RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04117
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20050406

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Food Service Specialist, medically separated for “idiopathic central nervous system hypersomnolence” 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 - 20041129	VARD - 20060718	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Idiopathic Central Nervous System Hypersomnolence	8108	10%	Idiopathic CNS Hypersomnolence	8999-8911	10%	20060216	
Cognitive Disorder NOS	Not Unfitting	Cognitive Disorder with Memory Loss	9399-9310	NSC	20060107	
Anxiety Disorder NOS, with PTSD Traits	Not Unfitting	Post Traumatic Stress Disorder	9411	30%	20060107	
Chronic Cervical Soft Tissue Injury	Not Unfitting	Diskogenic Disease of the Cervical Spine with Spondylosis	5237	10%	20060216	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Idiopathic Central Nervous System Hypersomnolence.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s sleep disorder was diagnosed via sleep study in June 2004.  The 2 August 2004 MEB NARSUM examination, 8 months prior to separation, noted complaints of excessive daytime sleepiness and low energy.  In 1992, the CI started to have gradual increase in need for sleep.  Her need for sleep worsened over the years.  In recent months, she had required 9-12 hours of sleep per night and became dependent on caffeine supplements.  The CI was unable to drive while taking muscle relaxants for her neck condition.  She was unable to go to the movie theaters because she would fall asleep within 5 minutes.  The CI denied cataplexy.  She was started on stimulant medication and reportedly achieved good results.  She was on work restrictions related to the diagnosis and the medication used to treat it.  Physical examination noted that she was alert and had no difficulty remaining awake.  

The 13 September 2004 MEB NARSUM addendum, 7 months prior to separation, noted complaints of difficulty concentrating, increased anxiety, low energy and increased feelings of fatigue.”  The CI reported she first became aware of sleepiness and fatigue in Iraq.  She was diagnosed with a sleep disorder and was taking medication with good results.  The CI also noted that during her time in the Gulf in 1991, she was raped.  She had been seen by a psychologist, once or twice a week up until 2 months prior.  Mental status examination was unremarkable.  The examiner noted that she did not appear tired.  The examiner stated, “most likely, her daytime somnolence has contributed to her cognitive deficits in general memory and delayed visual and auditory memory.”  The diagnoses of idiopathic central system hypersomnolence, cognitive disorder NOS, and anxiety disorder NOS with PTSD traits were recorded, and a Global Assessment of Functioning (GAF) score of 65 for mild symptoms and or impairment was assessed.  The condition of cognitive disorder NOS was noted to have mild impairment for further duty and the anxiety disorder was found to have no impairment for further military duty and mild industrial and social impairment.  

At the 16 February 2006 VA Compensation and Pension (C&P) evaluation, 10 months after separation, the CI reported she slept 8 hours per night and took a stimulant medication.  She reported that she did well with the medication.  At the time of the examination, the CI was in nursing school and was not having any problems with studying because of the medication.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the sleep disorder 10%, coded 8108 (narcolepsy).  The VASRD directive rates narcolepsy as epilepsy: petit mal, under the general rating formula for minor seizures.  However, the PEB used AR 635-40, appendix B-107 and applied a 10% rating for mild impairment in social and industrial adaptability.  The VA also rated the idiopathic central nervous system hypersomnolence condition 10%, coded analogously as 8911, (epilepsy, petit mal), based on the C&P examination 10 months after separation, citing symptoms similar to the need for continuous medication for the control of epilepsy.  The higher rating of 20% under the 8911 code is warranted when there is at least one major seizure in the last 2 years; or at least two minor seizures in the last 6 months.  The panel notes the absence of cataplexy and therefore, the disability is not reflective of a 20% rating.  The panel also considered the rating scheme prescribed under VASRD 4.130 for social and occupational impairment since the PEB rated the condition based on social or occupational impairment.  The panel considered the NARSUM addendum, the C&P examination and the commander’s statement.  The commander indicated the CI was not capable of performing her duties in a combat or peaceful environment, and that she was unable to accomplish tasks that required mental tracking because she had “short-term memory loss.”  However, there was no report of the CI falling asleep on duty.  As noted above, the NARSUM psychiatrist indicated that her memory problem was most likely due to her sleep disorder, which had improved significantly with medication.  The C&P examiner noted the CI was having no problems in nursing school and medication had controlled her sleep symptoms.  Both the NARSUM and C&P examination noted the CI’s condition had improved significantly with medication and was stable.  Therefore, panel members agreed, there was no route to a higher rating under 4.130.  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 disorder.  

Contended PEB Conditions:  Cognitive Disorder NOS; Anxiety Disorder NOS with PTSD Traits.  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 noted on the profile, restrictions related to the cognitive disorder or anxiety disorder were not present, and neither of the two conditions were judged to fail retention standards.  The NARSUM addendum documented the anxiety disorder presented no impairment for further military duty, and the cognitive disorder was considered mild.  The commander's statement implicated both conditions, but the CI was having no problems with cognitive functioning after separation (nursing student) and her cognitive disorder was recorded as mild on the NARSUM.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the cognitive disorder or anxiety disorder so no additional disability ratings are recommended.  

Contended PEB Condition:  Chronic Cervical Soft Tissue Injury.  The chronic cervical soft tissue injury was profiled and physical restrictions were noted.  The NARSUM examiner opined this condition was disabling, did not allow deployability and did not meet retention standards.  The CI complained of neck pain and an MRI showed bulging disks from C4 through C7.  Physical examination of the cervical spine revealed pain elicited by left side rotation at the extreme limits of range of motion (ROM), but ROM measurements were not recorded.  The orthopedic exam, 11 months before separation, showed forward flexion and extension at 40 degrees each without spasm.  The C&P examination, 10 months after separation, recorded flexion to 40 degrees without pain, and no spasm found on palpation.  The commander's statement indicated the CI’s injuries prevented her from performing her duties as a food service sergeant since she was unable to stand for extended periods of time.  The condition was noted to have caused her to be taken off regular shift work.  After due deliberation, the panel majority agreed there was not a preponderance of evidence with regard to the functional impairment of the chronic cervical soft tissue condition to favor recommendation as an additionally unfitting condition for disability rating.  

BOARD FINDINGS:  In the matter of the sleep disorder and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the contended cognitive disorder and anxiety disorder, the panel recommends no change from the PEB determinations as not unfitting.  In the matter of the contended chronic cervical soft tissue injury, the panel majority recommends no change from the PEB determination as not unfitting.  The single voter for dissent recommends modification to 20%, but does not elect to submit a minority opinion.  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 20070424, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20180006252, 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