RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXXX CASE: PD1200059 BRANCH OF SERVICE: ARMY BOARD DATE: 20130403 SEPARATION DATE: 20071118 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (31B20/Emergency Dispatcher) medically separated for epilepsy. The CI related three seizures between March 2006 and April 2007, the first being a grand mal that caused him to blackout. The epilepsy condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS). He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The epilepsy condition, characterized as “seizures, epilepsy” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated epilepsy as unfitting rated 10%, referencing AR 635- 40. The CI made no appeals, and was medically separated with that disability rating. CI CONTENTION: “Request review of my disability rating, for fairness and accuracy. With research gathered on the VA rating system, I believe the rating I received from the Army may have been to low.” SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting epilepsy condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20070810 VA - (51 Mos. Post-Separation) Effective - 20100401 Condition Code Rating Condition Code Rating Exam Epilepsy, Partial Motor w/ Secondary Generalization 8999-8910 10% Seizure Disorder 8910 10%* 20110815 No Additional MEB/PEB Entries Other x 2 20110815 Combined: 10% Combined: 20% Derived from VA Rating Decision (VARD) dated 20120327 (most proximate to date of separation) *No change to rating with subsequent C&P exam ANALYSIS SUMMARY: Epilepsy Condition. Service treatment records (STRs) indicated the CI experienced a convulsion associated with reported loss of consciousness (LOC) while stationed in Germany, 14 March 2006. The seizure was not witnessed and was without incontinence or tongue biting. His father found him in the kitchen about 20 minutes after the event. The CI was sluggish but conversant and transported to the hospital, where the he was hospitalized for 2 days and started on anti-epileptic medication. Neurology consult, 2 months later diagnosed convulsive disorder. The CI reported a second convulsion on 25 October 2006. The CI presented to the emergency room (ER) on 27 October 2006, stating he had been seen in another ER on 25 October after a witnessed seizure. Reportedly he was told that he flopped around uncontrollably and was speaking incoherently for 15 minutes. The CI reported, during the seizure on 25 October, he bit his tongue and hit his head, but on examination no oral abnormality or visible bruising of the head or body was noted. A possible seizure was diagnosed. On 25 January 2007, the CI was evaluated by neurologist who diagnosed “partial epilepsy with secondary generalization.” On 17 April 2007, the CI presented to the ER for follow up of a reported seizure that occurred on 13 April which was not witnessed. The CI stated he felt the seizure beginning before he lost conscious. He remembered the time just before it all happened and he was able to determine by the time he awakened that it was about 10 minutes of unconscious time. There was no tongue biting and no bruising noted on examination. After having medications adjusted he remained seizure free until the time of the MEB/narrative summary (NARSUM). A magnetic resonance imaging (MRI) performed 13 November 2006 demonstrated no significant intracranial abnormality. On 13 March 2007, the CI had a normal electroencephalogram study in both sleep and waking states. The MEB/NARSUM evaluation, 23 July 2007, 4 months prior to separation, noted the description of the CI’s first convulsion was consistent with a grand mal seizure. The general physical examination was normal. The CI was non-attendant for the VA Compensation & Pension (C&P) exam; he had returned to Germany and was evaluated by his treating physician in Germany. This evaluation took place 15 August 2011, approximately 4 years after separation. At this time the CI had no seizure activity in 2 years. The PEB and VA chose the same coding option, 8910 (grand mal seizures) for the condition, and assigned the same 10% rating for “a confirmed diagnosis of epilepsy with a history of seizures” that requires continuous medication for control. A rating of 20% under the 8910 code would require “at least one major seizure in the last 2 years; or at least two minor seizures in the last 6 months. After review of the records the Board unanimously agreed the CI in the last 2 years prior to separation, had one documented grand mal seizure, March 2006 (within 2 years of separation) and two possible minor seizures on 25 October 2006 (greater than a year from separation) and 13 April 2007 (within 6 months of separation). After deliberation the Board agreed the records supports a rating of 20% under 8910 for one major seizure in the last 2 years. The VA noted that the CI had not had a major seizure within the last 2 years prior to its exam; however, that was 4 years after separation. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the epilepsy condition. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. As discussed above, PEB reliance on the AR 40-501 for rating epilepsy was operant in this case and the condition was adjudicated independently of that regulation by the Board. In the matter of the epilepsy condition, the Board unanimously recommends a disability rating of 20% coded 8910 IAW §4.124a. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation: UNFITTING CONDITION VASRD CODE RATING Epilepsy, Partial Motor w/ Secondary Generalization 8999-8910 20% COMBINED 20% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120112, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxxxxx, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202- 3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxx, AR20130007442 (PD201200059) 1. I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation to modify the individual’s disability rating to 20% without recharacterization of the individual’s separation. This decision is final. 2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum. 3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures. BY ORDER OF THE SECRETARY OF THE ARMY: Encl xxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)