RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-03018
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Wheeled Vehicle Mechanic, medically separated for “transient alterations of awareness” with a disability rating of 20%.   

CI CONTENTION:  He should have been diagnosed with traumatic brain injury, not seizures.  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 - 20090427	VARD - 20090624	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Transient Alterations of  Awareness	8999-8911	20%	Petit Mal Seizure Disorder	8911	20%	20080812	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70% 	

ANALYSIS SUMMARY:  

Transient Alterations of Awareness.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s seizure disorder began in early 2007 when he was “observed stopping in mid sentence, only to pick back up where he left off sometimes roughly 30 seconds later.”  Neurology noted he had been discharged from the Marine Corps in 1995 for a seizure disorder described as “eye fluttering” followed by unresponsiveness for a few minutes.  The CI was accepted into the Army in 2003 following a negative EEG at enlistment.  

During the neurology examination in December 2007, the CI reported daily episodes of eye fluttering which were often preceded by a headache and lasted up to an hour after the eye fluttering ceased.  He reported having one to four episodes per day since 1995.  The CI’s fiancé witnessed the episodes and confirmed he was inattentive, but would respond somewhat with “huh.”  The episodes lasted for less than one minute in duration and were not associated with any convulsions, automatisms or bowel/bladder incontinence.  The examiner noted there was no history of prior head/neck trauma.  The CI was started on Keppra, an anti-epileptic drug (AED), but a seizure evaluation, including EEGs and brain MRI, was normal.  At a neurology follow-up examination in January 2008 his episodes had reportedly decreased on Keppra, but he did not like the side effects so he was started on Lamictal.  The CI’s fiancé reported that on Lamictal the CI’s episodes were “a lot better” and the last witnessed episode was in April 2008.  The neurologist noted the CI’s history was compatible with absence seizures, and the CI reported having a seizure at age 4 or 5 when he lost consciousness for a few minutes, got up, and felt fine.  He also reported a history of a motor vehicle accident with loss of consciousness for a few minutes, but the examiner noted some records indicated that at one point the CI did not think he had lost consciousness.  He did not have a history of febrile seizures or a central nervous system infection.  

At the 12 August 2008 VA Compensation and Pension (C&P) examination, 10 months before separation, the CI reported periods of absence when he stopped talking, gazed blankly ahead and then seconds to minutes later would resume talking.  He denied incontinence, tongue biting or other symptoms related to seizures.  The CI reported having two episodes per day, but on Lamotrigine he had not had any episodes for 6 weeks (May 2008).  Neurologic examination was normal.  The VA examiner listed a diagnosis of petit mal seizure disorder.  

The 24 October 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, noted that in the week before video EEG monitoring in June 2008, the CI reported he was asked to stop his AED medication for a week and experienced one blank spell in that time
At the 12 February 2009 MEB NARSUM examination, 4 months prior to separation, the CI reported having his last known seizure in November 2008, but noted he was not working around others as often as before and it was possible he was continuing to have episodes since he was unaware of the episodes when they happened.  The examiner noted the CI was compliant with his medication.  A complete neurological examination a week before separation on 6 June 2009 was normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the seizure disorder 20%, analogously coded 8999-8911 (epilepsy, petit mal), citing “at least two episodes in the last six months.”  The VA also rated the seizure disorder 20%, 8911, based on the C&P examination, citing “at least one major seizure in the last two years, or at least two minor seizures in the last six months.”

The panel noted that there was no evidence of epileptic seizures on multiple EEGs, including long-term video EEG monitoring in this case; however, the CI’s episodes of transient alterations of awareness were analogous in symptoms and impairment to minor seizures and the PEB rated them as such.  Therefore, the panel considered a rating recommendation under 8999-8911.  There was evidence of “at least 2 minor seizures in the last 6 months” to support a 20% rating, but there was no evidence of “averaging at least 5 to 8 minor seizures weekly” proximate to separation to support a higher rating.  After due deliberation, considering all 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 seizure disorder.  

BOARD FINDINGS:  In the matter of the seizure disorder and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  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:

	PD-2017-03018
[AR NUMBER], XXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXX

	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.

Enclosure

	PD-2017-03018