RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03196
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080128

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Aerospace Maintenance Craftsman, medically separated for “narcolepsy” with a disability rating of 20%.  

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 - 20071212	VARD - 20080722	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Narcolepsy	8108	20%	Excessive Daytime Somnolence 	8199-8108	10%	20080714	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Narcolepsy.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s narcolepsy began over a 3-year period when he would fall asleep in less than 5 minutes when not active.  He reported not feeling safe working as a crew chief, but could work a 12-hour shift if kept busy.  He was involved in one motor vehicle accident but denied that this was caused by his condition.  A sleep study in September 2007 was consistent with excessive daytime somnolence.  The 28 November 2007 MEB NARSUM examination, 2 months prior to separation, noted CI complaints of persistent symptoms, but much improvement with Provigil (stimulant).  The physical examination was essentially normal. 

At the 29 May 2008 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported falling asleep at inappropriate times.  The course had been intermittent with remissions.  He was employed full-time as a farmer and symptoms caused some effect on instrumental activities of daily living.  Physical examination was unremarkable.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the narcolepsy 20%, coded 8108 (narcolepsy), citing definite industrial impairment.  The VA rated the excessive daytime somnolence 10%, analogously coded 8199-8108, based on the C&P examination, citing the sleep study diagnosis and a history of falling asleep quickly at inappropriate times, but no documentation of frequent episodes.  Panel members noted that the rating options under code 8108 rely on the frequency and timing of “seizures.”  The panel adjudged that episodes of unplanned falling asleep could be considered analogous to minor seizures, and carefully considered the frequency and timing of the CI’s episodes with deliberation over a 40% (averaging at least 5 to 8 minor seizures weekly) rating versus a 20% (at least 2 minor seizures in the last 6 months).  Treatment records reflected that medication was working well, but not completely, for daytime drowsiness.  The CI also stated that he could work a 12-hour shift if kept busy, and the VA examiner noted that he worked full-time with intermittent episodes and remissions.  Thus, panel members agreed there was insufficient evidence to support a higher 40% 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 narcolepsy.  

BOARD FINDINGS:  In the matter of the narcolepsy and IAW VASRD §4.124, 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:

SAF/MRB

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03196.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.