RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03469
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071016

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E5, Cavalry Scout, medically separated for “narcolepsy,” with a disability rating of 10%.

CI CONTENTION:  He was given a higher rating for his condition by the VA.  He was also not rated for Tinnitus by the PEB.  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 - 20070717	VARD - 20080507	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Narcolepsy	8108	10%	Narcolepsy	8108	20%	20071227	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Narcolepsy.  After years of excessive daytime somnolence, the CI was evaluated by Neurology and Pulmonology and was diagnosed with narcolepsy in late 2004.  Although symptoms did improve with medication, a P3 profile was recorded on 19 June 2007 which cautioned the activities of using firearms, driving, or other tasks that required alertness.  The commander’s performance letter dated April 2007 stated the CI was physically incapable of reasonably performing his duties due to his medical condition.  The NARSUM was conducted on 8 June 2007 (4 months prior to separation) whereby the CI maintained compliance in taking his prescribed medication.  His physical examination (PE) was cursory, but normal.  His diagnosis remained as narcolepsy.  The psychiatry addendum to the NARSUM dated 27 April 2007, noted that the CI’s impairment for military duty was ‘marked’ with ‘definite’ social and industrial adaptability.  At the VA Compensation and Pension (C&P) examination in December 2007, performed 2 months after separation, the CI reported “a good response” from taking his medication for narcolepsy with no adverse side effects.  He reported having an average of 4 attacks per month and that during an attack he would “…just fall asleep.”  His usual occupation was ‘security’ for which he was currently employed.  His physical and mental status exams were normal.  His diagnosis remained unchanged.  The examiner additionally added the CI did not have a seizure disorder.  There was no comment with regard to cataplexy or sudden incapacitation.     

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 8108 code (narcolepsy), citing mild industrial impairment.  The VA assigned a 20% rating also using the 8108 code based on the VA C&P examination 2 months after separation, citing at least one major seizure in the last 6 months or two in the last year, or averaging at least five to eight minor seizures weekly.  The VASRD indicates that narcolepsy, under code 8108, should be coded and rated as epilepsy, petit mal, under code 8911, and in accordance with §4.121.and §4.122.  In accordance with VASRD guidelines, it remained clear that near the time of separation, the CI’s condition was well controlled, but required daily medication.  The VA examination noted that all reported ‘attacks’ were completely manifested with sleep and not associated with seizure activity.  The VASRD prescribes a maximum 10% rating for “a confirmed diagnosis of epilepsy…with a history of seizures,” and requiring daily medication.  Although daily medication was employed in this case, the absence of documented seizure activity would not support a positive rating impairment.  However, the Board’s precedence is that its final recommendation may not produce a lower rating than that of the original PEB.  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:  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.  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 20140619, 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 XXXXXXXXXXXXXXXXXXXX, AR20160008094 (PD201403469)

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