RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX  	CASE:  PD-2017-04938
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20050118

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

CI CONTENTION:  Review requested of the seizure disorder as well as additional conditions not identified by the Medical Evaluation Board (MEB) and/or Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 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 - 20040728	VARD – 20060331 and 20060720 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Seizure Disorder… 	8910-8108	10%	Seizure Disorder	8911-8108	10%	20050630	
Major Depressive Disorder 	Cat II	Major Depressive Disorder	9434	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:   

Seizure Disorder.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI reported sleep problems in the summer of 2002, which included oversleeping in the morning, despite having adequate time to sleep, and falling asleep at work due to excessive tiredness.  A multiple sleep latency test and EEG results suggested seizure activity and he was started on anti-seizure and anti-depressant (for probable narcolepsy) medications with some improvement in his fatigue.  During the 25 March 2004 MEB NARSUM examination, 10 months prior to separation, he complained of constant tiredness.  The examiner did not note any report of a clinical seizure (falling out, starring spells, abnormal behaviors, or a seizure aura) and physical findings, including a neurological examination, were unremarkable.  At the 30 June 2005 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported he was not taking any medication due to financial reasons.  He complained of tiredness and sleep difficulties, and was told that he had “many seizures” in his sleep based on previous studies. The examination was unremarkable, and a diagnosis of seizure disorder “by history” was recorded.
The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the seizure disorder 10%, coded 8910-8108 (epilepsy, grand mal-narcolepsy).  The VA also rated the seizure disorder 10%, but analogously coded 8911-8108 (epilepsy, petit mal-narcolepsy), based on the C&P examination, citing a confirmed diagnosis of epilepsy with a history of seizures or continuous medication for the control of epilepsy.  Panel members noted that the STR did not document a single seizure in the 6 months prior to separation, and that there was no indication that the CI suddenly fell asleep while engaged in activities or suffered impairing fatigue.  Thus, a rating higher than 10% was not warranted.  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.  

Contended PEB Condition:  Major Depressive Disorder (Existed Prior to Service without Permanent Service Aggravation).  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  Although the mental health condition was temporarily S4 profile in March 2004, there were no restrictions, and the condition was also not specifically implicated in the commander’s statement.  According to DoDI 1338.38.E3.P3.3.4 (cause and effect relationship), “regardless of the presence of illness or injury, inadequate performance of duty, by itself, shall not be considered as evidence of unfitness due to physical disability unless it is established that there is a cause and effect relationship between the two factors.”  The term “physical disability” includes mental disease (E2.1.25), and the STR demonstrated one incident when the CI made a suicidal gesture with a knife during an argument with a girlfriend.  That incident occurred in March 2004 and was likely the genesis of the temporary profile.  There were no additional suicidal behaviors or hospitalizations, and treatment records documented resolved mood symptoms. The last mental health entry, 1 month prior to separation, recorded a completely normal mental status examination and a Global Assessment of Functioning score of 80 for absent or minimal symptoms.  Panel members agreed there was not a preponderance of medical evidence in the STR to support that the CI’s major depressive disorder would have independently cut his career short.  Additionally, there was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the seizure disorder associated with hypersomnia and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.   In the matter of the contended major depressive disorder, the panel agrees it cannot recommend it for an additional disability rating.  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.   

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04938.

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 rating modification or re-characterization 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 modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.

						Sincerely,