RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01753
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090928

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Public Health Journeyman, medically separated for “syncopal episodes” with a disability rating of 10%.  

CI CONTENTION:  “I have been on epilepsy medication for years…”  The 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 - 20090625	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Syncopal Episodes	8199-8108	10%	No VA Examination in Evidence	
Possible Seizure Episode…	Cat II		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

Syncopal Episodes.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s seizure episodes began during early childhood with her first seizure occurring at age one.

The 19 February 2009 MEB NARSUM examination, 7 months prior to separation, noted that 10 days previously (during a time of significant work and family stress) the CI reported becoming lightheaded, warm, and that she stiffened up while watching a particular scene in a movie.  The CI then lost consciousness.  Another soldier witnessed the episode and described the CI flexing her arms at the elbow while stiffening, saying a few words and making snorting sounds.  The soldier attempted to rouse the CI and she became limp and made moaning sounds.  The entire episode last about one minute with whole body stiffness occurring during the first 20 seconds, with no clonic (jerking) movements (clonic movements, along with loss of consciousness, define a major seizure, as opposed to a minor one).  Neurological evaluation was unremarkable.  The examiner noted the episode reported by the witness was strongly suggestive of a generalized seizure but the possibility of syncope (temporary loss of consciousness caused by low blood pressure) could not be excluded.  Given the available history the CI had no seizures between age 17 and age 27 (indicating a low probability of frequent or uncontrollable seizures).  There was no indication for anti-seizure medication at the time.  There was no VA Compensation and Pension examination in evidence proximate to separation.

The panel next directed attention to its rating recommendation based on the above evidence.  The PEB rated the syncopal condition 10%, coded 8199-8108 (analogous to narcolepsy).  The panel noted the CI had a seizure within the past year that was strongly suggestive of a generalized seizure (coded 8910, ratable at 20% disability) but it was not possible to rule out a syncopal episode.  To achieve the next higher 20% rating under the 8108 code, 2 minor seizures must occur within the past 6 months and there was no evidence of this frequency of seizures.  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 syncopal condition.  

BOARD FINDINGS:  In the matter of the syncopal episodes and IAW VASRD §4.124a, 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 20150629, w/atchs
Exhibit B.  Service 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-2015-01753.

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