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AF | PDBR | CY2014 | PD-2014-02357
Original file (PD-2014-02357.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2014-02357
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20150415
date of separation: 20011123


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Aerospace Maintenance Journeyman) medically separated for migraine headaches. The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards. He was issued a temporary P4/E2 profile and referred for a Medical Evaluation Board (MEB). The “migraine headaches,” was forwarded 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 unfitting, rated 10%, c iting application of Department of Defense Instruction (DoDI) 1332.39/Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “Please consider all conditions”


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 20010926
 VA* - (~1 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Migraine Headaches 8100 10% Migraine Headaches 8100 30% 20011019
Other x 0 (Not In Scope)
 Other x 3
RATING: 10%
 RATING: 40%
* Derived from VA Rating Decision (VA RD ) dated 200 20211 (most proximate to date of separation [ DOS ] ) .



ANALYSIS SUMMARY:

Migraine Headaches Condition. The CI’s headaches were typical for migraine and diagnosed as such by Neurology; imaging and standard ancillary evaluations were normal. The MEB narrative summary (NARSUM) examination performed on 7 August 2001 (4 months prior to separation), indicated the CI first experienced headaches in January 2001 associated with classic aura to include flashing lights, nausea, and vomiting. He denied history of head trauma. His initial clinical work-up was unremarkable and with resolution of symptoms, no immediate and or long-term treatment was initiated. He deployed on 30 May 2001 where he experience his next two headaches during deployment air travel. Due to persistent exacerbations of intermittent headaches, the CI was returned back home for a neurologic work-up. The NARSUM clearly spelled out the CI’s frequency, duration, and timing of headaches since their onset in January 2001; all of which correlated well with individual service treatment records which noted symptom relief by lying in a dark room. From the time of initial symptom onset until the NARSUM (7-month period), there were a total of seven reported episodes of headaches. The CI endorsed “occasional headaches with associated photophobia, nausea, and aura.” His treatment consisted of both rescue and preventive headache medications. His MEB physical examination (PE) was unremarkable. His diagnosis remained migraine headaches with intractable course. His profiled diagnosis remained unchanged and his sole restriction was “not world-wide qualified.” The commander’s statement was laudatory in regards to the CI’s abilities and performance and recommended service retention.
At the VA Compensation and Pension examination performed on 19 October 2001 (a month prior to separation), the CI reported usually having two or three headaches per month. His symptoms were described as sharp lancinating and throbbing frontal headache associated with nausea, abnormal envisions of lights and sound, and occasional vomiting. The examiner additionally noted “He has a prostrating attack about once a month on average that lasts from four to six hours.” His VA neurologic PE was normal.
The Board directed attention to its rating recommendation based on the above evidence. The VASRD §4.124a rating schedule for 8100 (Migraine) is excerpted below:
                  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
It is clear that the rating under 8100 hinges on the frequency of “prostrating” attacks; and, it is incumbent on the Board to apply DoDI 6040.44-compliant and uniform criteria which would define a recurrent migraine episode as “prostrating” and ratable. Under DoDI 6040.44, the Board is directed to: “Use the VASRD in arriving at its recommendations, 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).” Since the VASRD does not provide a definition of “prostrating,” it can be argued that the Board is directed to apply the DoDI 1332.39 definition which requires evidence that medical treatment is sought for each rated episode. The Board, by precedence, has not required rigid proof of medical attention for each and every episode to characterize it as prostrating; but, does require reasonably convincing evidence that rated attacks force the abandonment of work or current activity to treat the migraine; although, self-management (medication and/or sleep) has been accommodated within this threshold.
The PEB rated the headaches at 10% using VASRD code 8100 (migraine) citing “condition is not compatible with the rigors of military service.” The VA rated the CI at 30% under code 8100 citing “prostrating attacks about once a month.” The VASRD §4.124a rating schedule for migraine code 8100 rests heavily on the frequency of “characteristic prostrating attacks … over last several months.” The rating options under 8100, which are open to consideration in this case, rely on the frequency and severity 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.” However, VASRD §4.124a does not require seeking medical attention for an attack to be considered prostrating and a common (court-sanctioned) approach is to apply the clear English definition of prostrating. The Board deliberated on the parameters of the “prostrating” definition in relation to this condition. The Board carefully considered the frequency and nature of the CI’s headaches including objective evidence and a preponderance of corroborating subjective evidence.
All Board members first agreed that the diagnosis of migraines remained consistent and appropriate in light of the presented medical evidence. Next, Board members carefully considered and discussed on whether the CI’s headache attacks were of a ‘prostrating’ nature. Members agreed that relief provided by the lying in a dark room did indeed support an acknowledgment of prostration. Board members then deliberated on the final criterion for impairment rating headache frequency.
The Board agreed that both the MEB and VA exams sufficiently documented prostrating headaches in the preceding several months that exceeded an average occurrence of once every 2 months, but more accurately described occurring at least once a month in support of a higher impairment rating. There was insufficient evidence to support the 50% criteria of “very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.” Therefore, 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 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. As discussed above, PEB reliance on DoDI 1332.39 for rating headaches was operant in this case and the condition was adjudicated independently of that instruction by this Board. In the matter of the migraine headache condition, the Board unanimously 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 re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

CONDITION VASRD CODE RATING
Migraine Headaches 8100 30%
COMBINED 30%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140527, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record








XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review
invalid font number 31506

SAF/MRB

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


Dear XXXXXXXXXXXXXXXXXXXX:

         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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities. Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly. The office responsible for making the correction will inform you when your records have been changed.

         As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP). Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election. If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

Sincerely,





XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

cc:
SAF/MRBR
 DFAS-IN

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