RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00047
BRANCH OF SERVICE:  Army	BOARD DATE:  20140729
SEPARATION DATE:  20070412

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (19D10/Cavalry Scout) medically separated for narcolepsy.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  The CI was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The narcolepsy condition characterized as “not meeting retention standards” and was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded four other conditions (borderline hypertension, allergic rhinitis, idiopathic hive syndrome and attention deficit hyperactive disorder).  The informal PEB adjudicated “narcolepsy” as unfitting, rated 10%.  The remaining conditions were determined to be not unfitting.  The CI made no appeals and was medically separated.

CI CONTENTION:  “I was discharged prior to my sleep apnea and narcolepsy could be fully developed.  Immediately after my discharge the VA determined I need a C-PAP machine ultimately determining my 50% disability.”  

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 narcolepsy condition 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 Military Records.

RATING COMPARISON:  

Service IPEB – Dated 20070129	VA - (2 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Narcolepsy	8108	10%	Narcolepsy	8108	0%	20070623	
No Other Items in Scope	Other x 6 (Not in Scope)	 	
Combined:  10%	Combined:  10%	
Derived from VA Rating Decision (VARD) dated 20080228 (most proximate to date of separation)
Rating for narcolepsy increased to 10% effective 20070413 by VARD 20080708.

ANALYSIS SUMMARY:  

Narcolepsy Condition.  The CI underwent evaluation for complaint of excessive daytime drowsiness with nighttime sleep study and daytime multiple sleep latency testing in August 2006.  The nighttime sleep study demonstrated an apnea/hypopnea index of 4.8 events per hour indicating mild sleep apnea (the result was at the threshold for diagnosis of sleep apnea with a normal up to 5).  The daytime multiple sleep latency test demonstrated onset of sleep of 4.9 minutes (normal 10 minutes or more) suggestive of narcolepsy.  He was diagnosed with mild obstructive sleep apnea and narcolepsy uncomplicated by cataplexy (drop attacks) and started on medication (Provigil) for excessive daytime drowsiness.  At the time of a clinic appointment, dated 26 September 2006, the CI reported he had not had problems with daytime sleepiness since starting the Provigil.  A neurology consult for the MEB, dated 24 October 2006, noted “improvement of most of the symptoms” with the medication.  An evaluation on 14 November 2006, similarly noted significant improvement.

The VA compensation and pension (C&P) examination dated 23 June 2007, (2 months after separation) the CI reported easily falling asleep if not active, but never while driving or meeting.  He indicated he was tolerating his medication well.  A VA neurology clinic appointment on 30 July 2007, 3 months after separation, noted he was “doing much better” with the medication.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB rated the narcolepsy 10% based on DoDI 1332.38 for mild impairment (coded 8108, narcolepsy).  The VA initially rated the narcolepsy (8108) 0%, however subsequent rating decision dated 8 July 2008, increased the rating to 10% citing requirement for continuous medication.  Narcolepsy is rated under VASRD diagnostic code 8108 which provides that narcolepsy is to be rated as for epilepsy petit mal, which is rated under the general rating formula for minor seizures.  Following diagnosis, the CI’s narcolepsy was controlled with medication supporting a 10% rating.  No episodes due to narcolepsy equivalent to a minor seizure were documented prior to separation to support consideration of a rating higher than 10%.  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 narcolepsy 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.  In the matter of the narcolepsy condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB 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.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20121220, 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 XXXXXXXXXXXXXXXXXX, AR20150003761 (PD201400047)

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						
 
CF: 
(  ) DoD PDBR
(  ) DVA