RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01592
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050330

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Self-Propelled Field Artillery Systems Mechanic, medically separated for “history of seizure disorder” with a disability rating of 0%.  

CI CONTENTION:  “Seizures cause hardship to employment.  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 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 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 - 20050201	VARD – 20060214	
Condition	Code	Rating	Condition	Code	Rating	Exam	
History of Seizure Disorder	8910	0%	Seizures	8911	20%	20050926	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

History of Seizure Disorder.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s seizure disorder began in 2002 after squatting down to lift an ice chest.  The CI had intermittent loss of consciousness, and evaluations from cardiology and neurology led to a diagnosis of a seizure disorder.  Despite treatment, the seizure condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for an MEB.  The MEB forwarded “epilepsy, complex partial seizure disorder” for PEB adjudication.  

The MEB NARSUM examination on 20 December 2004, 3 months prior to separation, noted complaints of noted complaints of approximately 16 episodes of loss of consciousness over the past 2 years, including three episodes following starting epileptiform medications (October 2004, 16 November 2004 and 3 December 2004).  Episodes were preceded by subjective symptoms or hand shaking and had a post-ictal period.  Episodes were described by witnesses as having tonic posturing.  The CI was restricted from driving.  Physical examination showed no focal neurologic deficits.  The neurologist’s diagnosis was epilepsy, complex partial seizure disorder.  The CI’s memo dated 18 January 2005 provided background to the seizure events dated 10 October 2004, 16 November 2004 and 1 December 2004.  

At the 26 September 2005 VA Compensation and Pension (C&P) evaluation, performed 6 months after separation, the CI reported seizures starting in 2002 with syncopal episodes twice a month.  The CI reported generalized seizures for one year and occasionally had warning of left hand shaking.  “These continue about three times a month.  Wife's description is consistent with generalized tonic/clonic seizures.”  The CI reported taking anti-seizure medications and that the course of seizures was progressively worse.  Brain diagnostic imaging (MRI) in July 2005 showed no significant abnormalities.  Physical examination showed an essentially normal neurologic examination.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the history of seizure disorder condition 0%, coded 8910 (epilepsy, grand mal), citing non-compliance with medical management.  The VA rated the seizure disorder 20% coded 8911 (epilepsy, petit mal), based on the VA C&P examination 6 months after separation, citing “at least one major seizure in the last two years, or at least two minor seizures in the last six months.”  The rating options for epilepsy, which are open to consideration in this case, rely on the type of seizure (major or minor) as well as the frequency and timing of seizures.  VASRD §4.124a (schedule of ratings–neurological conditions and convulsive disorders) states that “a major seizure is characterized by the generalized tonic-clonic convulsion with unconsciousness.”  The Board carefully considered the frequency and nature of the CI’s seizures including objective evidence and corroborating subjective evidence.  Members agreed that there was not sufficient evidence prior to separation that the seizures met the VASRD definition for “major” seizures.  The evidence indicated the CI had three minor seizure in the 6 months prior to separation.  This most closely approximated the 20% rating criteria under VASRD code 8911.  There was insufficient evidence that the CI’s seizure frequency more nearly approximated “averaging at least 5 to 8 minor seizures weekly” for the next higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the seizure disorder, coded 8911.  

BOARD FINDINGS:  In the matter of the seizure disorder, the Board unanimously recommends a disability rating of 20%, coded 8911 IAW VASRD §4.124a.  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, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
History of Seizure Disorder	8911	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150623, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170006478, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	 
Enclosure