RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02981
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20051114

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

CI CONTENTION:  He received a higher rating for his seizure condition from the VA.  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 - 20050927	VARD - 20060511	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Seizure Disorder	8999-8911	10%	Seizure Disorder	8999-8910	100%	20060214	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  100%	

ANALYSIS SUMMARY:

Seizure Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s seizure disorder began in April 2005 while having intercourse with his spouse.  He developed a severe headache in the back of the head and fell, but denied loss of bowel/bladder control or any violent movements or jerking when this occurred.  During subsequent treatment in the emergency room, the provider noted a previous head injury in September 2003 which caused the CI to become “unresponsive” while recuperating in his supervisor’s office; a Glasgow Coma Scale test indicated a mild head injury.  

The CI was hospitalized for further evaluation after the April 2005 incident, and reported prior concentration and attention difficulties and easily making errors.  Neuroimaging was negative but an electroencephalogram (EEG) suggested epileptic activity.  He was treated with anti-convulsion medication, and during a follow-up neurology examination, reported continuing seizures and “momentary lapses.”  He was again hospitalized in June 2005 due to seizure and headache recurrence, and an inpatient neurology evaluation noted the CI had stopped taking his seizure medication because it did not seem to work, and had experienced several “spells” and a severe headache.  An EEG was interpreted as abnormal with epileptiform sharp transient waves in the left temporal area, and an ambulatory EEG in July 2005 (for 24 hours) was inconclusive.

At a neurology follow-up visit on 11 August 2005, 3 months prior to separation, the CI reported having continued spells lasting for 5-10 seconds about twice a month.  During an episode, he got dizzy, his vision slowly started to black out, and he lost his bearing and forgot what he was doing.  He still experienced headaches but felt they were manageable and likely due to physical stress.  A diagnosis of complex partial seizures with secondary generalization was rendered.  

The 31 August 2005 MEB NARSUM examination, 2 months before separation, noted CI complaints of occasional seizures with the last episode occurring 2 weeks earlier; he was taking two anti-convulsion and two pain medications.  Physical examination and lab studies were normal.  The examiner noted he still had headaches and diagnosed “seizure disorder, possibly petit mal versus other” which was possibly related to the past work-related head injury.  

At the 14 February 2006 VA Compensation and Pension (C&P) brain and spinal cord examination, 3 months after separation, the CI reported seizures once or twice a month which presented as a sudden loss of consciousness and falling to the floor, but no tonic-clonic movements or urinary incontinence.  His wife reported that after falling to the floor, he was generally completely unresponsive for a couple of hours, and then would “groan to pain or withdrawal to pain.”  A few minutes before a seizure, the CI experienced a sudden throbbing bilateral, posterior headache, and afterwards, he felt very fatigued and sluggish for about 2 hours, was extremely sensitivity to light, and stuttered.  On one occasion he became violent post-seizure, but had no recollection of this.  He was not driving, but had started a new job working nightshift at a store, and was attending college classes.  Physical and neurological examination were unremarkable, and the provider diagnosed “partial onset seizure disorder with possible deep brain focus” noting atypical and neither generalized tonic-clonic or complex partial seizures.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the seizure disorder 10%, analogously coded 8999-8911 (epilepsy, petit mal), citing mild social and industrial adaptability impairment and abnormal EEG.  The VA rated the seizure condition 100%, analogously coded 8999-8910 (epilepsy, grand mal), based on the C&P examination, citing one major seizure per month over the past year.  Under the VASRD General Rating Formula for Major and Minor Epileptic Seizures, a 40% rating requires at least 1 major seizure in the last 6 months or 2 in the last year; or averaging at least 5 to 8 minor seizures weekly.  A 20% rating requires at least 1 major seizure in the last 2 years; or at least 2 minor seizures in the last 6 months.  Per VASRD §4.124A, a major seizure disorder is coded 8910 and a minor seizure disorder is coded 8911.  Members noted that while the C&P examination showed evidence of post-separation worsening of seizures, the STR indicated reduced seizure activity. The MEB NARSUM examination, which was most proximate to separation, recorded a diagnosis of a possible petit mal seizure disorder, with the last seizure occurring on or about 17 August 2005; and the PEB used code 8911, which is consistent with the neurologist’s diagnosis of complex partial seizures with secondary generalization. Members agreed that the seizure condition was best characterized by the 20% rating criteria, and that there was no major seizure disorder diagnosis or evidence in the STR or an average of 5-8 minor seizures a week to support a 40% rating.  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, coded 8999-8911.

BOARD FINDINGS:  In the matter of the seizure disorder, the panel recommends a disability rating of 20%, coded 8999-8911 IAW VASRD §4.124a.  There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Seizure Disorder	8999-8911	20%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170428, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs 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-2017-02981.

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

Attachments:
1.  Directive
2.  Record of Proceedings