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AF | PDBR | CY2013 | PD-2013-02742
Original file (PD-2013-02742.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2013-02742
BRANCH OF SERVICE: Air Force     BOARD DATE: 20150305
SEPARATION DATE: 20070522


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Vehicle Operator) medically separated for migraine headaches. The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty. He was issued a P4 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded the “migraines” condition to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other condition was submitted by the MEB. The Informal PEB adjudicated “migraine headaches” as “Existed prior to but exacerbated by military service” as unfitting and rated it 50% but subtracted 30% as for the pre-existing factor resulting in a final rating of 20% citing DoD and VA guidelines. The CI made no appeals and was medically separated.


CI CONTENTION: “Migraine headaches have improved with medication however the medication has impaired abilities to perform task. My condition is considered chronic migraine syndrome.”


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 Veterans Affairs Schedule for Rating Disabilities (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 20060407
 VA - based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Migraine Headaches. Existed prior to but Exacerbated by Military Service 8100 20% (50% - 30%) Migraine Headaches 8100 0%* STR
Other x 0 (Not is Scope)
 Other x 4
RATING: 20%
 RATING: 10%
Derived from VA Rating Decision (VA RD ) dated 200 70806 (most proximate to date of separation [ DOS ] )
*Initially rated 0% due to rescheduled exam; Rating increased to 30% effective 20070523 by VARD dated 20080416


ANALYSIS SUMMARY: IAW DoDI 6040.44 (E3, 4.d) the VASRD is used “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).” Members agreed that the Board’s recommendation regarding the existing prior to service (EPTS) nature and rating deduction of the migraine headache condition must therefore defer to DoDI 1332.39 which was in effect on the DOS and not in conflict with any content of the VASRD. That instruction includes the following passage that is pertinent to this case:

In cases involving service members with permanent service aggravation and a current degree of impairment less than total, the rating will reflect only the degree of disability over and above that existing at the time of entrance into active service. This requirement applies whether the particular condition was noted at the time of entrance into active service or is later determined, upon the evidence of record, to have existed at that time. It is necessary, therefore, to deduct from the present degree of disability the degree of disability, if ascertainable, that existed prior to entrance into active service. In assessing EPTS disability, the full EPTS clinical course of the impairing medical condition will be taken into consideration.

Migraine Headaches. The evidence supports that the CI had migraine headaches that began as a young teenager. He did not annotate these headaches on his entrance medical history and physical examination. When his headaches increased in frequency the medical director of a training course the CI was attending included the following statement in his assessment:

“He relates a history of similar headaches since the age of 13, 4 to 6 times a month, lasting 2 to 3 days; something he did not divulge on his enlistment or deployment questionnaire.”

The CI was sent back to his base and was evaluated and treated by two neurologists. Numerous treatment notes document that the headaches had been present since puberty. He was evaluated with magnetic resonance imaging and lumbar puncture that did not identify another cause of his headaches. He was treated with numerous anti-migraine regimes and several pain relievers useful in migraine headaches. A neurology treatment note 6 months prior to separation contained the following statement:

“He is currently taking Topamax 125 mg/day. His headache frequency has come down to an average of 2 headaches/week from 4-5 headaches/week on Topamax 125 mg/day. His headaches are also relieved by Fioricet.”

The narrative summary prepared approximately 3 months prior to separation contained the following passages:

“He began having headaches very infrequently as a 13-14 year old. He received a blow to his head/neck region with a hammer while on active duty 1½ years ago and his migraines increased in frequency, he was coping with OTC [over the counter] migraine meds. In March of 2006 he was sent to the Basic Combat Convoy Course when his headaches became much worse. He was sent home from the course and was subsequently sent to two neurologists for further evaluation and treatment. He continues to have frequent migraines (approximately 2-3 times per week) and side effects from migraine prescriptions that severely limit his ability to perform his primary military duties of vehicle operator.”

His neurological examination was normal. At the VA Compensation and Pension exam performed approximately 6 months after separation, contained the following excerpt:

“The veteran states that at the age of thirteen he began to have migraines. He did not understand it at that time. He had what he called very bad headaches, and he was light and sound sensitive. He had one about every two months. He took over the counter Tylenol. During the school year the veteran states that he could function through school on Tylenol. In the military he had increasing intensity and frequency of his headaches from about one every two months to 2-3 per month.”
His headaches were now once per week and required 4 hours of rest in a dark room. He had 4 months on his new job as a forklift operator and had five to six workdays lost secondary to a migraine headache. He did feel that his job was endangered, though nothing had been said to him at that time. The neurological examination was normal.

The Board directed attention to its rating recommendation based on the above evidence. The PEB adjudicated the migraine headache condition by applying VASRD code 8100 (Migraine) and rated it 20%. The PEB rated the migraine condition 50% disabling then deducted 30% for the degree of disability that EPTS to arrive at its 20% rating. The VA initially granted a 0% rating (CI had to reschedule his examination) which was later increased to 30% rating for the migraine condition, also coded 8100, citing, “…whenever there are characteristic prostrating attacks occurring on an average of once a month over the last several months.” The rating criteria for migraine headaches are copied here for the reader’s convenience:

8100 Migraine:
-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 evidence supports that the CI had migraine headaches prior to his entrance into the service and that the disability prior to entrance was most consistent with the 30% rating criteria as adjudicated by the PEB. The evidence supports that the CI’s migraine headache frequency increased upon entrance into the service and along with the data present for Board review, the CI’s migraine headache condition at the time of separation was most consistent with the 50% rating criteria as adjudicated by the PEB. As previously noted, DoDI 1332.39 was in effect at the time of separation and its treatment of EPTS conditions and the procedure for applying an EPTS deduction did not conflict with the VASRD. Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that the disability rating of 20% for the migraine headache condition was appropriately recommended in this case.


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. As discussed above, PEB reliance on DoDI 1332.39 for rating the migraine condition was operant in this case, and the Board’s recommendation will be independent of any DoDI 1332.39 content that conflicts with the VASRD. 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 20131219, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record








XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review


 SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXXXXXXXXXXXX :

         Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2013-02742 .

         After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation.

         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.

 Sincerely,





XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR

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