RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX		BRANCH OF SERVICE: army
CASE NUMBER:  PD0900174		COMPONENT: regular
BOARD DATE: 20090610 		SEPARATION DATE: 20051210

SUMMARY OF CASE:  This covered individual (CI) was an active duty E-6 medically separated from the Army in 2005 after 11 years of service.  The medical basis for the separation was chronic low back pain (LBP) and syncope.  CI was referred to the PEB, found unfit and separated at 10% disability.  The PEB and VA both rated the LBP at 10%.  The PEB rated the syncope at 0% and the VA non-service connected finding is undergoing appeal.  CI had a combined VA rating of 30%.  The CI contends that many of his VA-claimed conditions were not properly rated by the military with Syncope at 0% and conditions of Post Traumatic Stress Disorder (PTSD), sleep apnea, hypertension, peptic ulcer disease, left knee pain, costochondritis, and hemorrhoids were not properly evaluated or rated for his level of restricted movement, daily functions, and social impairment.

The CI’s LBP multiple examinations and non-surgical treatments clearly supported the PEB rating of 10% and the rating was equivalent to the VA LBP rating.  The CI’s Syncope was widely described in the treatment record, underwent an extensive evaluation, pre-dated any consideration of disability processing, and included substantive provider evaluations that there were periods of complete loss of consciousness.  The diagnosis of Syncope was clearly made.  Many entries addressed Syncope, while only a few specified the sub-classification of being vasovagal in origin versus not otherwise specified (NOS).  The Board considered all of the VA-rated and contended conditions and did not find sufficient justification to add any additional unfitting conditions to those determined to be unfitting by the PEB (LBP and Syncope).  There were specifically no PTSD symptoms noted that might have been part of the Army’s unfitting determinations.  The level of duty impairment noted in the treatment records for conditions excluding LBP and syncope do not appear to be near an unfitting level even had they been formally diagnosed at the time of the PEB.      
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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 found that there did not appear to be any application of the Army Pain Rule and that the LBP was appropriately rated at 10%.  Although there was some indication in the medical records that syncope frequency may have been less than that noted in the MEB narrative summary and in the PEB’s rating determination, the Board gave the benefit of the doubt to the CI and used the PEB syncope frequency of ’2-3x every 2-3 months’ for final rating determination.  Syncope VASRD coding schemas considered were 7099-7015 [AV-Block-cardiac], 8299-8210 or 7199-8210 [Tenth (pneumogastric, vagus) cranial nerve], and 8999-8911 [Epilepsy, petit mal]), recommended either historically or currently by DoD, the Army, other services, or the VA.  Recommendations for coding Syncope have changed over time, but the referenced VASRD codes and rating criteria have remained constant from before the date of CI’s PEB.  The details of the CI’s syncope condition of complete loss of consciousness were closest to body system and in disability to the 8999-8911 (Epilepsy, petit mal) code which is the currently recommended analogous coding for either Syncope, NOS or Syncope, Vasovagal by the Army (Adjudication Tools, Feb 2009).  Under 8999-8911 criteria, having syncope ’2-3x every 2-3 months’ (PEB language) clearly fits the 20% rating criteria of ‘at least 2 minor seizures in the last 6 months.’  CI did not meet the criteria for the next higher level of ‘5 to 8 minor seizures weekly.’  The Board considered, but specifically excluded using code 8299-8210 at the ‘incomplete, severe’ (30%) level.  The Board found coding syncope under 8999-8911 at 20% was the predominant determination.  

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RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation.

Unfitting Condition	VASRD Code	Rating	
Chronic LBP, due to Lumbar DDD	5299-5242	10%	
Syncope, occurring 2-3x every 2-3 months	8999-8911	20%	
Combined	30%	

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The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20090202, w/atchs.
Exhibit B.  Service Treatment Record.
Exhibit C.  Department of Veteran's Affairs Treatment Record.