RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  pd-2016-01183
BRANCH OF SERVICE:  Air force 	SEPARATION DATE:  20040920

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Diagnostic Imaging Journeyman, medically separated for “seizure disorder” with a disability rating of 10%.  

CI CONTENTION:  “Increase in migraines.  Extreme depression and anxiety, new meds per MD request.”  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 - 20040505	VARD - 20050707	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Seizure Disorder	8910	10%	Seizure Disorder	8999-8910	20%	20050131	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Seizure Disorder.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), in June 2003, the CI had an episode of loss of consciousness.  A complete cardiology workup was normal.  On 14 March 2004, the CI experienced a second episode of loss of consciousness which was unwitnessed.  She was seen by neurology and anti-convulsant medication was initiated until true nature of the episodes were determined.  At the 9 April 2004 neurology appointment the MRI and EEG were noted to be normal.  Neurological examination remained normal.  A second EEG was also normal.  

The 16 April 2004 MEB NARSUM examination, 5 months prior to separation, noted the CI’s report that she had 2 episodes of loss of consciousness.  The last episode was in March, and she lost bladder control.  There were no witnesses and it was presumed that she had a seizure.   Physical examination was unremarkable.  A neurological consultation conducted in June 2004 noted the CI reported that in March 2003 she “blacked out” while shopping.  The episode was witnessed by another “medical person” who informed her that she had “full body jerks” during the episode.  She did not have loss of control of her bladder or bowel at the time and she did not seek medical attention.  The CI also reportedly stated she had another episode in March 2004 while shopping.  During that episode she felt lightheaded and then she “blacked out.”  There were no witnesses, but she woke up in an ambulance.  She had lost of bladder control during the episode.  Physical examination was unremarkable including the neurological examination.  The neurologist assessed “presumed seizure disorder” and noted that the episodes may have been of vasovagal origin (fainted).  Family clinic examination dated 25 August 2005, 1 month before separation, noted the CI was stable on her medication and had not had any seizures since the March 2004 episode.  

At the 31 January 2005 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the CI reported no ER or hospital visits for seizures since she got out of the military.  The CI had continued her medication.  Physical examination was unremarkable.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the seizure disorder condition 10%, coded 8910 (epilepsy, grand mal).  The VA rated the seizure disorder condition 20%, coded 8999-8910, based on the C&P examination 4 months after separation, citing at least one major seizure in the last 2 years, or at least two minor seizures in the last 6 months.  The panel undertook a careful review of the STR and noted the June 2003 episode described by medical personnel, was consistent with a major seizure.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the seizure disorder condition, coded 8911.  

BOARD FINDINGS:  In the matter of the seizure disorder condition, the panel unanimously recommends a disability rating of 20%, coded 8911 IAW VASRD §4.121 and §4.124a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel 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	
Seizure Disorder	8911	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160926, 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-2016-01183.

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 modification of your assigned disability rating without re-characterization of your 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 direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  This will not result in any change to your separation documents or the amount of severance pay you are entitled to.  Disability severance pay is computed the same regardless of a rating of 0, 10 or 20 percent.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings