RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04335
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060721

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E4, Food Service Operator, medically separated for “generalized seizure disorder” with a disability rating of 10%.  

CI CONTENTION:  Rating for seizures should be higher.  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 - 20060626	VARD - 20070824	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Generalized Seizure Disorder	8910	10%	Seizure Disorder	8911	20%	20070725	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Generalized Seizure Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s seizure disorder began in Iraq in November 2005 when he fell, lost consciousness and recalled Soldiers trying to restrain his legs while he was fighting them not knowing what was going on.  He reported another similar episode in Iraq and while at home on leave.  Electroencephalogram was normal.  He reported daydreaming a lot associated with hearing voices as a child but was never diagnosed with a disorder.  He was taking Topamax (anti-convulsion).  Neurology diagnosed generalized convulsive myoclonic disorder.  During the 12 January 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, a diagnosis of simple, partial seizure was rendered.  
The 3 March 2006 MEB NARSUM examination, 5 months prior to separation, noted complaints of memory problems and an occasional twitching sensation that felt like spider webs on his face.  Sometimes he had numbness in his fingertips and toes.  Neuroimaging of the head was normal.  The examiner noted the last seizure activity was 20 January 2006, but did not differentiate whether it was major or minor.  The CI’s medication was changed from Topomax to Depakote (anti-seizure).  Physical examination was unremarkable.  The 12 April 2006 MEB NARSUM addendum noted no seizure activity for 3 months since stabilizing on Depakote, but he did report continued episodes of jerking.  His Depakote level was at a therapeutic dose.  

At the 25 July 2007 VA Compensation and Pension (C&P) evaluation, 12 months after separation, the CI reported tremors, twitches and jerks, usually when tired.  He was taking Valproic acid (anti-convulsion).  He reported no seizures since discharge.  Physical examination was unremarkable.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the seizure disorder 10%, coded 8910 (epilepsy, grand mal), citing treatment had aborted seizure activity.  The VA rated the seizure disorder 20%, coded 8911 (epilepsy, petit mal), based on the C&P examination, citing STR entries showing three seizures in the past 2 years with the last seizure occurring in January 2006.  

As per VASRD 4.124, generalized seizure disorder is coded 8910 and the criteria for rating epilepsy are based on the frequency of major or minor seizures.  The rating of 20% required at least 1 major seizure in the last 2 years; or at least 2 minor seizures in the past 6 months.  The clinical description of the CI’s initial seizure is consistent with VA criteria for a major seizure (generalized with loss of consciousness).  Neurology also documented the presence of partial complex seizures (minor seizures.)  The panel could not differentiate whether the last seizure, reported on NARSUM as January 2006, was major or minor.  Members concluded the evidence best matched the 20% criteria.  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 8910.  

BOARD FINDINGS:  In the matter of the seizure disorder, the panel recommends a disability rating of 20%, coded 8910 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	
Generalized Seizure Disorder	8910	20%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170519, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20180006275, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs and to the counsel you listed on your application, XXXXXXXXXXXXXXXXXX.

Sincerely,					      
Enclosure