RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03300
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE: 20060808

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Munitions Systems Craftsman, medically separated for “idiopathic hypersomnolence…” with a disability rating of 20%.

CI CONTENTION:  The applicant contends “Was not fully diagnosed at the time.”  The CI’s 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 Physical Evaluation Board (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 

SERVICE PEB - 20060627	VARD - 20070129	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Idiopathic Hypersomnolence	8199-8108	20%	Idiopathic Hypersomnolence/ Narcolepsy, also Claimed as Chronic Fatigue Syndrome	8108	NSC	20061218	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Idiopathic Hypersomnolence.  The first record in evidence for the hypersomnolence condition is primary care note dated 8 February 2005.  The CI reported a 3-4 year history of fatigue despite sleeping 6-8 hours per night.  He was referred for sleep studies which showed hypersomnolence with the possibility of early narcolepsy (a condition of uncommanded sleep).  He was begun on a stimulant (Provigil) and prescribed 30-minute afternoon naps.  This was beneficial and he was able to continue working, albeit with restrictions which included no driving.  The narrative summary (NARSUM) was dated 6 April 2006 and noted good control with the above regimen.  He reported that he no longer fell asleep in the day and felt well rested.  His physical examination was unremarkable.  The commander noted that the CI’s performance had not been “drastically impacted” by his condition in his assessment dated 24 April 2006.  Following the NARSUM dictation and Medical Evaluation Board (MEB), he reported that his control was not satisfactory and on 22 June 2006, the medication was changed to extended release Ritalin (a different type of stimulant).  The final enlisted performance report (EPR) in the record closed out on 1 July 2006, a month prior to separation.  He received 4/4 ratings (out of 5), but immediate promotion was recommended.  

At the VA Compensation and Pension (C&P) examination performed on 18 December 2006, 4 months after separation, the CI reported that he had been working in a local store the past 3 months and did not have problems as long as he was busy, but was symptomatic if he was at home or had a slow time.  He remained on Ritalin and was now able to drive short distances.  

The Board directed attention to its rating recommendation based on the above evidence.  The Formal PEB increased the Informal PEB rating from 0% to 20%, coded 8199-8108 (narcolepsy).  It noted the commander’s statement, the recent EPR, and the CI’s statement that he had recently been moved to a position of higher responsibility.  The VA noted that a specific diagnosis had not been made and did not service connect the condition.  It also used the code 8108 though.  The 8108 code is rated analogous to petit mal epilepsy which in turn bases the rating on the frequency of “spells.”  This (frequency) was not recorded.  The Formal PEB based its rating on the demonstrated level of function at separation.  The Board found no evidence to support a higher rating.  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 hypersomnolence condition.  

BOARD FINDINGS:  In the matter of the hypersomnolence 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.  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 20140714, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear XXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03300.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings