RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 
 

    BRANCH OF SERVICE:  ARMY 
  SEPARATION DATE:  20041223 

 
NAME:  XXXXXXXXXXXXXX 
CASE NUMBER:  PD1201136 
BOARD DATE:  20130130 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SPC/E-4  (63A10/Abrams  Tank  System  Maintainer) 
medically separated for chronic daily headaches.  In July 2000, the CI was diagnosed with a mild 
concussion after suffering a closed head injury.  Despite symptomatic treatment, he developed 
chronic  daily  headaches  that  could  not  be  adequately  treated  to  meet  the  physical 
requirements of his Military Occupational Specialty.  He was issued a permanent P3U2 profile 
and  referred  for  a  Medical  Evaluation  Board  (MEB).    The  MEB  identified  post-traumatic 
headaches  and  syncope  conditions  as  “unacceptable”  and  forwarded  them  to  the  Physical 
Evaluation  Board  (PEB).    The  PEB  adjudicated  the  chronic  daily  headaches  and  occasional 
syncopal  episodes  as  unfitting  and  rated  10%  with  likely  application  of  the  Veteran’s  Affairs 
Schedule  for  Rating  Disabilities  (VASRD).    The  CI  made  no  appeals  and  he  was  medically 
separated with a 10% disability rating. 
 
 
CI CONTENTION:  “I was given a disability of 10%.  I am not satisfied with the percentage that I 
was given.  At the time my unit was being deployed and it was suggested that I take the 10% 
because it was going to take longer for them to process me out if not.” 
 
 
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 ratings 
for unfitting conditions will be reviewed in all cases.  The unfitting chronic daily headaches and 
brief  syncopal  episode  conditions  meet  the  criteria  prescribed  in  DoDI  6040.44  for  Board 
purview  and  are  addressed  below.    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 service Board for Correction of Military Records. 
 
 
RATING COMPARISON: 
 

VA (Service Treatment Records (STR)) – All Effective Date 20041224 

*Service Treatment Records(STRs) used for 8045-9304 as CI failed to report for three separate neurologic disorders 
C&P examination appointments.  **Included in the total zero percent ratings. 
 
 

Service IPEB – Dated 20041208 
Condition 

Code 

Chronic Headaches 
and Syncopal Episodes 

8045-9304 

↓No Additional MEB/PEB Entries↓ 

Combined:  10% 

Rating 
10% 

Condition 

Post Traumatic Headaches 
and Syncope 

Rating 
0%** 

Code 

8045-9304 
0% x2** 

Combined:  0% 

Exam 
STR* 

ANALYSIS SUMMARY:  The Board acknowledges the CI’s assertions that “At the time my unit 
was  being  deployed  and  it  was  suggested  that  I  take  the  10%  because  it  was  going  to  take 
longer for them to process me out if not.”  It is noted for the record that the Board has neither 
the  jurisdiction  nor  the  authority  to  scrutinize  or  render  opinions  in  reference  to  asserted 
service improprieties in the disposition of a case.  The Board’s role is confined to the review of 
medical records and all evidence at hand to assess the fairness of PEB rating determinations, 
compared to VASRD standards, based on severity at the time of separation.  It must also judge 
the fairness of PEB fitness adjudications based on the fitness consequences of conditions, as 
they existed at the time of separation. 
 
Chronic  Daily  Headaches  Condition.    At  the  MEB  exam  accomplished  3  months  prior  to 
separation, the  CI  reported that  he  still  suffered  from  blackouts  and  severe  headaches  since 
2002.  He also noted that in 2000, he “slammed head into Humvee bumper while fixing brakes” 
and  “mild  concussion  due  to  head  trauma.”    The  MEB  physical  exam  noted,  “Romberg’s 
Negative and balance tests within normal limits but has blackouts per service member.” 
 
The narrative summary (NARSUM) prepared 2 months prior to separation noted that the CI was 
in his usual state of good health until July 2000 when he struck his head against a metal bumper 
and experienced a period of unconsciousness for about a minute or two.  Upon awakening, he 
complained of a severe headache for which he was seen in the emergency room.  A CT scan was 
performed at that time, and revealed no significant findings.  He was diagnosed as having a mild 
concussion and was treated symptomatically.  Since that event however, he continued to have 
severe headaches almost daily.  The headaches were made worse by any kind of light or noise.  
This  combination  of  headache  plus  light  or  noise  was  often  followed  by  a  period  of  loss  of 
consciousness.  These episodes were witnessed and the CI had no tonic-clonic movements, he 
appeared  as  if  "asleep."    These  episodes  of  unconsciousness  come  on  abruptly  and  without 
warning.  They occurred while driving a car.  In July 2004, he was seen by a civilian neurologist 
who  felt  that  the  CI’s  headaches  were  post-traumatic.    An  electroencephalogram  (EEG)  was 
performed  and  was  interpreted  as  normal.    Magnetic  resonance  imaging  (MRI)  exam, 
performed in July 2004, revealed a Chiari 1 malformation, a common type of brain abnormality 
that is often asymptomatic.  Because of this finding, the neurologist recommended consultation 
at a major university epilepsy clinic.  The CI was seen at this clinic and it was recommended that 
he  have  a  video  EEG  performed  but  this  was  never  accomplished.    Significant  past  medical 
history was that the CI had a left testicular cancer removed in January 2003 with a diagnosis of 
teratocarcinoma  of  the  testes.    He  had  chemotherapy  following  the  surgery  and  had  no 
evidence of recurrence and his tumor markers had remained normal.  The NARSUM noted that 
several officers in his chain of command documented that the CI was incapable of performing 
his  required  duties  because  of  his  condition,  presumably  the  headache  condition.  
Nevertheless,  the  service  treatment  record  (STR)  did  not  provide  evidence  of  other  officers 
witnessing the CI being incapable of performing his required duties because on his condition.  
The  commander’s  statement  did  not  mentioned  the  CI’s  headaches  or  the  CI  having  any 
frequencies of unconsciousness nor was the CI profiled for unconsciousness.  The diagnosis was 
post-traumatic headaches and syncope.  The recommendation was that, due to the CI’s severe 
unrelenting  and  almost  daily  headaches,  some  of  which  were  associated  with  unpredictable 
episodes  of  syncope,  these  events  clearly  interfered  with  performance  of  his  military 
responsibilities and he did not meet retention criteria for the headaches and syncope. 
 
In  addition  to  the  above  data,  the  STR  documents  a  “convulsive”  syncopal  episode  after 
micturition while the CI was hospitalized for chemotherapy treatment in February 2003.  During 
that  hospitalization,  he  was  started  on  an  anti-seizure  medication  that  was  promptly 
discontinued after evaluation by a neurologist resulted in that episode being called convulsive 

syncope.    A  brain  MRI  and  a  cardiac  echocardiogram  were  performed  during  that  hospital 
admission and were normal.  Also documented was the frequency of the CI’s syncopal episodes 
as  3-4  times  per  week,  usually  after  standing  up.    The  headaches  began  after  the  CI’s 
concussion and were accompanied by blurry vision and pain over the right side of his head.  He 
described the pain as close to the vertex of the skull on the right posterior part of the head.  
The pain would be very sharp at times and somewhat disabling for him.  He had no nausea but 
did have  a history  of photophobia  and phonophobia.    He  had to  go to a  dark  room to relax 
during the time of the headache.  The pain could last for about 3 to 4 hours.  He also appeared 
to have muscle tension headaches on a daily basis.  A neurological disorder VA Compensation 
and Pension (C&P) exam for the chronic headache condition was not performed.  The CI failed 
to show up for three different appointments to accomplish that examination.  Lastly, NARSUM 
noted that “the last blackout was four to five weeks ago” and on the most recent Report of 
Medical  Assessment,  the  CI  didn’t  report  any  medical  concerns  or  problem  associated  with 
having headaches. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB  applied  the  VASRD  code  of  8045-9304  for  the  chronic  daily  headaches  with  occasional 
syncopal episodes condition and rated it 10%.  This coding and rating scheme was compliant 
with  VASRD  §4.124a  Schedule  of  ratings—neurological  conditions  and  convulsive  disorders 
guidance when applying VASRD code 8045, (Brain disease due to trauma).  This guidance states 
the  following,  “Purely  subjective  complaints  such  as  headache,  dizziness,  insomnia,  etc., 
recognized  as  symptomatic  of  brain  trauma,  will  be  rated  10  percent  and  no  more  under 
diagnostic code 9304.  This 10 percent rating will not be combined with any other rating for a 
disability due to brain trauma.  Ratings in excess of 10 percent for brain disease due to trauma 
under  diagnostic  code  9304  are  not  assignable  in  the  absence  of  a  diagnosis  of  multi-infarct 
dementia  associated  with  brain  trauma.”    The  VA  also  applied  the  same  coding  scheme  but 
assigned a non-compensable evaluation based symptoms that were not severe enough either 
to interfere with occupational and social functioning or to require continuous medication.  The 
VA received no data or other medical records showing treatment for this condition since the 
CI’s  discharge  from  service.    The  CI  failed  to  show  for  three  neurologic  disorder  C&P 
examination appointments and there is no C&P examination from which additional rating data 
can  be  gathered.    Therefore,  the  NARSUM  and  the  STRs  contain  the  only  probative 
documentation useful for rating purposes at the time of separation.  The Board discussed and 
considered an alternative coding and rating option utilizing VASRD code 8100, migraine, for the 
CI’s  recurrent  headache  condition.    This  code  relies  on  the  frequency  and  severity  of  the 
headaches  to  arrive  at  the  proper  disability  evaluation.    During  deliberations,  the  Board 
searched the combined primary file and all STRs for corroborating evidence to reasonably apply 
and rate the headaches using VASRD code 8100.  This search yielded no objective evidence of 
medication use or provider visits for management of the headache condition on a routine or 
urgent basis.  The Board also noted contradictions between historical information presented by 
the CI and the information documented in the STRs.  These significant inconsistencies, along 
with the lack of additional VA evidence, gave the Board no room to recommend a change in the 
PEB’s  adjudication.    At  the  time  of  separation,  the  CI  had  purely  subjective  complaints  of 
headaches after a closed head injury with occasional syncopal episodes of unknown cause and 
no evidence for multi-infarct dementia.  This constellation of complaints and evidence requires 
a  10%  evaluation  IAW  VASRD  §4.124a  as  applied  by  the  PEB.    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 for 
the chronic daily headaches and occasional syncopal episodes 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 chronic daily headaches and occasional syncopal episodes 
condition and IAW VASRD §4.124a, the Board, on a vote of 2:1, recommends no change in the 
PEB adjudication.  The single voter of dissent, who voted for VASRD code 8100 rated at 30%, 
elected not to submit a minority opinion.  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 

Chronic Daily Headaches and Occasional Syncopal Episodes 
Condition 

VASRD CODE  RATING 
8045-9304 
COMBINED 

10% 
10% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120712, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           xxxxxxxxxxxxxxxxxxxxxx, DAF 
           Acting Director 
           Physical Disability Board of Review 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXX, AR20130002996 (PD201201136) 
 
 
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 
 
 
 

     XXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)