RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00276
BRANCH OF SERVICE:  navy 	SEPARATION DATE:  20041019

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Submarine Nuclear Propulsion Plant Operator, medically separated for “narcolepsy” with a disability rating of 10%.  “Major depressive disorder” was determined to have existed prior to service (EPTS) and was not rated.  

CI CONTENTION:  He wants re-evaluation of all PEB conditions for which he was found unfit and rated.  He was under duress from chain of command so he did not appeal, but feels his narcolepsy was not controlled by medications that his right shoulder had an injury that was discovered after the PEB findings were issued but prior to separation.  He also contends his left shoulder pain was caused by arthritis in his neck impinging on a nerve.  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 - 20040719	VARD - 20050210	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Narcolepsy	8108	10%	Narcolepsy	8108	10%	20040812	
Major Depressive Disorder	EPTS	No VA Exam in Evidence Proximate to Separation	
Shoulder Pain, AC Joint Irritation	Not Unfitting	Left Shoulder Strain	5019-5203	10%	20040812	
		Acromioclavicular Separation, Right Shoulder, with Strain	5019-5023	10%	20040812	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Narcolepsy.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s narcolepsy condition began in April 2002 after being unable to stay awake while on watch.  At the 13 May 2004 neurology NARSUM addendum examination the patient complained of having problems with fatigue in the early and late afternoon.  The examiner noted the CI's narcolepsy was poorly controlled on medication with only partial relief of his daytime somnolence and that future control was unpredictable.  

At the 27 May 2004 MEB NARSUM examination, 5 months prior to separation, this examiner also noted the CI’s narcolepsy control was unpredictable with definite severe consequences for employment and activities of daily living.  Physical examination showed a well-nourished male in no acute distress who was alert and oriented times four.  

At the 12 August 2004 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported falling asleep without wanting to on 6 out of 7 days.  The examiner concurred with the diagnosis of narcolepsy based on the history and military medical records.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the narcolepsy condition 10%, coded 8108 (narcolepsy).  The VA also rated the narcolepsy condition 10%, coded 8108, based on the C&P examination 2 months before separation.  

The panel agreed a 10% rating, but no higher, was justified for a confirmed diagnosis of narcolepsy with a history of unplanned daytime sleeping coded 8108 (narcolepsy, rate as for epilepsy, petit mal).  The 10% rating under petit mal seizures (8911) requires a confirmed diagnosis of epilepsy or as applied to this case narcolepsy.  The CI did not have evidence of at least 2 daytime narcoleptic episodes in the last 6 months to justify a 20 percent rating.  Though the CI reported to the VA examiner that he fell asleep without wanting to six times in one week and there is documentation of recurring episodes of being late for duty there was no mention of the frequency or number of actual daytime sleeping events documented in the STR.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the narcolepsy condition.  

Major Depressive Disorder (MDD).  According to the STR and MEB NARSUM, the CI’s MDD condition began during adolescence, prior to his entry into the Navy in December 1999.  The 8 June 2004 MEB NARSUM psychiatry addendum examination, 4 months prior to separation, related complaints of being depressed.  The examiner noted a history of intermittent depressed moods that lasted for a couple of months and then resolved.  Mental examination showed no psychomotor retardation.  His affect matched his description of being depressed.  His memory was intact with concept formation and abstract thinking unimpaired.  There were no indications of a disturbance in thought process or content.  Insight, judgment and impulse control were felt to be adequate.  Both homicidality and suicidality were convincingly denied.  His Global Assessment of Functioning was 50.  There was no VA mental health examination in evidence within the 12-month allowable window for adjudication.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB determined the MDD condition was EPTS and did not provide a disability rating.  The VA also did not provide a rating for the MDD and did not address this condition in its rating decision proximate to separation.  The panel concluded there was clear evidence in the STR the CI had been diagnosed with recurrent major depression with suicidal ideation in March 1998 prior to entering the Navy even though the CI marked no on his SF 93 Report of Medical History for history of depression or excessive worry.  There was no evidence of service aggravation.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the MDD condition.  

Contended PEB Conditions:  Dysthymic Disorder and Shoulder Pain, AC Joint Irritation.  Dysthymic disorder is a milder form of depression.  The symptoms of which are within the definition of and are the more severe diagnosis of MDD and therefore cannot be separately rated. 
 
In the matter of the shoulder pain condition, the panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance prior to entering into the DES.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the narcolepsy condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the MDD condition and IAW VASRD §4.130, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended dysthymia condition, the panel unanimously agrees it cannot recommend it for an additional disability rating. In the matter of the contended shoulder condition, the panel unanimously agrees it cannot recommend it for additional disability rating.    There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160427, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

		
							XXXXXXXXXXXXXXXXXXX
	     				Principal Deputy, Assistant 
						Secretary of the Navy
						(Manpower and Reserve Affairs)
						Performing the Duties of the 
						Assistant Secretary of the Navy
						              (Manpower and Reserve Affairs)