Grand mal epilepsy is a recurrent paroxysmal disorder of cerebral function marked by sudden, brief attacks of altered consciousness and uncontrolled motor activity.

Finding the cause for the abnormal discharge of cerebral neurons is not always possible. Scar tissue, brain tumor, or a progressive neurological disorder may be the etiology. Occasionally, fever, hypoglycemia, or hypoxia may occur prior to a seizure. However, in the majority of cases, there is no pathological basis. These cases are said to have idiopathic etiologies.

A grand mal seizure is characterized by: a sudden cry; loss of consciousness; falling down; and a brief period of muscle rigidity (tonic phase). These manifestations are then followed by a 1- to 2-minute period of severe, violent, rhythmic convulsive shaking (clonic phase). This is followed by a short, deep, relaxed sleep, and then a return of consciousness with no memory of the event. There is usually a period of confusion, headache, or drowsiness after the seizure.

A detailed medical history is necessary. Other diagnostic measures include: physical and neurological examinations; electroencephalography (EEG); computed tomography (CT) scan; magnetic resonance imaging (MRI); blood tests; and lumbar puncture. Investigations may be completed to disclose any metabolic, endocrine or other neurological causes for the seizure.

Medication can control or greatly reduce seizure activity. Close supervision of dosage and specific drug choice is needed. Occasionally, surgery may be an option. In such cases, the site of the seizure activity in the brain is surgically removed.

If persons have not experienced a seizure for 6 months to 1 year, most countries will permit driving an automobile. Participation in sports is allowed. If seizures are uncontrollable, then driving, swimming, operating certain machinery, and ladder-climbing should not be allowed.

• Rating Specialists must bear in mind that the epileptic, although his or her seizures are controlled, may find employment and rehabilitation difficult to attain due to employer reluctance to the hiring of the epileptic. 

• Where a case is encountered with a definite history of unemployment, full and complete development should be undertaken to ascertain whether the epilepsy is the determining factor in his or her inability to obtain employment. 

• When rating grand mal epilepsy, the primary factor for rating severity is the frequency of seizures and not the severity of the seizures.

• A diagnosis of epilepsy must be confirmed/verified by a medical doctor. This does not mean that the MD has to personally witness a seizure but that he has to have enough medical evidence to make, confirm, or verify the diagnosis.

• Psychiatric disorders secondary to epilepsy should be rated separately.

• This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309(a). [chronic disease].

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• A major seizure is characterized by the 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).

• When continuous medication is shown necessary for the control of epilepsy, the minimum evaluation will be 10%. This rating will not be combined with any other rating for epilepsy.

• In the presence of major and minor seizures, rate the predominating type.

• There will be no distinction between diurnal and nocturnal major seizures.

• A thorough study of all material in 38 CFR 4.121 and 38 CFR 4.122 of the preface and under the ratings for epilepsy is necessary prior to any rating action.