RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01782
BRANCH OF SERVICE:  Army 	DATE of separation: 20040331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve O-2, Health Service Administrator, medically separated for idiopathic hypersomnolence syndrome.  The condition could not be adequately rehabilitated to meet the physical requirements of her Military Occupational Specialty.  She was issued a permanent L3 profile and referred for a Medical Evaluation Board (MEB).  The “idiopathic hypersomnolence syndrome” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded five other conditions, (Seasonal Allergic Rhinoconjunctivits, Hashimoto’s hypothyroidism, Llial Tibial Band Friction Syndrome, Pes Planus, Posterior Tibial Tendonitis) for PEB adjudication.  The Informal PEB adjudicated “idiopathic hypersomnolence syndrome)” as unfitting, rated 20%, then the US Army Physical Disability Agency (USAPDA) made a change to 40%, with application of Department of Defense Instruction (DoDI) 1332.39/Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was placed on Temporary Disability Retired List (TDRL).  Approximately 15 months later, the IPEB adjudicated the idiopathic hypersomnolence syndrome conditions as unfitting, rated 20%. 

CI CONTENTION:  Improper methods were used to determine her final rating.  Her complete submission is at Exhibit A.

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 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:  

FPEB – 20051115	VA Rating Decision - 20060303	
TDRL Placement – 20040401	Code	Rating	Condition	Code	Rating
Proximate	
Condition		TDRL
Placement	TDRL Removal			TDRL
Placement/Removal	
Idiopathic Hypersomnolence Syndrome	8199-8108	40%	20%	Idiopathic Hypersomnolence Syndrome	8199-6847	30%	
Allergic Rhinoconjunctivits	Not Unfitting	Not Addressed	
Hashimoto’s hypothyroidism	Not Unfitting	Hashimoto’s hypothyroidism	7903	NSC	
Iliotibial Band Friction Syndrome	Not Unfitting	Right Knee Iliotibial Band Friction Syndrome	5099-5024	NSC	
Pes Planus	Not Unfitting	Bilateral Pes Planus	5276	0%	
Posterior Tibial Tendonitis	Not Unfitting	Not Addressed	
Other x 0 (Not in Scope)	Other x 1	
RATING: 40% → 20%	RATING:  30%	

ANALYSIS SUMMARY:  

Idiopathic Hypersomnolence Syndrome Condition.  A sleep study and multiple sleep latency studies performed in August 2002 for excessive day time sleepiness yielded a diagnosis of idiopathic hypersomnolence (excessive daytime sleepiness of an unknown origin).  She was started on Ritalin (methylphenidate a mild central nervous system stimulant) and Prozac (antidepressant).  A repeat sleep study performed in April 2003 was not consistent with narcolepsy and the diagnosis of idiopathic hypersomnia was continued.  At the narrative summary (NARSUM) examination performed 2 months prior to TDRL removal, the CI reported some improvement, but not resolution of her day time sleepiness with medication.  At the VA Compensation and Pension (C&P) examination performed a month after TDRL placement, the CI reported persistent day time sleepiness and sleeping 14 hours per day.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the hypersomnolence condition at 40% at TDRL placement and 20% at TDRL removal, coded 8199-8108 (analogous to narcolepsy).  VA rated the condition at 30%, coded 8199-6847 (a neurologic condition rated analogous to sleep apnea).  The Board considered whether the evidence supported a higher rating at TDRL placement and removal.  Board members determined that CI’s excessive daytime somnolence most closely approximate that of sleep apnea (6847) versus episodes of spontaneous sleep associated with narcolepsy (8108).  Board members agreed that at the time of TDRL placement there was no avenue to a higher rating under VASRD code 6847 and concluded that there was insufficient cause to recommend a change in the PEB adjudication for the condition at TDRL placement.  

Board members agreed that persistent hypersomnolence met criteria for a 30% rating under VASRD code 6847 at the time of TDRL removal.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% at TDRL removal.
 
Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that seasonal allergic rhinoconjunctivitis, Hashimoto’s hypothyroidism, illiotibial band friction syndrome, pes planus, and posterior tibial tendonitis conditions were not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.   All were reviewed and considered by the Board.   There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  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 conditions and so no additional disability ratings are 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 §4.124 a, the Board unanimously recommends no change in the PEB adjudication at TDRL placement.  In the matter of the idiopathic hypersomnolence condition, the Board unanimously recommends a disability rating of 30% at TDRL removal, coded 8199-6847 IAW VASRD §4.124a and §4.97.  In the matter of the contended seasonal allergic rhinoconjunctivitis, Hashimoto’s hypothyroidism, illiotibial band friction syndrome, pes planus, and posterior tibial tendonitis conditions, 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 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 her prior medical separation:  

CONDITION	VASRD CODE	RATING	
		TDRL	PERMANENT	
Idiopathic Hypersomnolence	8199-6847	40%	30%	
COMBINED	40%	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131021, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-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 XXXXXXXXXXXXXXXXXXXXX, AR20160000999 (PD201301782)

1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

	a.  Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

	b.  Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

	c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

	d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

			      
						      					
Enclosure
					
CF: 
(  ) DoD PDBR
(  ) DVA