RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY 

CASE NUMBER: PD1201375 SEPARATION DATE: 20030805 

BOARD DATE: 20130122 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an active duty SGT/E-5 (13B20/Cannon Crew Member), medically 
separated for narcolepsy. The CI had multiple medical problems and was on profile for various 
aliments for a significant portion of his career. He was evaluated by a neurologist on 17 August 
2001 for headaches and leg pain. Among others, a diagnosis of “questionable sleep apnea” was 
made and nocturnal polysomnography (PSG-sleep study) recommended. While sleep apnea 
was not ruled out by the sleep study, the CI underwent another nocturnal polysomnography 
with continuous positive airway pressure breathing device (CPAP) and multiple sleep latency 
testing on 27 January 2002 was interpreted as diagnostic of narcolepsy. The CI did not meet 
retention standards for military duty in accordance with AR 40-501, or DoD Instructions. He 
was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The 
MEB also identified and forwarded three other conditions, identified in the rating chart below, 
as being medically acceptable. The Physical Evaluation Board (PEB) adjudicated the narcolepsy 
condition as unfitting, rated 20%, with cited application of Department of Defense Instruction 
(DoDI) 1332.39, and the Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The 
remaining conditions were determined to be not unfitting and not ratable. The CI initially 
appealed but subsequently withdrew his request. He was then medically separated. 

 

 

CI CONTENTION: “I have received a 50% rating from the VA for the same condition.” 

 

 

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 ratings for unfitting conditions will be 
reviewed in all cases. The unfitting narcolepsy condition, as requested for consideration meets 
the criteria prescribed in DoDI 6040.44 for Board purview and is addressed below. The 
condition of OSA with CPAP, considered part of the CI’s contended VA 50% rating proximate to 
separation, and any other 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 respective service Board for the Correction of Military Records. 

 


RATING COMPARISON: 

 

Service IPEB – Dated 20030303 

VA (At Separation) – All Effective Date 20030806 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

Narcolepsy 

8108 

20% 

Obstructive Sleep Apnea w/ 
Narcolepsy 

8108-6847 

50% 

20030828 

Maxillary Sinus Disease 

Not Unfitting 

Maxillary Sinus Disease, Post-Op Nasal 
Cysts 

6513 

0% 

20030828 

Chronic Testicular Pain 

Not Unfitting 

Post-Op Rt Testicle Scar 

7805 

0% 

20030828 

Post-Op Rt Testicle Scar 

7805 

0% 

20030828 

Chronic Lower Extremity 
Pain 

Not Unfitting 

Fibromyalgia w/ Lower Extremity (& 
Other) Pain 

5025 

10% 

20030828 

.No Additional MEB/PEB Entries. 

Heart Condition Mitral Valve Prolapse 

5025 

30% 

20030828 

Tinnitus 

6260 

10% 

20030828 

Asthma 

6602 

10% 

20030828 

Headaches 

8100 

10% 

20030828 

0% X 5 (Includes Above) / Not Service-Connected x 3 

20030828 

Combined: 20% 

Combined: 80% 



 

 

ANALYSIS SUMMARY: 

 

Narcolepsy Condition. Initial onset of symptoms was not detailed; however, in October 2001 
the CI presented to the pulmonary outpatient office on referral from the primary care clinic for 
evaluation of possible sleep apnea. The pulmonologist determined a need for a sleep study 
with multiple sleep latency (MSLT) tests; study findings were consistent with idiopathic 
hypersomnia (excessive sleepiness), and “possibly an occult OSA syndrome.” The CI was given a 
trial of CPAP and reported feeling better with CPAP. The physician stated, “It is difficult to know 
whether he has true idiopathic hypersomnia or simply mild sleep apnea not sufficiently treated 
with CPAP therapy and for this reason, nocturnal PSG with CPAP and MSLT were arranged.” 
Narcolepsy was diagnosed based on the MSLT results. Between the January 2002 sleep study 
and follow up visit with the sleep center, 11 months later, the CI was started on Modafinil and 
reportedly was doing extremely well with the medication. 

 

The narrative summary (NARSUM) dictated 10 months prior to separation acknowledged the 
result of the sleep study and it’s finding of narcolepsy and stated “No significant obstructive 
sleep apneas were identified,” and noted the CI no longer used CPAP. It was concluded the 
diagnosis of narcolepsy was incompatible with continued military service. A NARSUM 
addendum was conducted approximately 2 weeks after the initial NARSUM. It recorded the 
CI’s complaint of falling asleep easily and episodes of sudden paralysis which had occurred after 
events such as sneezing. The CI attributed a motor vehicle accident (MVA) to one of his sleep 
attacks, where he fell asleep and hit a truck. The CI subsequently lost his driver’s license. The 
examiner stated “His condition greatly effects his job in that he cannot accomplish tasks as a 
section chief because he falls asleep easily.” The CI’s diagnosis was narcolepsy with evidence of 
cataplexy (loss of muscle tone in response to emotional stimuli). Degree of military impairment 
was stated as “moderate,” with social and industrial impairment as “definite.” The 
commander’s performance statement (9 months prior to separation) stated, “The soldier does 
not have the ability to operate a motor vehicle or a weapon due to his narcolepsy.” He was 
working in his unit as a repair and upkeep NCO. The CI had had a profile that restricted his use 
of driving and power tools. 

 

A letter from a pulmonologist to an Army Administrative Law Attorney about 5 months prior to 
separation referenced the CI’s diagnosis of narcolepsy without cataplexy and indicated there 
was no contraindication to the operation of a motor vehicle or the operation of power 


equipment. The examiner stated: “(The CI’s) level of excessive somnolence is well controlled 
with Modafinil 400mg daily. There is no history of classic cataplexy.” 

 

At the VA Compensation and Pension (C&P) exam, approximately 3 weeks after separation, the 
examiner noted that the CI was being medically separated from the Army for narcolepsy 
evident by attacks of sleep that had occurred for at least 3 months. “He is on CPAP and he is 
getting medically boarded out for the same. Symptoms of classic narcolepsy are described. … 
This does him a moderate amount of physical impairment.” 

 

The Board directs its attention to its rating recommendation based on the above evidence. The 
PEB assigned a 20% rating (based on “at least 2 minor seizures in the last 6 months”). The VA 
rated the CI’s narcolepsy combined with obstructive sleep apnea (OSA) at 50%, coded 8101-
6847. The VA rating decision specified use of the 6847 OSA criteria for their rating, and did not 
specify frequency of narcolepsy events. The PEB specified application of DoDI 1332.39 (now 
rescinded) for their rating. Although sleep attacks were reported, there was no quantification 
of the frequency or timing of the episodes, and the CI did not experience episodes of cataplexy. 

 

The CI had a confirmed diagnosis of narcolepsy. VASRD rating criteria for narcolepsy uses the 
criteria of petit mal epilepsy, under the general rating formula for minor seizures. These 
criteria are based on the number of episodes over specified time periods; “5 to 8 minor seizures 
weekly” are rated at 40% and “at least 2 minor seizures in the last 6 months” are rated at 20%. 
The Board noted that there was no quantification of episodes of inappropriate falling asleep, 
other loss of awareness symptoms equivalent to a minor seizure aside from the single report of 
an MVA related to falling asleep, or cataplexy episodes. The pulmonary specialist indicated no 
episodes of cataplexy, and that excessive somnolence was controlled on medication. Rating 
strictly on the number and frequency of episodes specified in the record did not support rating 
above the 20% criteria. 

 

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable 
doubt), the Board concluded that there was insufficient cause to recommend a change in the 
PEB’s 20% adjudication for the narcolepsy 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 DoDI 1332.39 for rating narcolepsy was operant in this case and the condition was 
adjudicated independently of that instruction by the Board. In the matter of the narcolepsy 
condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB 
adjudication. There were no other conditions within the Board’s scope of review for 
consideration. 

 

 

RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of 
the CI’s disability and separation determination, as follows: 

 

UNFITTING CONDITION 

VASRD CODE 

RATING 

Narcolepsy 

8108 

20% 

COMBINED 

20% 



 


 

 

 

 

 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120904, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 XXXXXXXXXXXXXXXXXXXXX, DAF 

 Acting Director 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / XXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXX, AR20130003935 (PD201201375) 

 

 

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 and hereby deny the individual’s application. 

This decision is final. The individual concerned, counsel (if any), and any Members of 
Congress who have shown interest in this application have been notified of this decision 
by mail. 

 

 BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl XXXXXXXXXXXXXXXXX 

 Deputy Assistant Secretary 

 (Army Review Boards)