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AF | PDBR | CY2013 | PD-2013-02829
Original file (PD-2013-02829.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02829
BRANCH OF SERVICE: NAVY  BOARD DATE: 20140813
SEPARATION DATE: 20070417


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Damage Control Fireman) medically separated for migraines. The migraines could not be adequately rehabilitated to meet the physical requirements of her rating or satisfy physical fitness standards. She was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB). The migraines, characterized as “migraine, unspecified, w/o intractable migraine” and “dizziness and giddiness,” were the only conditions forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. The Informal PEB adjudicated “migraine headaches” as unfitting, rated 10%, with application of the VA Schedule for Rating Disabilities (VASRD). The PEB also adjudicated migraine-associated dizziness as Category II, a condition contributing to the unfit migraine headaches. The CI made no appeals and was medically separated.


CI CONTENTION: The CI writes: “It is a constant hindrance everyday. It is hard to concentrate and function with so many migraines. I feel like I miss out on everyday life. Everyday is a struggle and many times the medications do not work. I have struggled with finding medications that provide relief over the years. It is also difficult because I am trying to grow my family and pregnancies can be challenging without medications. They have even affected the amount or children I would like to have.”


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 condition, along with the migraine-associated dizziness, 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 Naval Records.

The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected condition continues to burden her; 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 the Department of Veterans Affairs (DVA), operating under a different set of laws. The Board considers DVA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.



RATING COMPARISON :

Service IPEB – Dated 20070109
 VA - (3 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Migraine Headaches 8100 10% Migraine Headaches 8100 10% 20070112
Migraine Associated Dizziness Category II Benign Positional Vertigo 6299-6204 0% 20070112
Other x 0 (Not in Scope)
 Other x 2 20070112
Combined: 10%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 70726 ( most proximate to date of separation ).


ANALYSIS SUMMARY:

Migraine Headaches. Notes in the service treatment record indicate the CI reported a history of seasickness since childhood with migraines and vertigo, as well as motion sickness in cars and planes. She was evaluated for vertigo without associated hearing loss or ringing in her ears while shipboard by an ear nose and throat physician, and all specialized testing was negative. Intermittent visits noted changed hearing due to a full feeling in the ear, but no hearing loss was noted on examination. She was treated for dizziness associated with both migraines and motion sickness without significant improvement. The CI reported that the headaches decreased with treatment, but motion sickness continued when on a ship. The CI was placed on LIMDU in August 2006, approximately 8 months prior to separation to see if continued treatment of the migraine headaches reduced the motion symptoms. The narrative summary (NARSUM) notes the CI history of migraine headaches and migraine associated dizziness which continued despite treatment.

At the MEB examination (approximately 5 months prior to separation), the CI reported severe migraines associated with vertigo and hearing changes that occurred unpredictably once a week to several times per day. She reported being incapacitated for several hours after a headache. There was no examination noted at the MEB NARSUM evaluation. The DD Form 2808, Report of Medical Examination, noted no abnormalities on examination. The non-medical assessment noted that the CI lost 10 hours per week due to her condition, including time at medical appointments.

At the VA Compensation and Pension (C&P) examination (performed 3 months prior to separation), the CI reported that her migraine headaches started when she went on a ship and continued since then, but with decreased frequency on continuous preventive medication. She reported the migraines were triggered by bright light, with sensitivity to light and noise. She reported that she would take medication or lie down with the headaches, but that she continued to work despite her symptoms and would not go home. The CI also reported the dizziness lasted only as long as the headache; or car, plane or ship motion. The physical examination was normal.

The Board directs attention to its rating recommendation based on the above evidence. The PEB rated migraine headaches 10%, coded as 8100 (migraine) and migraine associated dizziness was adjudicated as a contributing to the unfitting condition, but not a separately unfitting condition in and of itself. The VA also rated migraine headaches at 10%, coded 8100 and benign positional vertigo 0%, coded 6299-6204 (analogous to peripheral vestibular disorders). The evidence in the record supports that the CI experienced severe motion sickness when on a ship and migraine headaches, both associated with dizziness. The Board noted that IAW DoDI 1332.38, Enclosure 5, airsickness, motion and/or travel sickness are conditions not constituting a physical disability and therefore are not eligible for disability rating. The Board first considered if the “migraine associated dizziness” was a separately unfitting condition at the time of separation, but the Board noted that the records indicated that the dizziness did not exist alone, but only in combination with either a migraine headache or motion sickness. There were no objective abnormalities noted on testing for the “dizziness” itself. Therefore, the Board agreed with the PEB’s adjudication that the dizziness was not a separately unfitting condition and therefore no additional disability rating could be recommended.

The Board next considered the rating of the migraine headache condition at separation. The migraine headaches were frequent and described as incapacitating by the CI at the MEB NARSUM examination, but the pre-separation C&P evaluation noted that the CI remained at work and continued working despite her migraines. The evidence in record supports that the CI’s migraine condition was aggravated by ship duty and was improving with treatment. Board consensus was that proximate to separation the migraine condition did not meet the code 8100 30% criteria specified as “characteristic prostrating attacks” on average once a month. The Board opined that there was not sufficient description provided at the C&P examination of the frequency of prostrating migraines to ascertain if the CI had a “characteristic prostrating attack averaging once or twice per month, over the last several months” (the 10% rating criteria) or prostrating headaches “with less frequent attacks” (the 0% criteria). However, the Board agreed that the higher evaluation of 30% was not achieved and IAW DoDI 6040.44 the Board may not recommend a lower combined rating than that conferred by PEB. Therefore, 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 headaches condition and IAW VASRD §4.124a the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended migraine associated dizziness condition, the Board unanimously recommends no change from the PEB determinations as not unfitting. 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 20131222, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




                                   
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review







MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 11 Mar 15

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN
- XXXXXXXXXXXXXXX, former USMC
- XXXXXXXXXXXXXXX, former USN


                                                      XXXXXXXXXXXXXXX
                                            Assistant General Counsel
                                                      (Manpower & Reserve Affairs)

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