RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03872
BRANCH OF SERVICE: AIR FORCE	SEPARATION DATE:  20070828

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Recruiter, medically separated for narcolepsy with a 20% rating.

CI CONTENTION: The CI attached a one page statement to his application which was reviewed by the Board and considered in its recommendations.  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 based upon a 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 - 20070711	VARD - 20071108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Narcolepsy	8108	20%	Narcolepsy	8108	10%	20070919	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS: 50%	

ANALYSIS SUMMARY:

Narcolepsy.  The service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), documented a diagnosis (by multi-latency sleep study) of narcolepsy in October 2003.  This was treated with stimulant medications with limited success, and the CI was unable to continue in his flight crew chief capacity.  He switched to recruiting duties and was reevaluated by sleep medicine.  A repeat sleep study re-confirmed the diagnosis; scheduled daytime naps (15 minutes twice daily) were recommended; and, medications were adjusted (changed to Adderall).  There was STR documentation of persistent daytime fatigue and impaired concentration; but, the CI was not spontaneously falling asleep (no drop attacks).  Subsequent STR entries indicated improvement (positive response to Adderall), but this was insufficient to allow unrestricted duty. The CI was referred for an MEB which in turn forwarded “narcolepsy” to the Physical Evaluation Board (PEB).

The NARSUM examination in May 2007, 4 months before separation, corroborated the history and symptoms from above, and documented the absence of drop attacks or any additional symptoms.  There were no pertinent findings on physical examination.  The commander’s performance statement did not provide any detail probative to rating.

A VA Compensation and Pension (C&P) neurological examination was conducted in September 2007, less than 1 month after separation.  The source examination was not available, but the probative evidence from it was well documented in the VA rating decision (VARD).  Members agreed that the missing detail would not materially affect the recommendation; thus, no delay for additional attempts at retrieval was warranted.  The VARD stated that the CI “denied suffering cataplexy attacks and sleep ‘attacks’ with sudden onset, but did report ongoing daytime somnolence,” and confirmed the STR treatment regimen of “Adderall and two 15 minute naps per day as per instruction from your physician.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the narcolepsy condition 20%, coded 8108 (narcolepsy), citing DoDI 1332.39 (E2.A1,4.1.5), assessing “definite” industrial impairment.  The VA rated the narcolepsy condition 10%, also coded 8108 based on the C&P examination less than 1 month after separation, citing continuous medication to control analogous epilepsy.  VASRD §4.124a defaults code 8108 to code 8911 (epilepsy, petit mal) which is rated under the general formula for minor epileptic seizures.  Under that formula a 10% rating requires only a “confirmed diagnosis,” and all of the higher ratings are premised on an increasing frequency of minor seizures.  Under this mandated rating scheme it would require uncontrollable sleep attacks to constitute events analogous to minor seizures.  In this case, therefore, no §4.124a rating higher than 10% can be supported; which was the rationale expressed by the VA for its 10% rating.  The PEB’s 20% rating was derived from DoDI 1332.39 (E2.A1,4.1.5), assessing “definite” industrial impairment; and, IAW DoDI 6040.44, ratings from Service or DOD directives in effect must also be applied by the Board if they are favorable to the VASRD.  Members thus agreed that the PEB’s 20% rating was the maximum justifiable recommendation.  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 of the narcolepsy condition.

BOARD FINDINGS:  In the matter of the narcolepsy condition, and favorably conceding DoDI 1332.39 (as above), 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 20140902, 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-2014-03872.

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