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AF | PDBR | CY2013 | PD-2013-02137
Original file (PD-2013-02137.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02137
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20150324
SEPARATION DATE: 20060412


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Health Services Management) medically separated for narcolepsy. The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty. He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB). Narcolepsy was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other condition was submitted by the MEB. The Informal PEB (IPEB) adjudicated narcolepsy as unfitting rated 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). Although the MEB Board Proceedings and narrative summary ( NARSUM ) did not list tobacco habituation , the IPEB adjudicated it as a C ategory III condition (not separately unfit and not compensable or ratable). The CI made no appeals and was medically separated.


CI CONTENTION: “My back continues to hurt me. It keeps me from enjoying several things, working out and holding my child for long periods of time. I also must take Zoloft for the rest of my life. Thank you for the review!”


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’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/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. The Board 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, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


 RATING COMPARISON :

IPEB – Dated 20060309
 VA* - (~3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Narcolepsy… 8108 10% Narcolepsy 8108 40% 20060713
Other x 1 (Not In Scope)
 Other x 8
RATING: 10%
 RATING: 40%
* Derived from VA Rating Decision (VA RD ) dated 20 061012 (most proximate to date of separation [ DOS ] ) .



ANALYSIS SUMMARY:

Narcolepsy Condition. The CI was referred to pulmonary medicine on 26 September 2005 for evaluation of an unrelated condition and observed to be asleep in the waiting room. Questioning revealed excessive daytime sleepiness and further evaluation was recommended. A sleep study on 12 December 2005 was significant for very mild obstructive sleep apnea (OSA). He underwent a multiple sleep latency test the next day which was diagnostic of narcolepsy. He was seen for a separate issue in mental health on 23 January 2006 and reported a one-year history of falling asleep at work when “things were slow.” He was begun on medications, but did not tolerate the first medication, but a different medication improved his symptoms without the unacceptable side effects. Follow-up sleep studies were scheduled, but it is not clear that they were accomplished. The commander noted that the CI could work full shifts, but had difficulty concentrating and completing assigned tasks. It was not noted that he fell asleep at work. The NARSUM, dated 21 February 2006, documented that the CI was tolerating the second medicine and that it was “working well.” He still had episodic daytime somnolence, but it is not clear if this meant that he was episodically sleepy or actually fell asleep during the day. The OSA was mild and did not require treatment. At the VA Compensation and Pension (C&P) examination performed 3 months after separation, the CI reported a good response to treatment and no side effects. No effects on the activities of daily living were present. He was working without significant impairment.

The Board directed attention to its rating recommendation based on the above evidence. The PEB and VA both used the 8108 code (narcolepsy), but rated the condition at 10% and 40%, respectively. The Board observed that the VA rater cited the 23 January 2006 mental health note which recorded that, over the past year, the CI fell asleep at work when things were slow. The frequency of this was not recorded though. The NARSUM noted episodic somnolence, but also did not record a frequency and it is not clear if the CI actually still fell asleep. The VA C&P clearly noted that the treated narcolepsy no longer had a significant effect on either his work or daily life. The use of daily medications supports a 10% rating. Two (confirmed) episodes over the previous 6 months are needed to support a higher 20% rating; the actual frequency of episodes is not documented. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination 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. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. 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 re-characterization of the CI’s disability and separation determination.
The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131102, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record





XXXXXXXXXXXXXXX
President
Physical Disability Board of Revi
SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762


Dear XXXXXXXXXXXXXXX:
        
Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2013-02137.

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

Sincerely,




XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency


Attachment:
Record of Proceedings

cc:
SAF/MRBR

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