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AF | PDBR | CY2012 | PD2012 01873
Original file (PD2012 01873.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX          CASE : pd1201873
BRANCH OF SERVICE: Army   BOARD DATE: 2013 1203
Separation Date: 20040304


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SGT/E-5 (44B20/Welder) medically separated for migraine headaches without aura. The CI claims a long history of migraine headaches that started prior to service entry. He was mobilized to active duty in March 2003 and noted worsening of the headache condition since that time. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS). He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The migraine condition, characterized as “migraine headache without aura, controlled on medication” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501 and no other conditions were submitted by the MEB. The Informal PEB adjudicated the migraine headache condition as unfitting, rated 0%, with application of Veterans Affairs Schedule for Rating Disabilities (VASRD). The PEB stated that the disability existed prior to service (EPTS) and was not permanently aggravated by service, but is compensable in accordance with 10 USC 1207a. The CI made no appeals and was medically separated.


CI CONTENTION : “ A sking , PDBR to review and change rating as follows , I) I having many cluster/migraines headaches throughout my military career I been on sick call, quarters, and in and out of hospitals and sometimes Emergency Rooms. 2) A fter ETS, in March or 1993 of active duty, I remain in National Guard I receive from VA, 10% for headaches in April 1993, and also receive an increase to 30% for headaches in July 1999, all before I was activated on orders for Iraq in March 2003. 3) I was told by a doctor, when I went on sick call for headaches around April 2003 that I was non deployable and will be going through a Medical Board, this would this would end my career with no hopes of higher rank”.


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.

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RATING COMPARISON :

Service IPEB – Dated 20040114
 VA - (3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Migraine Headaches 8100 0% Cluster Headaches 8100 30% 20040603
No Additional MEB/PEB Entries
 Other x3 20040603
Combined: 0%
 Combined: 40%
Derived from VA Rating Decision (VARD) dated 20041214 (most proximate to date of separation [DOS])


ANALYSIS SUMMARY : The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the service member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career, and then only to the degree of severity present at the time of final disposition. However the Department of Veteran s Affairs , 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 V eteran’s disability rating should the degree of impairment vary over time.

Migraine Headaches Condition . The CI has a long well documented history of migraine headaches as evidenced by the numerous notes i n the service treatment record . There is documentation that the CI had migraines prior to entry into the s ervice; however they worsened during his s ervice time. At the Military Entrance Physical in September 1983 there is no mention of any type of headache listed. The CI was first seen for severe headaches that had been present for months in May 1987 . The CI was seen for headache complaints 2 months later and stated that he had a history of headaches however they had recently gotten worse. In the time between July 1987 and April 2002, the CI was seen intermittently for migraine headaches. In 2000 the headaches were stable with medications of a non-steroidal anti-inflammatory drug (NSAID) and a combination medication of aspirin, phenacitin and butalbital for migraines (Esgic). In April 2002, the CI reported that the migraines had worsened, occurred every other day and occasionally occurred at night also. The CI was seen for chronic daily migraines that responded intermittently to an NSAID (Motrin ) and a narcotic ( Fiorinol ). The examiner added a nasal spray migraine medication (Imitrex ) on an as needed basis if the Esgic failed. The CI was followed closely throughout 2003 for chronic severe migraine headaches which caused associated nausea and vomiting, photophobia and prevented him f r o m working . In March 2003 the CI was restricted to Quarters for 72 hours due to the severity of the migraine headache. The examiner diagnosed severe recurrent migraines limiting duty. Throughout 2003, the CI was seen monthly for migraine exacerbations and at no time was the CI non-compliant with his treatment regimen. An undated n eurology note documented headaches that occurred at least once weekly lasting one to three days which were occasionally worse with routine activity, photophobia, phonophobia, nausea and vomiting. All brain imaging was normal. The n eurology visit 2 days prior to the MEB exam was a thorough documentation of the CI’s migraine headaches and indicated that the migraines occurred at least once per week, lasting one to three days with photophobia, phonophobia and nausea and vomiting and required Imitrex as needed and Gabapentin daily. The MEB narrative summary exam approximately 7 months prior to separation documented that the migraine headaches were not EPTS. The examiner also documented that the CI had a long history of migraines with four visits to the emergency room ( ER ) for treatment in the prior 7 months . The CI was given a permanent P3 Profile for migraine headaches . The c ommander’s s tatement specifically indicated that the CI was physically incapable of performing his MOS due to the migraine headache condition. A headache diary kept for 4 months from 29 July 2003 until 1 December 2003 documents chronic daily headaches that responded to CI’s treatment regime except for once on 31 October 2003 when he went to the ER for treatment. T he VA Compensation and Pension n eurology exam approximately 3 months after separation noted that the CI had non-radiating dull ache headaches in the frontal aspect of the head every other day that lasted from 4 to 24 hours accompanied by nausea and vomiting. He was able to work with these headaches however his intense headaches occurred at least three times over the prior 12 months with the pain increased to 8 or 9 and lasting anywhere from 6 to 24 hours. With these intense headaches, the CI would require emergency care, an Imitrex injection and bed rest. The examiner diagnosed migraine headaches (without aura) with moderate impairment secondary to pain and frequency.

The Board directs attenti on to its rating recommendation based on the above evidence . The PEB and the VA chose the same disability code 8100 ( m igraine) however the PE B rated 0% and the VA rated 30%. On the DA Form 199, the PEB documented “this disability existed prior to service and was not permanently aggravated by service, but is compensable in accordance with 10 USC 1207a. ” All documentation agrees that the CI’s headache condition EPTS therefore; t he Board’s main charge regarding this condition is whether it was permanently aggravated by service and the appropriate rating level for disability compensation as the PEB adjudicated the h eadache condition as “unfitting.” Board members agreed that the CI’s length of service (7 years active and 11 years reserve) presumes service aggravation and therefore proceeded with a rating recommendation for the headache condition. As the CI had a history of sporadic migraines prior to the s ervice entry and met the standards for acceptance into the s ervice , the prior to service is a 0% and therefore no deduction from the disability rating percentage at separation is required. The VASRD § 4.124a rating schedule for 8100 ( m igraine) is excerpted below for convenience:

With very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability 50
With characteristic prostrating attacks occurring on an average once a month over last several months 30
With characteristic prostrating attacks averaging one in 2 months over last several months 10
With less frequent attacks 0

The DoDI 1332.39 (E2.A1.4.1.4) which defined prostrating as “the Service member must stop what he or she is doing and seek medical attention” was in effect during the MEB period, but is not applicable to the Board’s recommendations. VA guidance uses the clear English definition of prostrating and significantly differs from the DoDI definition in that seeking medical attention is not required. The Board evaluated the CI’s history for prostrating headaches relying primarily on the CI’s 4 - month headache diary completed a month prior to the PEB and 4 months prior to separation. That dairy documented almost daily headaches that responded to treatment and that did not prevent the CI from working. There was one headache over that 4- month period that did not respond to treatment, requir ed emergency care and therefore constituted sufficient severity to meet the prostrating threshold . The Board identified three headaches that met the prostrating threshold over the 12 months prior to separation. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a separation rating of 10% for the migraine headaches and mixed headaches 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 mi graine h eadache condition, the Board unanimously recommends a disability rating of 10% , coded 8100 IAW VASRD §4. 124a. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION : The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

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


The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20 121130 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans ’ Affairs Treatment Record





                           XXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SFMR-RB                   

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXX, AR20140007230 (PD201201873)

1. 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 to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation. This decision is final.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

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