation, when the CI reported a “recent” increase in headaches frequency to once per week.  The CI reported having been started on blood pressure (BP) medication “a couple of weeks ago,” but had been noncompliant with this medication use.  BP’s at this time were 177/96 and 160/98, both significantly elevated.  The examiner exhorted the CI to be compliant with “both BP and headache medications” with consideration of increasing the headache medication later if symptoms persisted after BP control.  The NARSUM/MEB exam, 4 months prior to separation, provided no information concerning current frequency or intensity of headache activity.  The commander’s statement dated 28 April 2003 noted the CI to have “1 or 2 days a month of down time due to headaches or medical treatment for them.”  He recommended that “because her headaches can be controlled with medication,” she be retained for duty with deployment restriction.  Review of the record in evidence reveals no hospitalizations, emergency department or clinic visits for emergent treatment or placement on quarters for the migraine headache condition.  At the VA Compensation and Pension (C&P) exam performed on 23 September 2003, a month after separation, the CI reported headache attacks “a couple of times a week, lasting 4 to 12 hours.”  She reported “losing one day every 2 months” because of headaches.  The examiner noted the CI to be able to do all aspects of daily living.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA both adjudicated the migraine headache condition under VASRD code 8100, migraine, but at different rating levels.  When rating headaches under the diagnostic code 8100 migraine headaches, VA guidance uses the clear English definition of prostrating.  The standard dictionary definition of "prostration" is "utter physical exhaustion or helplessness."  Under code 8100 a rating of 10% requires “characteristic prostrating attacks” averaging 1 in 2 months over a several month period.  The next higher rating of 30% requires characteristic prostrating attacks averaging once a month over a several month period.  The highest rating of 50% requires completely prostrating attacks productive of severe economic inadaptability.  The PEB rated at 10% without clarification.  The VA rated at 30% citing the prostrating attacks 2 to 3 times a month as reported on the C&P exam.  Both the VA and PEB agreed that a rating of 50% was not supported by the record in evidence.  The Board debated whether the CI's headaches at the time of separation merited a 10% or a 30% disability rating.  The Board opined that the migraine condition was frequent and severe at its inception, but responded with continued improvement with adjustment of medication.  The Board noted an increase in symptoms 6 months prior to separation, possibly related to medication noncompliance and BP elevation, but agreed the condition had evolved to a level of stability with treatment and, at the time of separation, the migraine attacks were occasional, and infrequently prostrating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that the chronic headache condition more nearly approximated the 10% rating under the VASRD code 8100 at separation.  All evidence considered, there was no reasonable doubt in the CI’s favor supporting a change from the PEB’s rating decision for the headache condition.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the migraine headache condition and IAW VASRD §4.124, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board's scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION	VASRD CODE	RATING	
Migraine Headaches	8100	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120610, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

	XXXXXXXXXXXXXXXXXXXX, DAF
	President
	Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2012-00687.

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings