RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD1300281
BRANCH OF SERVICE:  Army	BOARD DATE:  20131107
SEPARATION DATE:  20040703

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard SPC/E-4 (54B) medically separated for hypersomnolence.  He was mobilized in February 2003 and was soon identified with medical conditions, including hypersomnolence, which precluded him from deploying.  Various treatments for these conditions were undertaken including sleep studies and examinations to treat these conditions.  The hypersomnolence condition could not be adequately rehabilitated to meet the requirements of general fitness standards, so the CI was issued a permanent P3-U2-S2 profile and referred for a Medical Evaluation Board (MEB).  The hypersomnolence, characterized as “idiopathic hypersomnolence…” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  All three conditions were identified as having existed prior to service (EPTS).  The MEB also identified and forwarded two other conditions (see rating chart below) for Physical Evaluation Board (PEB) adjudication.  The CI disagreed with the MEB and submitted an appeal to his MEB dictation (narrative summary [NARSUM]).  The PEB adjudicated “idiopathic hypersomnolence…” as unfitting, rated 10%, IAW AR 635-40.  The remaining conditions were determined to be not unfitting.  The CI did not concur with the PEB, but waived a formal hearing and submitted no appeal.  The US Army Physical Disability Agency provided a response to the non-concurrence by the CI that indicated the PEB had adjudicated the case correctly.  The CI was then medically separated.

CI CONTENTION:  “Even though this condition was only 10 percent, it's assignment ended my military career.  Since this ended my military career and this condition prevented me from doing my job, why wasn't I awarded 100 percent?”

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 hypersomnolence condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  In addition, in accordance with Secretary of Defense directive for a comprehensive review of mental health diagnoses that were changed during the Disability Evaluation System (DES) process, the CI’s case file was reviewed regarding diagnosis change, fitness determination, and rating of unfitting mental health diagnoses in accordance with the Veterans Affairs Schedule for Rating Disabilities (VASRD) §4.129 and §4.130.  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 Military Records.

RATING COMPARISON:

Service PEB – Dated 20040502	VA - (~15 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Idiopathic Hypersomnolence	8199-8108	10%	Idiopathic Hypersomnolence	8199-8108	NSC	20051019	
Hypertension	Not Unfitting	Hypertension		NSC		
Depressive d/o, NOS		Anxiety d/o w/ MDD	9413	NSC		
No Additional MEB/PEB Entries	Other x 1		
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20060222.

ANALYSIS SUMMARY:

Idiopathic hypersomnolence:  The CI was found unfit to deploy with his reserve unit during initial processing after activation on 10 February 2003.  He was given a physical capacity or stamina level two (P2) profile for excessive tiredness and high blood pressure.  The CI remained in medical hold for 17 months until separation.  His blood pressure was treated.  He also had a longstanding excessive daytime somnolence which had caused him disciplinary problems in the past working at Tyson Foods as a forklift operator.  The permanent profile on 22 September 2003 was for idiopathic hypersomnolence, hypertension, anxiety, allergies, chest pain, and was a physical limitations level 3, upper extremities level 2, and psychiatric level 2; no driving until cleared by neurology, must take medications as prescribed.  The commander’s statement on 26 January 2004 stated the CI was incapable of reasonably performing his duties and mentioned all his profiled conditions, indicating the Motor Transport Operator (88M) Military Occupational Specialty required a serial profile of P2, U2, L2, H2, E2, S2.  The CI had a P3 (for idiopathic hypersomnolence, U2 (chest pain), L1, H1, E1, S2 (major depressive disorder).  A sleep study performed on 27 Mar 2003, the CI reported he would fall asleep in the middle of conversations, sleepiness, hypnagogic hallucinations on occasion, occasional cataplectic symptoms, no sleep paralysis and no depressive symptoms.  He had a sleep study and was diagnosed with very mild obstructive sleep apnea syndrome, but due to the symptoms reported further testing was ordered to rule out narcolepsy.  He had multiple sleep latency testing performed on 7 May 2003 and was diagnosed with idiopathic hypersomnia, negative sleep apnea.  The CI did not take treatment medications as prescribed Provigil.  On 1 October 2003 neurology consultation, the CI reported nodding off during daytime since Dec 2002 when he was placed on a third shift (0100 to 0600) in his civilian job.  He reported falling asleep frequently sitting quietly for several minutes watching TV or reading, during conversations, passenger in a car and one episode of sleep paralysis awakening from sleep lasting a few seconds.  Epworth sleepiness scale of 17 (>10 is considered pathologic daytime sleepiness).  The NARSUM performed on 29 December 2003, 7 months prior to separation noted normal blood pressure and a normal physical exam.  The main diagnosis was idiopathic hypersomnolence, suspicion of narcolepsy.  At the VA Compensation and Pension (C&P) exam performed on 19 October 2005 (15 months after separation) the CI reported taking no medications for his condition.  He reported falling asleep after sitting 15 minutes in a quiet environment, watching television and doing well at work if he kept moving.  He had been working at Tyson Foods for 15 years and then at the Honda plant for 10 months.  He took Prozac for anxiety/depression and hydrochlorothiazide for hypertension.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB and VA applied the same VASRD codes of 8199 (rated analogously to)–8108 (narcolepsy), which defaults to the rating criteria of 8911 (epilepsy, petit mall) and were subject to the same rating criteria IAW §4.124a—schedule of ratings–neurological conditions and convulsive disorders.  The PEB rated the condition at 10% and the VA did not find a service-connection.  The Board did not find evidence of major episodes, or two minor episodes within the last 6 months for a higher 20% adjudication in the CI’s favor.  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 idiopathic hypersomnolence condition.

Depressive disorder not otherwise specified (NOS):  The Board considered the appropriateness of changes in mental health (MH) diagnoses, PEB fitness determination and, if unfitting, whether the provisions of VASRD §4.129 were applicable and a disability rating recommendation in accordance with VASRD §4.130.  The Board first considered if the depressive disorder NOS diagnosis was changed during the DES process.  The condition was referred by the MEB on 12 January 2004 to the PEB.  On 2 May 2004, the PEB adjudicated depressive disorder NOS condition as not unfitting and referred to as MEB diagnosis #3, unchanged from MEB.  The Special Review Panel determined that no MH diagnoses were changed to the CI's possible disadvantage in the disability evaluation process.  This CI therefore did not meet the inclusion criteria in the Terms of Reference of the Mental Health Review Project.  The Board then addressed the appropriateness of the PEB’s fitness adjudications.  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 CI had a history of “depression or excessive worry” reported on a periodic examination on 1 August 1990.  The CI reported that a private physician prescribed Zoloft to him months prior to activation, without medical records provided, which he stopped taking prior to deployment and restarted soon after activation.  The psychiatric NARSUM addendum on 14 April 2004, found the CI did not meet retention standards under AR 40-501, chapter 3-32 (mood disorders) for Axis I diagnosis of depressive disorder, recurrent, moderate, manifested by depressed and irritable mood, anxiety, hypersomnia and fatigue.  Impairment for military duty: marked; impairment for social/industrial adaptability: mild; EPTS yes, service aggravated yes; and primary hypersomnia, manifested by chronic daytime tiredness, falling asleep during the day, disrupted nighttime sleep pattern, with sleep study supporting this diagnosis and impairment for military duty marked; and impairment for social/industrial adaptability definite.  Mental status examination (MSE) found a cooperative, appropriately behaved individual with good eye contact, normal speech, depressed and irritable affect, logical thought processes, no hallucinations or delusions, thought content remarkable for worry about his physical health and geographic separation from family, not suicidal or homicidal, intact cognitions, mini-mental state exam 28 out of 30, partial insight and adequate judgment.  At the VA mental disorders C&P examination on 31 October 2005 (15 months after separation), the CI complained of some difficulties with depression and anxiety.  He reported a high school education, working at Tyson Foods for 15 years and then the Honda plant for 10 months.  He had not lost significant amount of time from work due to anxiety or depression.  He also functioned in a church as a minister doing community projects interacting with people.  He was married to his fourth wife for 10 years.  He was taking Prozac and hydrochlorothiazide.  He had not sought psychiatric treatment after May 2004.  His symptoms improved with Prozac.  MSE was alert, engage able and polite, normal speech and motor, some agitation and irritation while talking about his father and the military, congruent affect, no suicidal or homicidal ideations, no visual or auditory hallucinations, logical and goal directed thought process, fair insight and judgment.  He was given an Axis I diagnosis of anxiety disorder NOS and major depressive disorder recurrent; and a Global Assessment of Functioning of 60-65 (some mild symptoms).  The evidence showed the CI was employed as a civilian, reported no impairments due to the MH diagnosis and improved with Prozac medication.  There was no significant time lost from work for either symptoms of depression or treatment.  The Board thus could not come to a conclusion that depressive disorder NOS affected either his primary military duties (according to his commander’s statement) or his civilian employment (per VA records).  The MH diagnosis was profiled as a psychiatric level 2 condition.  The commander’s statement did not specifically address any psychiatric problems but mentioned all the conditions from the profile and additionally mentioned a MH condition profiled as S2 was compatible with duty.  The CI did not self-report any problems at work, at home, or socially due to MH condition.  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 any of the depressive disorder NOS condition; therefore, no additional disability ratings can be 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 idiopathic hypersomnolence condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the MH diagnoses, the Board did not find the diagnoses were changed during the DES and recommends no change in the PEB fitness adjudication.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION	VASRD CODE	RATING	
Idiopathic Hypersomnolence	8199-8108	10%	
Depressive Disorder NOS	Not Unfitting	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120510, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SFMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX, AR20140005218 (PD201300281)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl