RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00873
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20050713

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Aviation Boatswain's Mate, medically separated for possible seizure disorder, with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 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 - 20050315	VARD - 20051101	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Possible Seizure Disorder	8999-8911	10%	Seizure Disorder	8999-8910	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Seizure Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was cleared for flight deck duties and reported no problems with dizziness on when screened on 1 October 2002 and 18 December 2002.  He was initially seen for a problem with his left hand on 25 January 2003 while on board ship.  He reported that he could not fully open his hand and that the symptoms began after an anthrax vaccination.  His examination was noted to be inconsistent.  He was next seen 3 days later and reported that he could not use his left fingers due to pain and paralysis with occasional numbness and tingling.  This had started right after an anthrax vaccination in his left shoulder (deltoid).  The examiner noted that the CI used his left hand to button up his uniform when the CI was not aware that he was being observed.  The case was discussed with the chain of command and the CI was referred to mental health.  There it was noted that he wanted “off the boat” and to have shore duty.  He had been on board for 3 months and displayed “few skills for adjusting to the demands of Navy life.”  He was taught basic coping strategies.  One month later on a flight deck evaluation dated 19 March 2003, the CI reported frequent headaches and dizziness/fainting spells.  Follow-up was recommended.  The CI was seen for a sebaceous cyst and for a shaving waiver though, in May and August 2003, respectively.  The CI was then seen in mental health on 30 October 2003 requesting cross-training.  He reported that he performed well at work but was unhappy.  He freely discussed his evaluation in February (for the hand problem) in which he was determined to have an occupational problem.  The CI was found fit for duty and his current rating.  On a cardiac risk screen dated 15 November 2003, the CI again reported dizziness.  The next record in evidence is a sick call note dated 7 April 2004.  The CI stated that he had “passed out” while at work 4 times over the past 7 weeks.  These were always in the workplace where it was “too hot” and when rising from a seated position.  None were witnessed.  He woke up on the floor and was alert upon awakening.  His examination was normal and he was thought to have vasovagal syncope (fainting).  Behavioral modifications were advised and taught.  Three weeks later, the CI was seen falling from deck height onto his back and he had a bloody nose.  His examination was again unremarkable and he was treated with IV fluids and then sent to quarters for 24 hours.  The diagnosis was thought to be vasovagal syncope.  The CI then was seen on 14 June 2004, reporting 7 episodes of syncope over the prior 6 months.  Each was accompanied by a loss of consciousness (LOC).  He denied any preceding symptoms other than feeling sweaty (diaphoresis) and had no post-ictal symptoms (such as confusion after the episode).  The examination was again normal and he was referred to internal medicine for recurrent syncope.  At the internal medicine (IM) evaluation on 14 July 2004, the CI denied any premonition of symptoms (including the diaphoresis which he endorsed above) and noted that the episodes occurred suddenly when he was already standing (rather than when rising from a seated position as initially reported).  He denied any urinary or fecal incontinence or biting of his tongue.  There was no shaking per his friends who witnessed events.  The LOC was from less than 1 minute to several minutes.  He reported the bloody nose (above) and falling down stairs.  He stated that 2 had been witnessed.  The examination remained unremarkable.  The history was thought to be inconsistent with vasovagal syncope and further evaluation was recommended.  He was placed on MEDHOLD.  An echocardiogram on 29 July 2004 was normal.  A magnetic resonance imaging study (MRI) of the brain on 4 August 2004 was also normal without evidence of an intracranial abnormality or of the arterial circulation of the brain.  The CI had a follow-up in IM on 17 August 2004.  He reported an additional syncopal episode 2 weeks earlier that occurred as he turned his head while walking from his room (he was now in the bachelors’ enlisted quarters).  The CI reported that this was witnessed by his roommates and that he had LOC for 3-4 minutes, again without incontinence or confusion.  No “warning signs” were present.  It was noted that the CI had now had 2 episodes of syncope associated with turning his head.  The examination remained unremarkable.  A chest X-ray was normal.  The CI was issued a cardiac event monitor on 17 August 2004.  He was seen again on 31 August 2004 and reported an episode of shortness of breath and palpitations (pounding of the heart) that spontaneously resolved without syncope.  There was no abnormal rhythm captured on the event monitor.  The CI was referred to neurology and evaluated on 7 September 2004 where the CI reported over eight episodes of LOC since November 2003.  A few were witnessed and the last was over a month earlier.  He reported that one episode was accompanied by shaking (previously denied).  He was unconscious for minutes and these could occur while sitting or standing.  The CI denied tongue biting or incontinence, but possibly had post-ictal confusion.  The physical examination was normal.  Restrictions from driving and riding a bike were recommended as was placement on LIMDU (limited duty).  The CI was apparently placed on LIMDU although the formal paperwork for this is not in evidence.  He was also started on an anti-seizure medication.  An internal medicine (IM) visit on 9 September noted no additional episodes (since early August), but persistent high blood pressure for which the CI was placed on medications.  Awake and sleep deprived electroencephalograms from 10-12 September 2004 were normal.  

An undated neurology encounter documented that the neurologist had spoken to one witness who stated that the CI had LOC while standing in the bathroom, but did not have tonic clonic activity.  He was unresponsive for 5-6 minutes.  The date of this episode was not recorded.  An IM note dated 13 October 2004 recorded that no events had been recorded for over 45 days and that the event monitor was to be discontinued unless the CI became symptomatic again.  At a neurology evaluation on 24 January 2005, the CI reported 2 spells since the last visit.  One in November when the CI awoke on the floor with a cut lip, and another a few days earlier when he again woke on the floor.  Neither was witnessed.  The examination remained normal.  The Dilantin level (the anti-seizure medication) was increased.  The initial level suggested that the CI was not taking it or doing so rarely.  The MEB forwarded “possible seizure disorder” for PEB adjudication.  The MEB report, accomplished by the treating neurologist, was also dated 24 January 2005, 5 months prior to separation.  It noted “loss of consciousness” as the primary complaint.  It noted that there was one witnessed episode with some shaking (the records show that this was a report by the CI, not from direct testimony from the witness), while other witnessed episodes showed no shaking.  There was concern with compliance as the initial Dilantin level was zero.  It was noted that the CI had “spells” which could be epilepsy.  The CI was next seen in IM, on 14 February 2005.  It noted that the CI had been changed to a different anti-seizure medication due to potential liver damage from the first.  No further spells were recorded.  The examination remained normal other than his blood pressure.  The next day the CI was seen in IM again and stated that he had stopped his blood pressure medication because it “looked good.”  It was actually elevated at this appointment as well.  Compliance with his medications was emphasized.  The final records in evidence prior to separation were several primary care notes dated o/a 15 March 2005, 4 months prior to separation, for a sore throat.  No additional spells were documented.  There were no further clinical records in evidence after separation.  The CI did not present for the VA Compensation and Pension (C&P) evaluation scheduled on 12 October 2005.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the seizure disorder 10%, analogously coded 8911 (Epilepsy, petit mal).  The VA did not rate the condition as service connection was not established for seizure disorder.  There was no service or post-service medical evidence which contained a confirmed diagnosis and the CI did not report for the VA examination.  The Board considered the evidence.  The one documented witnessed spell, in which the examiner spoke with the witness, did not record the presence of tonic clonic movement or of post-ictal confusion.  The reports of the episodes varied consistently as to what provoked them.  Most were unwitnessed and none were witnessed by medical personnel.  The evidence does not support the presence of a grand mal seizure disorder (VA code 8910).  Review of the records shows that over the 12 months prior to separation, the CI reported a spell in early August 2004, November 2004, and January 2005.  A higher 20% rating, for the code 8911, has the requirement of 2 minor seizures in the past 6 months.  Only one was documented, supporting a 10% 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 possible seizure disorder condition.  

BOARD FINDINGS:  In the matter of the possible seizure disorder 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 20150606, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 13 Dec 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN 

						      	XXXXXXXXXXXXXXXXXX	     				  			      		Assistant General Counsel
	(Manpower & Reserve Affairs)