RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03009
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050221

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Explosive Ordnance Disposal) medically separated for idiopathic hypersomnolence, rated at 10%.    

CI CONTENTION:  The CI requested that the Board review all of his conditions.  His complete submission is at Exhibit A. 

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  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 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 20041223	VA* - (~3 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Idiopathic Hypersomnolence	8199-8108	10%	Idiopathic Hypersomnolence includes claim for Chronic Fatigue, Short Term Memory Loss and Decreased Comprehension	6399-6354	10%	20041104	
			Headaches associated with Idiopathic Hypersomnolence (includes claim for Chronic Fatigue, Short Term Memory Loss and Decreased Comprehension	8100	0%		
Hypertension	Not Unfitting		Hypertension	7101	0%		
Other MEB/PEB Conditions x 0 	Other x 4	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20050429 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  

Idiopathic Hypersomnolence.  In October 2003 the CI presented with a 2-month history of fatigue with cervical lymph nodes, and blood in his stools.  He was diagnosed with mononucleosis; however symptoms of weakness, fatigue, memory problems continued after treatment of this condition.  A computed tomography scan dated 5 January 2004 was normal except for mild splenomegaly (enlargement of the spleen).  Neurology evaluations and sleep studies were negative for sleep apnea, narcolepsy, restless leg syndrome, and cataplexy (emotionally-triggered transient muscle weakness).  He reported improvement in his daytime sleepiness, but no change in his fatigue, with Provigil (a medication used to treat excessive sleepiness.  The narrative summary (NARSUM) psychiatric addendum noted reports of fatigue, a lack of energy, and mild problems with concentration and sustaining a task.  He denied past of current psychiatric symptomatology.  The mental status examination was normal.  The examiner opined that there was no evidence of a past or current psychiatric condition.  An Axis I diagnosis of primary hypersomnia was rendered.  The VA Compensation and Pension (C&P) examination performed 3 months before separation noted a diagnosis of hypersomnolence with questionable element of chronic fatigue.  The neurologic examination was normal.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the unfitting idiopathic hypersomnolence condition at 10% for mild impairment in accordance with DODI 1332.39 para E2.A1.4.1.5.; coded 8199-8108 (analogous to narcolepsy). The VA rated the condition at 10% for symptoms controlled by continuous medication; coded 8199-8108 (analogous to narcolepsy) and 6399-6354 (analogous to chronic fatigue syndrome), respectively.  The Board considered whether the evidence supported a higher than 10% rating.  The Board noted that there was no evidence of symptoms consistent with the VASRD definition of minor seizures for a 20% rating under VASRD code 8108.  Although the fatigue was constant, there was no evidence of restriction of daily activities by less than 25% of the pre-illness level or periods of incapacitation for a 20% rating under VASRD code 6354.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 10% for the idiopathic hypersomnolence condition was appropriately recommended in this case.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that hypertension was 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 hypertension was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  All were reviewed and considered by the Board.   There was no performance based evidence from the record that hypertension 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 contended condition 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.  As discussed above, PEB reliance on DoDI 1332.39 for rating idiopathic hypersomnolence was operant in this case and the condition was adjudicated independently of that instruction by this Board.  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 contended hypertension condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  
The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140623, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160005000 (PD201403009)

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:

Enclosure

CF:
( ) DoD PDBR
( ) DVA