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Narcolepsy

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MPsgt

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I've got an Honorably discharged (non-combat) Veteran from the Navy for an undiagnosed sleep disorder.  The VA has rated him 0% for Narcolepsy.  In my research, and through my understanding.  IAW 38 CFR 4.124a, 8108 Narcolepsy rate as for 8911 Epilepsy, petit mal.  Since the VA acknowledges Narcolepsy, shouldn't they confer 8911 Epilepsy, Petit mal to determine his rating above 0%?  By meeting the definition, Epilepsy, petit mal of more than 10 minor seizures weekly.  Shouldn't the VA have rated him at least 80% for Narcolepsy that's uncontrolled by medication?  I'm unsure if the VA even acknowledges or treats his petit mal seizures in association with the Narcolepsy.  I'm ready to submit a NOD based on this information but, I'd like further and more experienced guidance, before doing so.

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 Assuming all his conditions are Service Connected? or no problem getting them S.C.? In other words he has medical records on this from his military service?

if so keep reading  if not then he will need a Nexus as you probably know!!! to connect this condition to his military days  using STR's

you need to watch out for pyramiding symptoms and diagnoses.

walking in shallow water here.

Narcolepsy

also if these symptoms run together then maybe he could file secondary claims 

does he have a C-PAP Machine That the VA Issued him and said it was medically necessary he needs the C-PAP? for a Sleep Apnea Claim...usually S.A. CLAIMS is 50% With use of a C-Pap but if he has the symptoms of other conditions  this is where the pyramiding comes into effect  and they will not rate a symptom from  another condition with the same symptom . if that makes any sense?

Epilepsy is a condition involving recurrent, unprovoked seizures. Seizures are defined as a period of abnormal electrical brain activity in the brain which causes the body to act uncontrollably and oftentimes unconsciously. Also, seizures may cause the brain the sense things that aren’t there (hallucinations). A lot of people with epilepsy have more than one type of seizure and might also have other neurological symptoms as well. Common symptoms associated with seizures include, but aren’t limited to the following:

Unconsciousness

Severe shaking of the body

Drooling

Mumbling

Falling down

Vomiting

Fear

Anger

Confusion

Sweating

Inappropriate behavior

Someone suffering from seizures may suffer from a single symptom or multiple symptoms during a seizure.  It may even appear that the person isn’t suffering a seizure at all because the symptoms aren’t obvious, but the person experiencing the seizure may act unusually, and they won’t remember anything during the seizure.

In order to receive VA disability compensation for a seizure disorder, a doctor must have witnessed the veteran experience a seizure and also must have performed neurological testing. It is also extremely important for the doctor to document the severity and frequency of the seizures. All epileptic/seizure disorders are rated according to the following criteria:

Major SeizuresMinor SeizuresRating Percentage

12 or more in the past yearN/A100%

4-11 in the past year11 or more per week80%

3 in the past year9-10 per week60%

2 in the past year5-8 per week40%

1 in the past 2 years2 in the past 6 months20%

Requires constant medication to control seizures or there is a definite diagnosis of epilepsy with history of seizuresRequires constant medication to control seizures or there is a definite diagnosis of epilepsy with history of seizures10%

 

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24 minutes ago, MPsgt said:

I've got an Honorably discharged (non-combat) Veteran from the Navy for an undiagnosed sleep disorder.  The VA has rated him 0% for Narcolepsy.  In my research, and through my understanding.  IAW 38 CFR 4.124a, 8108 Narcolepsy rate as for 8911 Epilepsy, petit mal.  Since the VA acknowledges Narcolepsy, shouldn't they confer 8911 Epilepsy, Petit mal to determine his rating above 0%?  By meeting the definition, Epilepsy, petit mal of more than 10 minor seizures weekly.  Shouldn't the VA have rated him at least 80% for Narcolepsy that's uncontrolled by medication?  I'm unsure if the VA even acknowledges or treats his petit mal seizures in association with the Narcolepsy.  I'm ready to submit a NOD based on this information but, I'd like further and more experienced guidance, before doing so.

The good thing is that the vet is SC 0%. Do you have a copy of the  SMR/STR that meets the 80% criteria for symptoms? If the service medical record is present for symptoms that meet the 80% criteria, by all means, file the NOD. 

If the Veteran you are representing has not been going to the VA or a private doctor, after-discharge, to follow up on the "symptoms" of Narcolepsy. A claim to  increase, will be difficult to be granted. The diagnosis alone won't help the veteran substantiate the increase. The diagnosis and "worsened symptoms" will. Veterans are compensated for symptoms, the diagnosis just opens the door. Symptoms knock that door down.

Here is part of an appealed case that granted a veteran Narcolepsy. Disregard the other issues. It provides valuable information on how to substantiate an increase for Narcolepsy. I hope this paints a better picture.

1. Entitlement to a rating in excess of 50 percent for obstructive sleep apnea, with narcolepsy, hypersomnolence, and disturbed sleep.

Narcolepsy with Cataplexy

As indicated, narcolepsy is rated under Diagnostic Code 8108 which provides that the disability be evaluated as petit mal epilepsy.  Petit mal epilepsy is rated under the general rating formula for minor seizures.  38 C.F.R. § 4.124a , Diagnostic Code 8911.  Under Diagnostic Code  8911, both the frequency and type of seizures that the Veteran experiences are considered in determining the appropriate rating.  A major seizure is characterized by generalized tonic-clonic convulsion with unconsciousness.  A minor seizure consists of a brief interruption in consciousness or conscious control associated with staring or rhythmic blinking of the eyes or nodding of the head (pure petit mal), or sudden jerking movements of the arms, trunk, or head (myoclonic type) or sudden loss of postural control (akinetic type).  38 C.F.R. § 4.124a, Diagnostic Code 8911.

Narcolepsy consists of recurrent, uncontrollable, brief episodes of sleep, often associated with hypnagogic or hypnopompic hallucinations, cataplexy, and sleep paralysis.  (See Dorland's Illustrated Medical Dictionary (32nd ed. 2012)).  However, narcolepsy and cataplexy are separate disorders.  Narcolepsy is a condition characterized by brief periods of sleep, while cataplexy is a condition in which there are abrupt attacks of muscular weakness and hypotonia.  See James v. Brown, 7 Vet. App. 495, 496 (1995) (citing Dorland's Illustrated Medical Dictionary (27th ed. 1988) for definition of cataplexy).

To warrant a rating for epilepsy, the seizures must be witnessed or verified at some time by a physician, and regarding the frequency of epileptiform attacks, competent, consistent lay testimony emphasizing convulsive and immediate post-convulsive characteristics may be accepted.  It is also provided that the frequency of seizures should be ascertained under the ordinary conditions of life while not hospitalized. 38 C.F.R. § 4.121. 

Under the rating criteria for petit mal epilepsy, a 10 percent disability rating is 
assigned for a confirmed diagnosis of epilepsy with a history of seizures.  A 20 percent disability rating is assigned when there has been at least one major seizure in the last two years; or at least two minor seizures in the last six months.  A 40 percent disability rating is assigned when there has been at least one major seizure in the last six months or two in the last year; or averaging at least five to eight minor seizures weekly.  A 60 percent disability rating is assigned when there has been an averaging of at least one major seizure in four months over the last year; or nine to ten minor seizures per week.  An 80 percent disability rating is assigned when there has been an averaging of at least one major seizure in three months over the last year; or more than 10 minor seizures weekly.  A 100 percent disability rating is assigned when there has been an average of at least one major seizure per month over the last year.  38 C.F.R. § 4.124a, Diagnostic Code 8911.

A VA medical record dated in August 2008 shows that the Veteran was said to have narcolepsy syndrome, which was a lifelong disease caused by an orexin deficit and associated with cataplexy and excessive daytime sleepiness.

VA outpatient treatment records dated from August 2008 to February 2010 show that the Veteran continued to experienced narcolepsy with cataplexy.  In April 2009, it was indicated that he had no problems with rebound cataplexy.  In May 2009 it was noted that he had one to two episodes of cataplexy during the preceding month.

A VA examination report dated in July 2009 shows that the Veteran was said to have a 20-year history of narcolepsy with cataplexy.  A typical attack was described as a loss of control of his muscle tone, nodding of the head and sometimes body function, feeling wiped out as if he cannot move any part of his body, and feeling like he is standing off in space.  It was said to be evoked by itself, with stress, and with anger or excitement.  It was alleviated by medication.  Over the preceding two years, he was said to have had 1,200 attacks in total, averaging 50 each month.  He kept no attack diary.  He added that he had lost many jobs as a result of the condition, and that the overall functional impairment included not being able to drive or play sports.  Following examination, the diagnosis was narcolepsy with cataplexy.  The examiner, a physician, indicated that the condition was active, and manifested by 10 narcolepsy attacks per week and six to eight cataplexy attacks per month.  Neurological examination was normal, and he did not have a seizure disorder.

A VA Narcolepsy Disability Benefits Questionnaire completed by the Veteran's physician in September 2012 shows, in pertinent part, that he was diagnosed with narcolepsy with cataplexy, excessive daytime sleepiness, sleep attacks, and sleep paralysis.  The frequency of cataplectic (narcoleptic) episodes was indicated to be more than 10 per week.  Anger was said to trigger the cataplexy, where his head would droop and feel jelly-like.  The examiner added that since the Veteran continued to have sleep attacks and episodes of cataplexy, it was hard for him to work.

In an October 2012 statement, a registered nurse who worked with the Veteran for more than two years indicated that she witnessed the Veteran experiencing the effects of narcolepsy on several occasions, to include during meetings and morning reports, and in the nurses' station at the computer.

A lay statement from the Veteran's supervisor received in October 2012 shows that the Veteran was said to have six to nine narcolepsy and cataplexy episodes a day just at work.

Additional lay statements received in October 2012 demonstrate that the Veteran experiences between five and 10 episodes of narcolepsy and/or cataplexy daily.

During the May 2015 hearing, the Veteran testified that he would experience more than 10 episodes of narcolepsy per day.  He added that he would experience three to four episodes of cataplexy per month.  He described that during such episodes he would lose body function and muscle control.

In light of the above and resolving all reasonable doubt in the Veteran's favor, the Board finds that he is entitled to a disability rating of 100 percent for narcolepsy.  In making this determination, the Board acknowledges that he has had at least, and often more than, 10 narcoleptic episodes on average per week (often daily), which is consistent with a higher 80 percent disability.  The Veteran is only entitled to a disability rating of 80 percent based solely on his narcolepsy as narcolepsy is rated as petit mal epilepsy under Diagnostic Code 8911. 

As indicated, Diagnostic Code 8911 provides for a 100 percent disability rating only in instances in which the seizure activity is characterized as major which contemplates tonic-clonic convulsions in addition to unconsciousness.  The medical evidence shows that the Veteran has been diagnosed with narcolepsy to include cataplexy.  He has testified that he experiences three to four episodes of cataplexy per month.  In addition, VA examiners have all confirmed ongoing monthly cataplexy episodes.  

In the case of this Veteran, the Board finds that the combination of narcolepsy and cataplexy results in attacks that are comparable to major seizure activity, including loss of muscle control.  Under these circumstances, the frequency of the Veteran's attacks, amounting to at least one per month, warrants a 100 percent disability rating under the criteria in Diagnostic Code 8911.  In making this determination, the Board has considered the VA examination reports along with the lay evidence of record.   In this regard, those providing lay statements are competent to describe the lay-observable symptomatology of the Veteran's narcolepsy and cataplexy.  See Layno v. Brown, 6 Vet. App. 465, 469 (1994) (noting competent lay evidence requires facts perceived through the use of the five senses).  Moreover, as to frequency of epileptic seizures, the Rating Schedule specifically provides that "competent, consistent lay testimony emphasizing convulsive and immediate post-convulsive characteristics may be accepted."  38 C.F.R. § 4.121. 

The Board notes that the regulations also provides that "[w]hen there is doubt as to the true nature of the epileptiform attacks, neurological observation in a hospital adequate to make such a study is necessary."  The RO did not order neurological observation in a hospital, and the Board concludes that a remand is not necessary here to obtain such a study or to obtain another medical opinion to decide the claim 
as the evidence of record is sufficient for that purpose.  

Accordingly, resolving the benefit of the doubt in favor of the Veteran, the Board will grant the higher disability rating of 100 percent for narcolepsy with cataplexy for the entire appeal period.  38 U.S.C.A. § 5107(b).  Furthermore, in light of the Board's assignment of a 100 percent schedular rating, the potential assignment of an extraschedular rating is rendered moot.

 

A separate 100 percent disability rating for narcolepsy with cataplexy is granted for the entire appeal period, subject to the applicable criteria governing the payment of monetary benefits.

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Is the "0" rating as NSC "0" or SC "0"?

We have had some narcolepsy vets here. This link is from one of them.

The veteran was awarded for narcolepsy due to heat stroke residuals,, and his nexus was his SW Asia service.

He had the analogous rating for narcolepsy ( analogous to petit mal)

 

https://community.hadit.com/topic/68776-what-to-do-for-narcolepsy-rating/

: I'm unsure if the VA even acknowledges or treats his petit mal seizures in association with the Narcolepsy.  I'm ready to submit a NOD based on this information but, I'd like further and more experienced guidance, before doing so."

He needs an inservice nexus- unless the "0" rating is already SC.

You need to go over the entire decision he got ,to prepare an adequate NOD.

If you can scan and post it here ,to include the evidence list( with this veteran's permission) -we can help more

(cover his C file #, name, (prior to scanning it)

 

 

 

Edited by Berta
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7 hours ago, Berta said:

Is the "0" rating as NSC "0" or SC "0"?

We have had some narcolepsy vets here. This link is from one of them.

The veteran was awarded for narcolepsy due to heat stroke residuals,, and his nexus was his SW Asia service.

He had the analogous rating for narcolepsy ( analogous to petit mal)

 

https://community.hadit.com/topic/68776-what-to-do-for-narcolepsy-rating/

: I'm unsure if the VA even acknowledges or treats his petit mal seizures in association with the Narcolepsy.  I'm ready to submit a NOD based on this information but, I'd like further and more experienced guidance, before doing so."

He needs an inservice nexus- unless the "0" rating is already SC.

You need to go over the entire decision he got ,to prepare an adequate NOD.

If you can scan and post it here ,to include the evidence list( with this veteran's permission) -we can help more

(cover his C file #, name, (prior to scanning it)

 

Attached is the most recent copy of the Veterans Decision Letter single page of Military Medical Record acknowledging Narcolepsy.  I appreciate the assistance with this deserving Veteran.

6
7

 

Medical Record (Naval).pdf

Decision Letter.pdf

Edited by MPsgt
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14 hours ago, Buck52 said:

 Assuming all his conditions are Service Connected? or no problem getting them S.C.? In other words he has medical records on this from his military service?

if so keep reading  if not then he will need a Nexus as you probably know!!! to connect this condition to his military days  using STR's

you need to watch out for pyramiding symptoms and diagnoses.

walking in shallow water here.

Narcolepsy

also if these symptoms run together then maybe he could file secondary claims 

does he have a C-PAP Machine That the VA Issued him and said it was medically necessary he needs the C-PAP? for a Sleep Apnea Claim...usually S.A. CLAIMS is 50% With use of a C-Pap but if he has the symptoms of other conditions  this is where the pyramiding comes into effect  and they will not rate a symptom from  another condition with the same symptom . if that makes any sense?

Epilepsy is a condition involving recurrent, unprovoked seizures. Seizures are defined as a period of abnormal electrical brain activity in the brain which causes the body to act uncontrollably and oftentimes unconsciously. Also, seizures may cause the brain the sense things that aren’t there (hallucinations). A lot of people with epilepsy have more than one type of seizure and might also have other neurological symptoms as well. Common symptoms associated with seizures include, but aren’t limited to the following:

Unconsciousness

Severe shaking of the body

Drooling

Mumbling

Falling down

Vomiting

Fear

Anger

Confusion

Sweating

Inappropriate behavior

Someone suffering from seizures may suffer from a single symptom or multiple symptoms during a seizure.  It may even appear that the person isn’t suffering a seizure at all because the symptoms aren’t obvious, but the person experiencing the seizure may act unusually, and they won’t remember anything during the seizure.

In order to receive VA disability compensation for a seizure disorder, a doctor must have witnessed the veteran experience a seizure and also must have performed neurological testing. It is also extremely important for the doctor to document the severity and frequency of the seizures. All epileptic/seizure disorders are rated according to the following criteria:

Major SeizuresMinor SeizuresRating Percentage

12 or more in the past yearN/A100%

4-11 in the past year11 or more per week80%

3 in the past year9-10 per week60%

2 in the past year5-8 per week40%

1 in the past 2 years2 in the past 6 months20%

Requires constant medication to control seizures or there is a definite diagnosis of epilepsy with history of seizuresRequires constant medication to control seizures or there is a definite diagnosis of epilepsy with history of seizures10%

 

Good Info and refer to t-bird for Veterans decision letter.

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Be careful on representation. You are only allowed to represent one Vet in your lifetime unless you are a National Service Officer of a recognized VSO or accredited. By announcing you "have an honorably discharged Vet" implies you are his legal representative and doing his claims. That's a far cry from "I'm asking because he asked me to ask." I do not say this to be mean but to protect you from the VA. This forum offers advice -and darn good advice in most cases. However, unless the author is accredited or a VSO, it's not advisable to announce ownership of the claim. Doing so can endanger your own rating. Best of luck on the Veteran, sir.

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