RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-00134
BRANCH OF SERVICE:  air force	BOARD DATE:  20140520
SEPARATION DATE:  20020201

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Air National Guard (ANG) Active Guard Reserve (AGR) TSgt/E-6 (3P071/Security Forces Craftsman) medically separated for a heart condition.  In December 1999, he was diagnosed with cardiomyopathy.  In August 2001, he underwent a Medical Evaluation Board (MEB).  The heart condition, characterized as mild dilated cardiomyopathy and left bundle branch block, was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other conditions were listed on the AF Form 618.  The Informal PEB found the “mild dilated cardiomyopathy with left bundle branch block” unfitting, and rated it 10%.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Other Service Connected Findings – METS”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting heart condition is addressed below.  No other conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions outside the Board’s defined scope of review may be eligible for consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Air Force PEB – dated 20011026	VA – (3 mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild Dilated Cardiomyopathy, with Left Bundle Branch Block	7020-7015	10%	Cardiomyopathy	7020	10%	20020429	
No Additional MEB/PEB Entries	Other x 4 	20020429  	
Rating:  10%	Rating:  30%	
	     Derived from VA Rating Decision (VARD) dated 20020723 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:  It is noted for the record that the Board is subject to the same laws for disability entitlements as those under which the military Disability Evaluation System (DES) operates.  While the DES can consider all of the CI's medical conditions, compensation can only be offered for those conditions that cut short a member’s career, and then only to the degree of severity present at the time of separation.  The Department of Veterans Affairs however, is empowered to compensate for all service-connected conditions and to periodically re-evaluate conditions for the purpose of adjusting the disability rating should the degree of impairment change over time.

Heart Condition.  In 1997, the CI was having chest pain.  Investigation revealed no evidence of myocardial infarction (heart attack).  In December 1999, he had a cardiac catheterization. The left ventricular ejection fraction (LVEF) was 40-45%.  Subsequently, he was diagnosed with cardiomyopathy and was started on medication.  In September 2000, the CI had an echocardiogram.  Both ventricles were found to be dilated.  The LVEF was estimated at 50-55%.  The CI underwent MEB/PEB.  In the narrative summary, it was noted that the CI was asymptomatic and was cleared for all normal daily activities, with no limitations.  The PEB found him unfit and assigned a disability rating of 10%.  He was separated from service in February 2002.  Three months later, he had a VA Compensation and Pension exam.  On physical examination, the CI was moderately obese with a weight of 231.8 pounds.  Blood pressure was 130/84.  Cardiac exam was normal.  As noted above, the Air Force PEB and the VA both assigned a disability rating of 10% for the heart condition.  For the reader’s convenience, the VASRD §4.104 language for diagnostic code 7020 (Cardiomyopathy) is excerpted below:

Workload of greater than 5 METs but not greater than 7 METs results in
dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac
hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray.........30 

Workload of greater than 7 METs but not greater than 10 METs results in
dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication
required……………..……………………………………………………………….................................10 

The Board carefully reviewed all evidentiary information available and directs attention to its rating recommendation.  The Board deliberated with regard to the appropriate disposition of this case.  IAW VASRD §4.104, a disability rating of 30% is warranted when there is echocardiographic evidence of cardiac dilatation (enlargement).  As noted above, the echocardiogram from September 2000 showed both ventricles to be dilated.  In fact, there was other evidence in the record as well, confirming cardiac dilatation (enlargement).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the heart condition.  It is appropriately coded 7020, and IAW VASRD §4.104, meets criteria for the 30% rating level due to echocardiographic evidence of ventricular dilatation.  He does not meet criteria for a higher rating of 60%.

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 heart condition, and IAW VASRD §4.104 the Board unanimously recommends a disability rating of 30%.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board, therefore, recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Mild Dilated Cardiomyopathy, with Left Bundle Branch Block	7020	30%	
RATING	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20120705
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

Dear XXXXXXXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-00134.

	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 not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

	I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept their recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

	As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 30 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married or had an eligible dependent child, in such a case, failure to render an election will result in automatic enrollment.

							Sincerely,

Attachment:
Record of Proceedings

cc:
SAF/MRBR
DFAS-IN