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AF | PDBR | CY2013 | PD-2013-02138
Original file (PD-2013-02138.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02138
BRANCH OF SERVICE: Army  BOARD DATE: 20150310
SEPARATION DATE: 20050314


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Motor Transport Operator) medically separated for migraine headaches. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The “migraine headache” condition was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other condition was submitted by the MEB. The Informal PEB adjudicated “migraine headaches…” as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “migraines have begun to be more frequent and cause work days to be missed (2-4 a week).”


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’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/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


 RATING COMPARISON :

IPEB – Dated 20041203
 VA* - (~2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Migraine Headaches… 8100 0% Migraine Headaches 8100 10% 20050131
Other x 0
Other x 2
RATING: 0%
 RATING: 40%
* Derived from VA Rating Decision (VA RD ) dated 200 50520 (most proximate to date of separation [ DOS ] ) .


ANALYSIS SUMMARY:

Migraine Headaches. Treatment records evidence that the CI reported daily left temple headaches after a left frontal craniotomy with evacuation of an epidural abscess in August 2002. The headaches were characterized as throbbing and rated 5-6/10. The CI also reported symptoms of nausea, vomiting, and light sensitivity with the headache. He was diagnosed with migraine headaches and treated with multiple headache prevention and abortive medications without relief. The CI also had a history of chronic sinusitis. An X-ray sinus series dated 10 November 2002 demonstrated bilateral cheek bone (maxillary) sinusitis. A primary care note dated 1 September 2004 documented reports of daily headaches with severe pain in the temporal region, light sensitivity, and nausea. The headache was worse in the heat, exercise, and wearing gear. The pain decreased with stopping the activity. The examiner noted that the headaches could be attributed to post surgical headache, chronic migraines, or chronic sinusitis. A neurology consultation on 4 October 2004 noted daily headaches made worse with physical training and wearing Kevlar. The physical examination was normal. The examiner rendered diagnoses of migraine and chronic daily headache. The examiner opined that the chronic daily headaches were possibly secondary to analgesic overuse. The narrative summary noted that the CI had chronic severe headaches not alleviated by medications. The headache was worse with exertion and precipitated by wearing Kevlar. The physical examination was normal. The examiner diagnosed migraine headache, frequent and severe, but not meeting criteria for “prostrating.” The CI was evaluated at the emergency department on 22 November 2004, 16 January 2005, and 17 January 2005 for migraine headaches. He was treated and given quarters (sent home) after each visit.

At the VA Compensation and Pension examination performed 2 months prior to separation, the CI reported daily headaches with nausea and vomiting. He rated the pain 5-6/10; flare-ups were rated above 10. He also reported headaches with sinus flare ups. The physical examination was significant for a tender, slightly elevated surgical scar, tenderness to palpation bilateral maxillary and left temple areas, and right turbinate hypertrophy. Diagnoses of post-operative scar; left frontal sinus, ethmoid sinus, and bilateral maxillary sinus disease; and migraine headache were rendered.

The Board directed attention to its rating recommendation based on the above evidence. The PEB adjudicated the migraine headache condition as unfitting and rated at 0% for non-prostrating. The VA rated the migraine headache condition at 10% for averaging one in 2 months for the past several months. The Board considered whether the evidence supported a higher than 0% rating for the migraine headache condition. The Board noted that the headaches were reported as occurring daily since the surgery and not responsive to multiple medications. The headaches decreased with cessation of physical training and wearing Kevlar, but did not resolve. The CI was evaluated, treated, and prescribed quarters for headaches twice in 12 months preceding separation (November 2005, and January 2005 X 2). The Board determined that criteria for "prostrating” were met; however, the frequency of the prostrating attacks was less than one every 2 months for the several months prior to separation; the criterion for a 0 % rating IAW VASRD §4.124a, code 8100 (Migraine). The Board also considered the history of sinusitis and sinus headaches; however there was no evidence of one to two incapacitating episodes of sinusitis requiring prolonged antibiotic treatment or three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting for a 10% rating under VASRD cods 6511 (sinusitis, ethmoid, chronic); 6512 (sinusitis, frontal, chronic), 6513 (sinusitis, maxillary, chronic). 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 migraine 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 §4.124a, 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131022, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record






XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review
SAMR-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 XXXXXXXXXXXXXXX, AR20150011171 (PD201302138)


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                       XXXXXXXXXXXXXXX
                                    Deputy Assistant Secretary of the Army
                                    (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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