RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2012-01873 COUNSEL: HEARING DESIRED: NO ________________________________________________________________ THE APPLICANT REQUESTS THAT: His disability discharge, with severance pay (DWSP,) be changed to a disability retirement, rated at 50 percent, with the corresponding change to his narrative reason for separation, re- entry code and separation code. ________________________________________________________________ THE APPLICANT CONTENDS THAT: He should have been medically retired with a combined compensable disability rating of 40 percent for Neurocardiogenic Syncope and General Anxiety Disorder. Counsel states the applicant’s conditions resulted from his deployment to Southwest Asia and is unfitting for military service. In support of his appeal, the applicant provides a letter from counsel; copies of the Secretary of the Air Force Personnel Council (SAFPC) Physical Evaluation letter, dated 6 May 11, and extracts from his Department of Veterans Affairs/servicemembers’ medical record (DVA/SMR). The counsel’s complete submission, with attachments, is at Exhibit A. ________________________________________________________________ STATEMENT OF FACTS: The applicant, a former member of the Ohio Air National Guard (OHANG) was called to active duty on 8 Dec 10, in support of Operation NEW DAWN. Based on a Medical Evaluation Board (MEB) report, on 3 Nov 09, the applicant was diagnosed with neurocardiogenic syncope and his case was referred to Informal Physical Evaluation Board (IPEB). On 30 Mar 10, the IPEB found the applicant unfit for both anxiety disorder, not otherwise specified, and neurocardiogenic syncope, and determined that both conditions existed prior to service (EPTS), not permanently service aggravated. They recommended the applicant be discharged under other than Chapter 61, with a condition that was EPTS. The applicant nonconcurred with their findings and his case was referred to the Formal PEB (FPEB). On 29 Jun 10, the FPEB agreed with the unfit findings of the IPEB, but found his conditions service aggravated and recommended DWSP, with a combined compensable disability rating of 20 percent, with a 10 percent disability rating assigned to each condition. The applicant disagreed with the findings of the FPEB and requested his case, with rebuttal, be referred to SAFPC. On 6 May 11, SAFPC found only the applicant’s neurocardiogenic syncope condition unfitting and directed the applicant be discharged with severance pay with a 10 percent compensable disability rating. On 24 Aug 11, the applicant was discharged with severance pay with a compensable disability rating of 10 percent. ________________________________________________________________ THE AIR FORCE EVALUATION: AFPC/DPSD recommends denial, stating, in part, that based on a preponderance of the evidence no error or injustice occurred during the disability process. DPSD notes that SAFPC found the applicant’s neurocardiogenic syncope unfitting for continued military service. They noted the anxiety could be unfitting but the medical records did not provide evidence to support imposition of duty or mobility restrictions … the physical evaluation board is required by law to rate a disability using criteria outlined in the Veterans Affairs Schedule of Rating and Disabilities (VASRD). The applicant began to experience blackouts Aug 07 after several months of extensive work-up; he was diagnosed with neurocardiogenic syncope. In relation to his syncope, it has been associated with a chronic cough that reportedly stemmed from his exposure to a burn pit while deployed. The treating physician states in his note the applicant experienced reflex medicated cough syncope and his cough is the trigger for his episodes. Although he contends that he still experiences prodrome of lightheadiness, dizziness, shortness of breath, medical record provides evidence that he has been treated with Beta blocker and selective serotonin reuptake inhibitor (SSRI) and that he has not had any episodes of syncope since May 10. In relation to his anxiety the psychiatrist stated in his evaluation that "member does not suffer with a condition that would make him unfit; therefore there is insufficient evidence to show that his anxiety was an unfitting medical condition." SAFPC rated the applicant's neurocardiogenic syncope at the 10 percent disability rating per VASRD guidelines. The complete DPSD evaluation is at Exhibit C. ________________________________________________________________ APPLICANT'S REVIEW OF THE AIR FORCE EVALUATION: Counsel requests the applicant be medically retired with a combined rating of 50 percent. He notes that while the applicant did not report his condition immediately following his second deployment, he did report exposure to environmental toxins in theater and within a short period began to experience the symptoms which led to his diagnoses of neurocardiogenic syncope and anxiety disorder. He notes the disagreement in the advisory opinion as to whether both diagnoses of neurocardiogenic syncope and anxiety disorder were unfitting and that, in 2007; the DVA rated the applicant at 10 percent for anxiety. Further, a major difficulty in evaluating the applicant’s medical condition is that the condition of Neurocardiogenic Syncope is not listed in the VASRD. According to the VA, if a disability is not specifically listed in the rating schedule it is rated "analogous to a disability in which not only the functions affected, but anatomical localization and symptoms, are closely related." The applicant contends that his neurocardiogenic syncope condition is more closely associated with epilepsy or narcolepsy, and that his frequency of syncope episodes and his requirement for continuous medication justify a higher rating than either the VA or the military has given him. He understands the disability boards must rate his condition at the time of the evaluation. Although he did not have a complete copy of his medical records at the time that he submitted his appeal, he has since obtained additional copies of his medical and mental health records and the VA records for 2006 through 2011. At the time of the FPEB, he testified that he was experiencing four to five syncopal episodes per week. This is consistent with the frequency he was reporting to his physicians at the Toledo VA from around that same period of time and continuing through Nov 11. It is also evident from a review of his medical records, both medical and mental health that his syncopal episodes are closely related to stress and we would argue that his anxiety disorder exacerbates his neurocardiogenic syncope and both medical conditions render him unfit for military service. In the most current edition of the VASRD, narcolepsy (diagnostic code 8108) is rated as petit mal epilepsy. Under diagnostic code 8911, an individual qualifies for a 40 percent rating if they have experienced at least one major seizure in the last six months or two in the last year or average at least five to eight minor seizures weekly. A minor seizure is defined as "a brief interruption in consciousness or conscious control associated with staring or rhythmic blinking of the eyes or nodding of the head, or sudden jerking movements of the arms, trunk, or head, or sudden loss of postural control." This definition is consistent with the applicant’s description of his blackouts in his medical records at or near the time of his disability evaluations. In conclusion, they believe the applicant’s conditions are analogous of narcolepsy or petit mal epilepsy as found by the VA. Unlike the VA assessment, however, they believe that his epilepsy-like symptoms, the necessity of continuous medication and his description of at least five syncopal episodes per week justifies the higher rating of 40 percent for neurocardiogenic syncope. They also argue that his anxiety disorder both separately and as an exacerbating factor in his syncope, renders him unfit for military service and justifies a 10 percent rating. In further support of his appeal, the applicant provides counsel’s letter; extracts from his DVA/SMR, and various other documents. The counsel’s complete response, with attachments, is at (Exhibit D). ________________________________________________________________ THE BOARD CONCLUDES THAT: 1. The applicant has exhausted all remedies provided by existing law or regulations. 2. The application was timely filed. 3. Insufficient relevant evidence has been presented to demonstrate the existence of error or injustice. We took notice of the applicant's complete submission in judging the merits of the case. While the applicant contends that he should have received a higher rating for his unfitting conditions of neurocardiogenic syncope and anxiety disorder, we note that prior to his separation, the DVA records reflect that his symptoms had somewhat resolved and rated his vasovagal syncope condition at zero percent and the anxiety disorder at 10 percent. Contrarily, SAFPC found only the applicant’s analogous condition of neurocardiogenic syncope unfitting and rated it at 10 percent. In this respect, the applicant is advised that diagnoses and opinions resulting from a given set of symptoms and stressors, as reported by a patient at a given point in time, may change over time. Consequently, different medical providers may reach different diagnostic conclusions, based upon disclosures that may vary between the time initial evaluation and subsequent evaluation. Addressing the contention that the applicant’s syncope should be rated under seizure disorder, the Board collectively noted that based on the demonstrated evidence after a series of testing and evaluations, the applicant’s symptoms were more likely vasovagal in origin and not due to a seizure disorder. The applicant’s case has undergone an exhaustive review by the Air Force office of primary responsibility (OPR) and we did not find the evidence provided sufficient to overcome its assessment of the case. In addition, we note the Military Disability Evaluation System (MDES), operating until Title 10, United States Code (USC), only offers compensation for the medical condition that is the cause for career termination; and then only to the degree of impairment present at the time of final disposition or military separation. Conversely, the Department of Veterans Affairs (DVA), operating under Title 38, USC, rates all conditions that are determined to be service-connected, regardless of whether they were unfitting. In doing so, the DVA takes into account the fact that a person can acquire physical conditions during military service that, although not unfitting at the time of separation, may later progress in severity and alter the individual's lifestyle and future employability. Thus the two systems represent a continuum of medical care and disability compensation that starts with entry onto active duty and extends for the life of the veteran. Therefore, we agree with the opinion and recommendation of the OPR and adopt the rationale expressed as the basis for our decision the applicant has failed to sustain his burden that he has suffered from an error or injustice. In the absence of evidence to the contrary, we find no basis to recommend granting the relief sought in this application. ________________________________________________________________ THE BOARD DETERMINES THAT: The applicant be notified that the evidence presented did not demonstrate the existence of material error or injustice; that the application was denied without a personal appearance; and that the application will only be reconsidered upon the submission of newly discovered relevant evidence not considered with this application. ________________________________________________________________ The following members of the Board considered AFBCMR Docket Number BC-2012-01873 in Executive Session on 11 Feb 13, under the provisions of AFI 36-2603: The following documentary evidence was considered: Exhibit A. DD Form 149, dated 11 Apr 12, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Letter, AFPC/DPSD, dated 12 Jun 12. Exhibit D. Letter, SAF/MRBR, dated 19 Jun 12. Exhibit E. Letter, Applicant Counsel, dated 19 Jul 12, w/atchs. Panel Chair