RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

 

 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20040212 

 
NAME:  XXXXXXXXXXXXXXXXX 
CASE NUMBER:  PD1100639                             
BOARD DATE:  20120911     
 
 
SUMMARY  OF  CASE:  Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  activated  Reserve  member,  SPC/E-4  (88M,  Motor  Transport 
Operator),  medically  separated  for  a  headache  condition.    The  CI  experienced  an  onset  of 
headaches after a head injury in 2001, which were exacerbated during a 2003 mobilization.  At 
that  time  they  were  associated  with  syncope,  and  the  CI  was  diagnosed  with  cavernous 
hemangiomas (congenital vascular tumors of the brain).  The condition could not be adequately 
stabilized  to  fulfill  the  requirements  of  his  Military  Occupational  Specialty  (MOS).    He  was 
consequently issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  
The  headache  condition  was  forwarded  to  the  Informal  Physical  Evaluation  Board  (IPEB)  as 
medically  unacceptable  IAW  AR  40-501.    Syncope  and  cavernous  hemangiomas  were  also 
forwarded by the MEB as separate medically unacceptable conditions.  The IPEB adjudicated 
the headache condition as unfitting, rated 10%, citing criteria of the Veterans Affairs Schedule 
for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  
The CI appealed to a Formal PEB (FPEB), which re-coded the headache condition; but arrived at 
the same 10% rating (IAW the VASRD), and also determined that the syncope and cavernous 
hemangioma conditions were not unfitting.  The CI made no further appeals, and was medically 
separated with a 10% disability rating. 
 
 
CI CONTENTION:  “Because the injury, I was discharged from military and now I suffer from it 
daily.  It affects my work life, personal life; aspects of my life deteriorate on a monthly basis.  
The medicines the army put me on to try to help have messed me up and made my muscle 
tension headaches worse”.  He further elaborates the current frequency, severity, and adverse 
occupational  consequences  of  his  headaches.    He  lists  other  conditions  for  which  he  has 
received  VA  ratings,  but  the  application  does  not  mention  the  syncope  or  cavernous 
hemangioma conditions.  
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB”.  The rating for 
the unfitting  headache condition is addressed below; but, since they were not requested for 
review, the syncope and cavernous hemangioma conditions (as a separate entities associated 
with  any  disability  other  than  headache)  determined  to  be  not  unfitting  by  the  PEB  are  not 
within  the  DoDI  6040.44  defined  purview  of  the  Board.    Those,  and  any  other  conditions  or 
contention  not  requested  in  this  application,  remain  eligible  for  future  consideration  by  the 
Army Board for Correction of Military Records. 
 
 
 

 

RATING COMPARISON:  
 

Service FPEB – Dated 20031120 
Condition 
Code 

Muscle Contraction Headaches 
Syncope 
Cavernous Hemangiomas 

5399-5323 

Not Unfitting 
Not Unfitting 

No Additional MEB/PEB Entries. 

Combined:  10% 

VA (5 Mo. Post-Separation) –Effective 20040213 

Rating 
10%  Muscle Tension Headaches 

Condition 

Code 
8100 

Rating 

0% 

Not identified for VA rating. 

Cavernous Hemangiomas 
Lumbosacral Strain 
PFS,  Right Knee 

5237 
5257 
0% X 2 / Not Service Connected x 4 

NSC* 
10% 
10% 

Combined:  20% 

Exam 

20040726 
20040726 
20040726 
20040726 
20040726 
20040726 

 

*Not Service Connected.  VA decision states: “The service medical records revealed when trying to determine the cause of your 
headaches,  the  hemangioma  was  found  on  scanning.    It  was  the  examiner's  opinion  [shared  by  the  action  officer],  and  the 
evidence of record, that this hemangioma was not due to the head injury, nor has it or was it aggravated by the injury you 
experienced or was it aggravated by your military service. … The condition identified as cavernous hemangioma (claimed as a 
brain  tumor)  is  considered  a  congenital  or  developmental  defect  which  is  unrelated  to  military  service  and  not  subject  to 
service connection.” 
 

ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application 
regarding the significant impairment with which his service-connected condition continues to 
burden him.  It is a fact, however, that the Disability Evaluation System (DES) has neither the 
role  nor  the  authority  to  compensate  service  members  for  anticipated  future  severity  or 
potential complications of conditions resulting in medical separation.  This role and authority is 
granted by Congress to the Department of Veterans Affairs (DVA).  The DVA, operating under a 
different  set  of  laws  (Title  38,  United  States  Code),  is  empowered  to  compensate  service-
connected  conditions  and  to  periodically  re-evaluate  said  conditions  for  the  purpose  of 
adjusting the veteran’s disability rating should the degree of impairment vary over time.  The 
Board  utilizes  VA  evidence  proximate  to  separation  in  arriving  at  its  recommendations;  and, 
DoDI  6040.44  defines  a  12-month  interval  for  special  consideration  to  post-separation 
evidence.  The Board’s authority as defined in DoDI 6044.40, however, resides in evaluating the 
fairness of DES rating determinations for the disability existing at the time of separation.  Post-
separation  evidence  therefore  is  probative  only  to  the  extent  that  it  reasonably  reflects  the 
disability at the time of separation.  The Board further acknowledges the CI’s assertion that his 
condition  was  worsened  by  medication  prescribed; but,  must note for the  record that  it  has 
neither  the  jurisdiction  nor  authority  to  scrutinize  or  render  opinions  in  reference  to  such 
allegations; nor, may a higher disability rating be premised on such factors.  The Board’s role is 
confined to the review of medical records and all evidence at hand to assess the fairness of 
Service rating and fitness determinations at separation, as elaborated above. 
 
Headache  Condition.    In  March  2001,  the  CI  suffered  a  head  injury  in  his  civilian  workplace.  
Imaging at that time revealed brain lesions which were subsequently identified as cavernous 
hemangiomas.  He developed headaches after that incident which were under treatment and 
reasonably  controlled  at  the  time  he  was  mobilized  in  2003.    He  suffered  a  fairly  abrupt 
recurrence of headaches after resuming active duty; and, in March 2003 he experienced two 
syncopal  episodes  (with  possibly  a  brief  seizure).    He  underwent  repeat  imaging  and 
consultations  by  neurology  and  neurosurgery,  and  suffered  no  recurrent  syncope  and/or 
seizures.  His headaches persisted in spite of various medication regimens; and, in August 2003 
his neurologist opined that the condition was not compatible with his MOS as a truck driver.  
Outpatient  notes  of  this  period  reflect  near-daily  frequency  of  headaches,  lasting  for  hours.  
Headache was more or less constant, and there was no documentation suggesting periods of 
complete relief with distinct quantifiable episodes.   He was prescribed narcotics for rescue, and 

responded  poorly  to  various  prophylactic  medications.    Other  than  emergency  visits  for 
syncope, there are no documented medical encounters for emergent treatment of headache.  
Neither  the  commander’s  statement  nor  other  records  document  missed  duty  or  quarters 
assignment due to the condition.  An outpatient note from May 2003 documented, “the patient 
states  his  headaches  continue,  although  they  do  not  limit  him  in  his  ability  to  do  his  job  he 
feels”.    There  are  no  entries  closer  to  separation  which  would  suggest  a  change  from  this 
baseline.  The narrative summary (NARSUM) stated “the headaches have been persistent and 
have  been  daily.”    There  is  no  further  elaboration  of the  ratable  features  of  headache.    The 
neurological examination was normal, as were all exams on record.  At his VA Compensation 
and Pension (C&P) evaluations (5 months post-separation) the CI was employed full time as a 
salesman, taking college business courses, and “getting all A’s.”  He was taking no medications 
and  had  experienced  no  recurrent  seizures  or  syncope.    None  of  the  various  VA  examiners 
(general, neurologic, psychiatric) noted any recurrent episodic headaches of significant severity, 
and it was documented that the CI had missed no work due to his condition.  Although the CI 
complained  of  difficulty  concentrating,  all  VA  neurological  and  mental  status/cognitive 
examinations were normal. 
 
The Board directs attention to its rating recommendation based on the above evidence.  Both 
the  PEB  and  VA  rating  nomenclature  referenced  the  preceding  head  trauma  (in  2001  and 
associated  with  the  syncopal  event  of  2003);  although,  the  action  officer  opines  that  the 
etiology  of  the  headache  may  have  been  linked  to  the  hemangiomas,  vascular  or  tension 
headache, or a combination of factors.  The IPEB’s rating was, in fact, under 8045 (brain disease 
due  to  trauma).    The  FPEB’s  rating  was  under  the  muscle  code  5323  (upper  neck  and 
suboccipital groups), although criteria under 8100 (migraine) were referenced on the DA Form 
199.  The Board concluded, since the association with head injury was moot (maximum rating 
for 8045 is 10%) and a rating for muscle disability is not applicable to the clinical features; that, 
a  rating  under  8100  (as  per the  VA)  was  most appropriate to the  case.    The  VASRD  §4.124a 
rating schedule for 8100 rests heavily on the frequency of “characteristic prostrating attacks … 
over last several months”; and, it is incumbent on the Board to apply DoDI 6040.44-compliant 
and  uniform  criteria  which  would  define  a  recurrent  migraine  episode  as  ‘prostrating’  and 
ratable.    Under  DoDI  6040.44,  the  Board  is  directed  to:  “use  the  VASRD  in  arriving  at  its 
recommendations, along with all applicable statutes, and any directives in effect at the time of 
the contested separation (to the extent they do not conflict with the VASRD in effect at the 
time  of  the  contested  separation).”    Since  the  VASRD  does  not  provide  a  definition  of 
‘prostrating’, it can be argued that the Board is directed to apply the DoDI 1332.39 definition 
which requires evidence that medical treatment is sought for each rated episode.  The Board, 
by precedence, has not required rigid proof of medical attention for each and every episode to 
characterize  it  as  prostrating;  but,  does  require  reasonably  convincing  evidence  that  rated 
attacks force the abandonment of work or current activity to treat the migraine; although, self-
management (medication and/or sleep) under outpatient monitoring and supervision has been 
accommodated  within  this  threshold.    The  Board  carefully  considered  the  historical  and 
subjective data presented, but was ultimately confronted by the paucity of objective evidence 
or corroborating subjective evidence that the ratable threshold was met for any occurrence of 
migraine in this case.  This conclusion, in strict conformity with the 8100 criteria, yields a 0% 
rating as conferred initially by the VA (subsequently raised to 10% effective 30 December 2004); 
although, IAW DoDI 6040.44 the Board’s recommendations cannot result in a lower combined 
rating than that awarded by the Service.  After due deliberation, considering all of the evidence 
and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient 
cause to recommend a change in the PEB adjudication of 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 headache condition and IAW VASRD §4.124a, 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: 
 

 

Muscle Contraction Headache 

UNFITTING CONDITION 

VASRD CODE  RATING 
5399-5323 
COMBINED 

10% 
10% 

 

 

The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20110815, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXX 
           President 
           Physical Disability Board of Review 

 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB /  ), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXXXXX, AR20120021438 (PD201100639) 
 
 
I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD 
PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under 
the authority of Title 10, United States Code, section 1554a,   I accept the Board’s 
recommendation and hereby deny the individual’s application.   
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress 
who have shown interest in this application have been notified of this decision by mail. 
 
 BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 
 
 
Encl 
 
 
 
CF:  
(  ) DoD PDBR 
(  ) DVA 
 
 

     XXXXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)