RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00755
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050505

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Medical Specialist, medically separated for “narcolepsy with cataplexy” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20050211	VARD - 20060517	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Narcolepsy with Cataplexy	8108	10%	Intrinsic Sleep Disorder with Idiopathic Hypersomnia	8108	10%	20060303	
Episodic Migraine Headaches	Not Unfitting	Migraine/Chronic Tension Headaches	8100	10%	20060303	
Chronic Tension Type Headaches	Not Unfitting					
Chronic Musculoskeletal Neck Pain	Not Unfitting	Degenerative Joint Disease of the Cervical Spine with Spasms	5242	20%	20060303	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Narcolepsy with Cataplexy.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s narcolepsy began in 2003 with the CI reporting over a year of excessive sleepiness and fatigue despite obtaining 8 to 10 hours of sleep regularly.  An Epworth sleepiness scale was scored 21/24 (severe daytime somnolence).  The CI also reported a history of cataplectic symptoms (transient limb weakness) associated with intense negative or stressful emotions.  A multiple sleep latency test on 3 August 2004, diagnosed Narcolepsy.  Medication was initiated to include Ritalin, to promote wakefulness, and Effexor for cataplexy, but both were discontinued due to increased restlessness and behavior changes.  Modafinil (used to treat excessive sleepiness) was initiated, but caused increased restlessness, tremulousness and anxiety.  

The 29 November 2004 MEB NARSUM examination, 6 months prior to separation, noted complaints of daytime sleepiness and fatigue, despite adequate sleep.  She reported frequently dozing off or uncontrollably falling asleep while working at the desk or reading.  She experienced cataplexy, which she described as “knees buckling.”  Her medications included Prozac for cataplexy and Dexedrine to promote wakefulness.  Physical examination showed normal posture, stance and gait.  The Neurologist reported the CI presented with all the typical clinical characteristics of narcolepsy.  It was noted the CI could obtain relief with pharmacotherapy. 

At the 3 March 2006 VA Compensation and Pension (C&P) evaluation, 10 months after separation, the CI reported easily falling asleep while driving, cooking or washing her hair.  Dexedrine and Prozac helped keep her awake during the day.  Physical examination showed no abnormalities of her posture or gait.  Polysomnographic diagnosis was intrinsic sleep disorder, idiopathic hypersomnia.  The CI did not meet the criteria for a diagnosis of narcolepsy.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the sleep condition 10%, coded 8108 (narcolepsy), citing mild industrial impairment.  The VA also rated the sleep condition 10%%, coded 8108 (narcolepsy), based on the C&P examination 10 months after separation, citing requirement for continuous medication.  The panel noted the CI was diagnosed with narcolepsy with cataplexy.  The panel also noted that the CI reported uncontrollable sleep attacks during daytime activities and cataplexy with negative emotions; however, frequency of these symptoms was not documented for a rating analogous to minor seizures.  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 sleep condition.  

Contended PEB Conditions:  Migraine Headaches, Tension Type Headaches, and Neck Pain.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Although the conditions were profiled and implicated in the commander’s statement as preventing the CI from firing a weapon or handling ammunition, they were not judged to fail retention standards.  Panel members agreed that the performance-based evidence from the record did not support that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the narcolepsy and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the contended migraine headaches, tension type headaches and neck condition, the panel recommends no change from the PEB determinations as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends 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 20170220, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180004814, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
Enclosure