RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01434
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050329

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E1, Aircraft Armament Systems, medically separated for narcolepsy, with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on 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(s) at the time of separation.  The panel 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 panel 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 - 20040825	NO VA CLAIM	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Narcolepsy	8108	10%	No VA Examination in Evidence	
Tobacco Abuse	Category III		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Narcolepsy.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was evaluated in 2003 after being reprimanded for falling asleep at work several times.  Initial sleep study was normal.  The CI had continued symptoms and episodes of fatigue (falling asleep at work, oversleeping and being late to work).  A repeat sleep study with addition of a mean sleep latency study (MSLT) was performed in June 2004; and the abnormal MSLT was consistent with a diagnosis of narcolepsy.  The MEB forwarded “narcolepsy on MSLT” for PEB adjudication.  

The MEB NARSUM examination on 22 July 2004, 8 months prior to separation, noted complaints of fatigue and falling asleep at work, as well as inability to awake with multiple alarms.  Physical examination was normal.  The June 2004 sleep study was negative for obstructive sleep apnea (OSA) and the MSLT was consistent with narcolepsy as noted above.  

Treatment records indicated that the CI was treated with medication (Wellbutrin) with good results in September 2004.  Treatment note dated 6 January 2005 indicated that by December 2004 the medication had lost effectiveness and the CI reported oversleeping for two weeks.  The physician increased the medication dosage.  There was no VA Compensation and Pension (C&P) examination in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the narcolepsy condition 10%, coded 8108 (Narcolepsy), citing mild social and industrial adaptability impairment (IAW DoD guidelines). Narcolepsy is rated as for petit mal epilepsy (minor seizures) IAW VASRD §4.124a.  Seizures are rated on the frequency, timing and type of seizures.  As none of the CI’s sleep episodes progresses to tonic-clonic activity, all of the CI’s sleep episodes were considered minor seizures IAW VASRD §4.124a, “The Epilepsies.”  

The panel majority adjudged that the CI’s history of “oversleeping for two weeks” (inability to awake with alarms for two weeks) during December 2004 and January 2005 most closely approximated the 20% rating criteria of “at least 2 minor seizures in the last 6 months.”  The CI’s episodes did not more nearly approximate the next higher rating criteria of “averaging at least 5 to 8 minor seizures weekly” over the 6 months prior to separation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority recommends a disability rating of 20% for the narcolepsy condition, coded 8108.  

Contended PEB Conditions:  Tobacco Abuse.  The tobacco abuse is a condition not constituting a physical disability, IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending it as unfitting.  After due deliberation in consideration of the preponderance of the evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination of the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the narcolepsy condition, the panel majority recommends a disability rating of 20%, coded 8108 IAW VASRD §4.124a.  In the matter of the contended tobacco abuse condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  The single voter for dissent recommended no change and did not elect to submit a minority opinion.  There were no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Narcolepsy	8108	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01434.

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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

Sincerely,

XXXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR