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AF | PDBR | CY2013 | PD-2013-02535
Original file (PD-2013-02535.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02535
BRANCH OF SERVICE: MARINE CORPS          BOARD DATE: 20140710
SEPARATION DATE: 20040430


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E6 (0369/Infantry Platoon Sergeant) medically separated for vascular headache (migraine). The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was placed on limited duty and referred for a Medical Evaluation Board (MEB). The vascular headache, migraine condition, was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated “vascular headache (migraine)” as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated.


CI CONTENTION: “I was a Platoon Commander at the School of lnfantry (East) and I believe that my medical folder just "fell" under the students (Pvt's) that would want out for a twisted ankle. I have a legit medical condition that is way more than the % that was given to me. I served almost 9 years, why would I wimp out then as a SNCO? My medical condition even caused me to suffer a stroke from the severe migraine headaches that I still have to this day. I worked from 1998 until 2004 dealing with these migraines. I still went out to the field, deployed overseas and what not. The medicines that the Navy Neurologists gave me to take are a big reason that I suffered a stroke. I have done research on these meds and all of them say that a stroke can occur. I was unaware of that at the time I was given these medicines. I think my case should be reconsidered and given a lot higher rating by the Marine Corps, if not a medical retirement. Marines are getting hurt in combat zones and getting to stay in, I was told that I had no choice in the matter and that I was being put out.”


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 vascular headache (migraine) condition is addressed below. Any condition 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 Naval Records.

RATING COMPARISON :

Service IPEB – Dated 20040302
 VA* - (1.5 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Vascular Headache (Migraine) 8100 10% Migraine Headache Disorder 8100 30% 20040319
Other x 0 (Not in Scope)
 Other x 5 20040319
Combined: 10%
 Combined: 50%
* Derived from VA Rating Decision (VA RD ) dated 200 40607 (most proximate to date of separation )


ANALYSIS SUMMARY: The Board acknowledges the CI’s information regarding the significant impairment with which his service connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by congress to VA, operating under a different set of laws.

Vascular Headache (Migraine) Condition: Although the CI had a history of headaches stemming from childhood, they progressively worsened after entering the service. An extensive evaluation by a neurologist did not reveal abnormalities suggestive of an etiology other than migraine. The LIMDU Board Report on 3 March 2003 (14 months prior to separation) stated: “Haven’t noticed any problems with his condition affecting performance of administrative duties.” A neurology evaluation on 17 November 2003 (5 months prior to separation) reported that the CI had experienced headaches intermittently since childhood, but that over the previous 3-4 years they had worsened. Headaches were experienced almost every day, and were usually accompanied by nausea and often by vomiting. Despite numerous over the counter medication and prescription regimens, the only relief he generally obtained was a hot shower followed by trying to sleep in a cold, dark room. The narrative summary on 18 December 2003 (4 months prior to separation) noted that marginal success in controlling the CI’s headaches had been achieved with abortive and prophylactic medications. The examiner reported that in January 2003 the CI was evacuated off a ship during a deployment due to his headache severity. He continued to experience daily headaches that had a significant impact on his assigned duties. The daily headaches were 5/10 in severity (0-10 scale), but severity could reach 9-10/10. Headaches could sometimes last for days. The non-medical assessment on 12 January 2004 indicated that the CI missed 12 hours of work per week for treatment, evaluation and/or recuperation; and that “at times, his headaches cause him to leave work early.” At the VA Compensation and Pension exam performed 6 weeks before separation, the CI reported that headaches “oftentimes interfere with his ability to be functional; oftentimes he has to go home and rest to help relieve his symptoms.” He usually experienced a headache every day, often at a 5/10 severity; but the severity could be 9-10/10. An over the counter headache medication decreased the pain “to some degree.” The examiner’s diagnosis was “severe, disabling migraine headaches.”

The Board directs attention to its rating recommendation based on the above evidence. The rating options under 8100 for migraine headaches rely on the frequency of “prostrating’ attacks.” The DoDI 1332.39 (in effect at separation, but since rescinded) required that “the Service member must stop what he or she is doing and seek medical attention.” When rating headaches under the 8100 code, VA guidance uses the clear English definition of prostrating. The standard dictionary definition of “prostration” is “utter physical exhaustion or helplessness,” and does not indicate that seeking medical attention is required. Board members agreed that the highest 50% rating was not supported (completely prostrating and prolonged attacks productive of severe economic inadaptability), and debate therefore settled on a 10% vs. 30% rating. A 10% rating is warranted for “characteristic prostrating attacks averaging once in 2 months over last several months” while a 30% rating requires “characteristic prostrating attacks occurring on an average once a month over the last several months.” The Board carefully considered the frequency and nature of the CI’s headaches including objective evidence and corroborating subjective evidence. Member consensus was that the ratable threshold was met for the 30% criteria excerpted above. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the vascular 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 vascular headache condition, the Board, by a majority vote, recommends a disability rating of 30%, 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; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation.

UNFITTING CONDITION VASRD CODE RATING
Vascular Headache (Migraine) 8100 30%
COMBINED 30%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131127, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




                 
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review


 MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
                  DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
        
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) PDBR ltr dtd 6 Mar 15 ICO XXXXXXXXXXXXXXXXX
         (c) PDBR ltr dtd 13 Mar 15 ICO XXXXXXXXXXXXXXXXX
         (d) PDBR ltr dtd 17 Feb 15 ICO XXXXXXXXXXXXXXXXX
         (e) PDBR ltr dtd 24 Feb ICO XXXXXXXXXXXXXXXXX

1. Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (f).

2. The official records of the following individuals are to be corrected to reflect the stated disposition:

a. XXXXXXXXXXXXXXX, former USMC : Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.

b. XXXXXXXXXXXXXXX, former USN : Entitlement to disability severance pay with a 20 percent (increased from 10 percent) disability rating effective date of discharge.

c. XXXXXXXXXXXXXXX, former USMC : Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.

d. XXXXXXXXXXXXXXX, former USMC : Placement on the Permanent Disability Retired List with a 30 percent disability rating effective date of discharge.

3. Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are completed.



          XXXXXXXXXXXXXXX
         Assistant General Counsel
         (Manpower & Reserve Affairs)

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