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AF | PDBR | CY2014 | PD 2014 00682
Original file (PD 2014 00682.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2014-00682
BRANCH OF SERVICE: MARINE CORPS          BOARD DATE: 20140912
SEPARATION DATE: 20070930


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty CPL/E-4 (0847/Field Artillery Operations) who was medically separated for migraine headaches. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was referred for a Medical Evaluation Board (MEB). The migraine headaches and mood disorder secondary to migraines (depression/anxiety) conditions, characterized as “migraine, unspecified, without intractable migraine and “mood disorder (depression/anxiety)”, were forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The Informal PEB adjudicated “migraine headache” as unfitting rated at 0% with likely application of Department of Defense Instruction (DoDI) 1332.39 and the Veterans Affairs Schedule for Rating Disabilities (VASRD). The mood disorder (depression/anxiety) condition was determined to be Category II condition. The CI made no appeals and was medically separated.


CI CONTENTION: “Medically separated for original diagnosis of ‘chronic headaches, mood disorder and anxiety’ conditions later re-diagnosed as a traumatic brain injury sustained in service, and post traumatic stress disorder.” [sic]


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 ratings for the unfitting migraine headaches and the Category II depression/anxiety conditions are addressed below; 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.

RATING COMPARISON :

Service IPEB – Dated 20070810
 VA - (4 Mos Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Migraine Headache 8100 0% Migraine Headaches 8100 30% 20071212
Mood Disorder Secondary to Migraines (Depression and Anxiety) Cat II Adjust ment Disorder With Depressed Mood… 9440 10% 20071212
Other x 0 (Not in Scope)
 Other x 9 (Not in Scope) 20071212
Combined: 0%
 Combined: 50%
D erived from VA Rating Decision (VARD) dated 20080124 ( most proximate to date of separation )

ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit and vital fighting force. While the DES considers all of the member's medical conditions, compensation can only be offered for those medical conditions that cut short a member’s career and then only to the degree of severity present at the time of final disposition. The DES has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation nor for conditions determined to be service connected by the VA but not determined to be unfitting by the PEB. However, the Department of Veteran Affairs (DVA), operating under a different set of laws (Title 38, United States Code), is empowered to compensate all service connected conditions and to periodically re-evaluate said conditions for the purpose of adjusting the Veteran’s disability rating should his degree of impairment vary over time. 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.

Migraine headaches Condition. The first documentation for the migraine headache condition was a neurology evaluation dated 4 May 2006 that documents a history of headaches that began at the age of seven and resolved at puberty; this was not disclosed at accession. The CI reported that the headaches returned in 2005, has a headache 50-60% of the time and he was currently taking prophylactic headaches medications also has failed trials of other prophylactic headaches medications.

During primary care appointment dated 16 August 2006, the CI reported having 12 headaches per month for the past 18 months. The CI was seen in both the primary care and neurology clinics for follow up care, medication management and for acute care for his migraine headaches. Review of the CI’s STRs from May 2006 through July 2007 the CI sought acute care 8 times and placed on 24 hours quarters 3 times, during his last year of active duty. The Board also noted that from January to June 2007, the CI was seen 9 times for conditions not related to either the migraine headaches or mental health conditions and was placed on 24 hours quarters twice. The CI was placed on LIMDU status dated 6 June 2007 for a treatment trial of a medication and restricted from field training and duty; physical training was to be at his own pace. Despite aggressive medical management, the migraine headache condition could not be controlled and therefore the CI was referred to MEB.

The narrative summary (NARSUM) dated 6 June 2007; the examiner noted that the CI onset of headaches at age seven and that resolved with puberty. His treatment included prophylactic medications and sleeping in a dark, quiet, cool room with minimal benefit with c medications. His neurological examination was normal and a diagnostic MRI of his brain taken October 2006 was “reportedly normal”. He was determined to have headaches with migraine features which were recalcitrant to treatment and at risk of a migraine in an arduous environment which rendered him unable to function.

The commander statement dated 12 June 2007 stated that the CI missed from 8 to 16 hours a week from duty due to his condition and medical appointments. The Board observed that the CI had missed work 11 times for the headache and mental health conditions the prior 4 months, but also had missed work for other conditions 9 times including 24 hours quarters twice for each time.

The original VA Compensation and Pension (C&P) examinations performed on 
12 and 19 December 2007, were not are in evidence. The VA rating decision dated 
24 January 2008, documented that the “examiner concluded these are prostrating attacks occurring at least twice weekly with characteristics consistent with migraine headaches”.

The Board directed attention to its rating recommendation based on the above evidence. The PEB adjudicated the migraine condition at 0% and coded it 8100, migraine headaches. While the PEB form does not indicate that a deduction was made for a existed prior to service (EPTS) condition, the joint disability evaluation tracking system form clearly noted the fact that the headache condition EPTS, beginning at age seven. The VA also coded the headache condition as 8100, but rated at 30% citing prostrating attacks twice a week and making no comment on the EPTS aspect. The Board considered the evidence as well as the natural history of migraine headaches. By the history of the given by the CI to multiple examiners, he suffered from migraine headaches from age seven until puberty. Although asymptomatic at the time of accession, recurrence of headaches in early adulthood is not uncommon and can be seen over 50% of the time. The Board opined that while it is not clear if EPTS deduction was made, it would be supportable if there were evidence of the level of disability at accession. The Board noted that the CI, by all reports, was asymptomatic at accession. Therefore, no basis for an EPTS deduction could be determined.

The Board then considered the migraine condition. The rating for a migraine condition is based on the frequency of “prostrating headaches”. Although the VA rated the CI at 30% for prostrating headaches twice a week, the records in evidence do not support this. The record shows that the CI had a total of 8 visits for an acute headache over the prior 14 months, slightly over 1 every 2 months, but less than once a month. The documented frequency of headaches requiring medical attention is much closer to the description for a 10% rating than 30%. The Board also observed that the comment in the commander statement that the CI was absent from 8 to 16 hour per week is consistent with the record with all medical appointments and instances of quarters taken into account. The records show that the CI had three recorded incapacitating headaches during the last 5 months of active duty (28 April 2007 until 
30 September 2007). The Board discussed if this was closer to the criteria for a 10% rating, one prostrating headache every 2 months, or a 30% rating, once every month and the Board majority determined that the 30% rating was supported. 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 headache condition.

Contended Mood Disorder Secondary to Migraines Condition. The Board’s main charge is to assess the fairness of the PEB’s determination that contended mental health condition was not unfitting. The PEB determined that it contributed to the unfitting condition (Category II), but did not assign it a separate VA diagnostic code or rate it. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. The mental health condition was not implicated in the commander’s statement. However, it was determined by the mental health examiner to warrant evaluation by the PEB and it was judged to fail retention standards by the MEB. However, a 30 April 2007 evaluation by the same psychiatrist determined that the CI was fit for duty from a mental health aspect. A month later, the CI reported an increase in symptoms over the past 2 weeks and indicated that there was increased stress from a new “gunny”.

During a Behavior Health appointment dated 7 August 2007, the CI reported a decrease in symptoms with treatment (which included medications). The final mental health evaluation on 15 August 2007, noted that CI’s symptoms were not improved and reported that the CI had a nervous breakdown the previous day. He was noted to have “severe work-related stressors” and convalescent leave was recommended until the Board’s process was complete. The VA rater, quoting the VA Mental health examiner, noted that the latter had determined that an adjustment disorder had been present for over a year, but that there was “no impairment in thought processing or communication, or employment capability”. There was no performance based evidence from the record indicated that stress from his workplace created the anxiety which interfered with satisfactory duty performance. After separation, the VA examiner noted not impairment in employment capability. All were reviewed by the action officer and considered by the Board. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended mental health conditions and so no additional disability rating is recommended.


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, the Board majority recommends a disability rating of 30%, coded 8100 IAW VASRD §4.124a. In the matter of the contended mood disorder secondary to migraines conditions the Board unanimously recommends no change from the PEB determination as Category II. 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
Migraine Headache 8100 30%
COMBINED 30%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131220, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                 
XXXXXXXXXXXXXX
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 29 Mar 15 ICO XXXXXXXXXXXXXX
         (c) PDBR ltr dtd 25 Mar 15 ICO XXXXXXXXXXXXXX
         (d) PDBR ltr dtd 23 Mar 15 ICO XXXXXXXXXXXXXX
         (e) PDBR ltr dtd 29 Mar 15 ICO XXXXXXXXXXXXXX
         (f) PDBR ltr dtd 29 Mar 15 ICO XXXXXXXXXXXXXX

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

b. XXXXXXXXXXXXXX, former USN : Placement on the Permanent Disability Retired List with a disability rating of 30% effective date of discharge.

c. XXXXXXXXXXXXXX, former USN : Placement on the Permanent Disability Retired List with a disability rating of 30% effective date of discharge.

d. XXXXXXXXXXXXXX, former USN : Placement on the Permanent Disability Retired List with a disability rating of 30% effective date of discharge.

e. XXXXXXXXXXXXXX, former USMC : Placement on the Permanent Disability Retired List with a disability rating of 30% 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.



          XXXXXXXXXXXXXX
         Assistant General Counsel
(Manpower & Reserve Affairs)

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