RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01478
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070302

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

CI CONTENTION:  “Review all conditions.”  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 - 20070111	VARD - 20071119	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Seizure Disorder	8911	20%	Seizure Disorder with Syncopal Episodes	8910	NSC	20070508	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Seizure Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s seizure condition began in October 2005 after sustaining a motor vehicle accident with a head injury.  The CI’s first seizure occurred at his place of duty on 17 October 2005.  The Ambulance run sheet revealed: “Pt stated, ‘What happened?’  ‘Where am I?’ Pt became fully oriented after approximately 1 min (of ambulance crew arrival).  Per bystanders patient blacked out and was assisted to the floor where he was shaking uncontrollably for approximately 2-3 min.”  He was evaluated by a neurologist on 31 October 2005 where it was noted that the CI stated he had no warning that a ‘seizure’ would occur, although he had a migraine headache that morning.  The CI reported a history of migraine headaches prior to his car accident.  He had a normal examination and normal CT.  The examiner opined that the myoclonic component of his seizure “raised the possibility of myoclonic juvenile epilepsy (which would not be related to his head trauma).”  At a primary care evaluation on 16 June 2006 the CI reported a two week history of recurrence of “passing out and seizures” and bad headaches.  His examination was normal.  He was diagnosed with post-concussion syndrome and referred to neurology.  A repeat MRI on 20 June 2006 was normal except for a non-specific asymmetric prominence of the left retrocerebellar subarachnoid space.  At a neurology examination on 7 August 2006 the examiner noted that the CI had discontinued his Depakote ER for 3 months due to increasing side effects.  The CI reported symptoms, once every other week, of twitching left upper arm followed by throbbing occiput head pain and then passing out and being confused when he came out of it 30 minutes later.  The physical examination was normal.  The examiner documented a diagnoses of basilar migraine headache versus seizures.  A treatment note on 14 September 2006 by his primary care provider discussed “a witnessed seizure episode on 11 September 2006 where the CI “was examined by the same health care provider that day just after the seizure.”  The CI reported ongoing episodes of left arm twitching [since the last seizure].  The provider noted: “He has had violent grand-mal seizures with incontinence in the past, although the seizure this week was quite mild” and “Trauma to the head about 8 months ago, seizures since then.”  The examination was normal and he was diagnosed with epilepsy, generalized convulsive grand mal.  At an examination on 11 October 2006 the use of Topamax twice daily since July 2006 for seizure control was noted.  The CI reported that his seizures (grand mal) began after injury (convulsions, loss of bladder control, loss of consciousness (LOC)).  He noted the frequency as one approximately every three months lasting 5 minutes in duration with a confused postictal state.  He reported that his last seizure was one month prior (September).  His absence seizures are usually one per week where he tends to stare off into space with no LOC, no body movement, but no control over his extremities lasting 1 minute with the last one the previous Saturday.  The physical examination was normal.  The examiner noted that the CI was not cleared to drive.  The examiner noted the CI’s most recent generalized tonic clonic seizures were in May, August and September 2006.  An EEG completed on 13 October 2006 was normal.  The report stated: “a normal EEG does not rule out the presence of intermittent seizure activity.”  A 22 October 2006 MRI was normal except for a cyst that was later deemed benign.  The MEB forwarded “seizures” for PEB adjudication.  

The MEB NARSUM examination on 14 October 2006, 5 months prior to separation, noted complaints of 1-2 episodes per week of “staring off” and “losing time” (absence seizures) lasting up to one minute and occasional “spells” that begin with lightheadedness and twitching of his left arm prior to losing consciousness lasting 1-10 minutes where he has a gradual thirty minute recovery from a confused state.  His last full seizures were in May, August, and September of 2005.  The CI was on medication for the control of his seizures.  Physical examination revealed a normal examination.  The examiner noted previous Magnetic Resonance Imaging (MRIs), Electroencephalogram (EEG) s, and Computed Tomography (CT) examinations were also normal.  The examiner noted seizures of unknown etiology and that the seizure disorder did not meet retention standards.  The CI’s commander’s statement of 20 November 2006 noted the CI “has had seizures while on duty, before and after medication adjustments, requiring ambulatory transportation to the local hospital”.  

At the 8 May 2007 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported “blanking-out spells” lasting 30 seconds to 2 minutes described as “he just lost time”.  He also reported lightheadedness with twitching of his left arm approximately three times a week mostly in the morning and blinding headaches that preceded a loss of consciousness.  Physical examination was normal.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the seizure condition 20%, coded 8911 (epilepsy, petit mal).  The VA did not service connect the seizure condition coded 8910 (epilepsy, grand mal), based on the VA C&P examination 2 months after separation, citing that there was no clarified diagnosis because the evidence showed syncopal episodes which were questionably related to basilar migraines versus seizures versus pseudo seizures.  The Board noted that the evidence showed that the CI had documentation of 4 major seizures from October 2005 to September 2006 (11 month period) and 3-4 minor seizures per month.  Board members agreed that the evidence supports major seizure averaging at least 1 in 3 months over the last year for an 80% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 80% for the seizure condition, coded 8910.  

BOARD FINDINGS:  In the matter of the seizure condition, the Board unanimously recommends a disability rating of 80%, coded 8910 IAW VASRD §4.71a.  There were no other conditions within the Board’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Seizure Disorder	8910	80%	

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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01478.

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 your separation be re-characterized to reflect disability retirement, rather than 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 determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at XXXXXXXXXXXXXXXXXX to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.
Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings 

cc:
SAF/MRBR