RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01588
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20071207

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

CI CONTENTION:  “Was discharged for epilepsy with no cause…”  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 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 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 determinations 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 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 - 20070828	VARD - 20080630	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Single Generalized Seizure…	8910	20%	Seizure Disorder	8999-8914	10%	20080312	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Seizure Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the seizure condition began approximately 10 months prior to referral for MEB.  The 5 February 2007 urine drug and plasma ethanol screening tests were negative.  A 14 February 2007 brain diagnostic imaging (MRI) study was normal.  The 2 March 2007 neurology evaluation documented the CI “had difficulties with what was witnessed to be a seizure on February 2, 2007.”  The examiner recounted the description of the episode which “began with facial distortion to the left, mostly the jaw, and was followed by convulsions.  She had foaming of the mouth, and she was unconscious during this time and not responsive.  Her body went limp afterwards and after about a minute, she had a blank stare.  Her pupils were dilated, and she regained consciousness but was confused.  She slowly began to be less confused over a period of 15 minutes.  She also bit her tongue during this as well.  She has no recollection of these events.  There also was a questionable other episode back in November 2006, where she woke up and her right eye was blackened for no apparent reason.  She had a headache and felt sore, similar to her soreness after the February episode.”  The impression listed generalized seizure.  

A 19 March 2007 electroencephalogram ([EEG] diagnostic test to assess for epilepsy) was abnormal with evidence of complex partial seizures with secondary generalization.  The CI was started on the anticonvulsant Topamax (Topiramate).  The 23 March 2007 neurology follow-up documented “We did an EEG, and it revealed that she had an electrographic seizure [seizure evident on EEG monitoring] during her EEG that originated from the right frontal region and rapidly generalized.  She had postictal [after seizure] slowing on her EEG after the seizure.  She was asleep at the time and had no recollection of this…The patient started tapering up on Topamax, this week.  She has had no further seizures but has had constant headaches.”  The impression listed complex partial seizures with secondary generalization.  The 5 June 2007 neurology follow-up documented “She has been on Topamax and been seizure free.”  The neurologist opined “At this time I think she is okay to drive, as she has been seizure free and under good control with her medication. … She appears to have a very mild case of epilepsy that is very well controlled on medications.”  

The 16 July 2007 MEB NARSUM, 5 months before separation, recounted the history and interventions.  The CI denied any idiosyncratic reaction to the Topamax and denied any seizure like activity.  She was continuing to do well on her medication, was allowed to drive, and remained seizure free.  The examiner recounted the findings of the brain MRI and EEG.  The impression listed partial complex seizure with secondary generalized seizure.  A 13 November 2007 family practice encounter documented “… on topamax for seizure x 1 earlier this year in Feb. 2007, none since, no se's [side effects] with meds.”  The assessment listed seizure disorder on Topamax 100 mg BID, no side effects of medications, and no seizure for 9 months since onset.  

The 12 March 2008 VA compensation and pension (C&P) examination, 3 months after separation, recounted the history and interventions.  “She was put on Topamax 100 mg. BID [twice daily].  Seizure free since 07/2007 that she is aware of.”  The CI denied weakness, paralysis, paresthesias (abnormal sensation, tingling, burning, prickling), numbness, memory loss, poor coordination, vision loss, or speech difficulty.  The neurologic examination revealed normal cranial nerve function, coordination, orientation, memory, and speech.  Strength, sensation, and deep tendon reflexes (DTRs) were normal and pathologic reflexes were absent.  The psychiatric examination revealed normal affect, mood, judgment, behavior, comprehension, and intelligence with no obsessive behavior, hallucinations, or delusions.  The examiner recounted the findings of the brain MRI and EEG.  The impression listed complex partial seizures with secondary generalization, controlled on medication.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 8910 code (epilepsy, grand mal) citing single generalized seizure with abnormal EEG.  The VA assigned a 10% rating under an analogous 8914 code (epilepsy, psychomotor) based on the C&P examination 3 months after separation, citing a single generalized seizure, abnormal EEG, seizure disorder partial complex, amnesia transient global, and continuous medication for control.  The panel concurred the seizure in February 2007 was consistent with a major seizure (characterized by the generalized tonic-clonic convulsion with unconsciousness).  The panel established the overall clinical picture was consistent with the 20% rating under the 8910 code.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the seizure condition.  

BOARD FINDINGS:  In the matter of the seizure disorder condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  There were no other conditions within the panel’s scope of review for consideration.  The panel, 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 20150622, 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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01588.

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,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings