RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-05596
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050526

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Preventive Medicine Specialist, medically separated for “narcolepsy” with a disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 – 20050415	VARD - 20051121	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Narcolepsy	8108	10%	Narcolepsy 	8108	10%	20050614	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Narcolepsy.  According to the service treatment record and MEB narrative summary (NARSUM), the CI had a history of daytime somnolence (8 hours per day), and underwent three sleep studies which confirmed a diagnosis of narcolepsy.  Psychiatric evaluation on 24 March 2005 noted that he found it difficult to complete tasks due to an irresistible urge to sleep.  Peers would joke about his tendency to fall asleep “at the drop of a hat.”  There was no frank loss of consciousness precipitated by intense emotion, no vivid dreams prior to sleep or upon awakening, and no perceptual disturbances during the daytime episodes.  There was no history of narcolepsy, paralysis or delusions. The mental status examination was unremarkable.  The provider diagnosed narcolepsy with a Global Assessment of Functioning (GAF) score of 50 (serious bordering on moderate symptoms, impairment), and noted current control was adequate to permit functioning in low level tasks.  Impact on more complex occupational and social activities, e.g. driving, was limited and prohibited overall function.  He was unable to drive or perform guard duty and was assigned as a clerical aide.  During the 30 March 2005 MEB NARSUM examination, 2 months prior to separation, the CI reported falling asleep “at inopportune times.”  The narrative reflected the findings of the psychiatric evaluation and physical examination was essentially unremarkable.  

At the 14 June 2005 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported occasional insomnia from his Provigil (stimulant) medication.  He had break through episodes with some excessive daytime somnolence, but reported he was quite a bit improved.  Physical examination was unremarkable.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the narcolepsy 10%, coded 8108 (narcolepsy), citing excessive daytime sleepiness with slight improvement with medications.  The VA also rated the narcolepsy condition 10%, coded 8108, based on the C&P examination, citing confirmed diagnosis of narcolepsy, use of medication, and some reported excessive daytime somnolence.  Both the PEB and VA utilized code 8108, which requires rating under the General Rating Formula for Major and Minor Epileptic Seizures for petit mal epilepsy.  The psychiatric examination described typical symptoms of narcolepsy, noting daytime sleepiness with unpredictable napping throughout the day.  The sleep study noted the presence of REM sleep that occurred early in the sleep cycle, a finding consistent with a diagnosis of narcolepsy.  There was no evidence of sleep apnea, and cataplexy was absent.  The initial line of treatment for narcolepsy, Provigil, greatly improved the condition.  Panel members agreed there was no evidence of cataplexy, hallucinations, paralysis or other aspects of narcolepsy to render a higher disability 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 condition.  

BOARD FINDINGS:  In the matter of the narcolepsy condition 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. 

	PD-2017-05596

XXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXX

	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.

	PD-2017-05596