RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-00020
BRANCH OF SERVICE:  AIR FORCE	SEPARATION DATE:  20050620

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Air Force E-3 (Security Forces) medically separated for a heart condition.  This condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards.  She was issued a permanent profile and referred for a Medical Evaluation Board (MEB).  Symptomatic premature ventricular contractions controlled by Beta Blockers were forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  No other condition was submitted by the MEB.  The Informal PEB (IPEB) adjudicated premature ventricular contractions controlled by beta blockers as unfitting, rated 0% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  The Department of Veterans Affairs her me 40% for my disabilities.  She was not evaluated for her back and shoulder conditions.  Her complete submission is at Exhibit A.

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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any condition outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20050428	VA* - (6 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Premature Ventricular Contractions controlled by Beta Blockers	7011	0%	Intermittent Arrhythmia with Occasional Premature Ventricular Contraction	7011	10%	20051201	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 5	
RATING:  0%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20060126 (most proximate to date of separation [DOS])

ANALYSIS SUMMARY:

Premature Ventricular Contractions.  In July 2004, during basic training, this CI began having palpitations.  She was evaluated by cardiology and was found to have premature ventricular contractions ((PVCs)…extra, abnormal heartbeats).  Echocardiography and radiologic imaging showed no evidence of structural heart disease or other cardiac abnormality.  She was started on Atenolol (a beta blocker medication [reduces blood pressure]).  This caused a decrease in her PVCs.  Due to the chronic nature of her cardiac dysrhythmia, and the need for controller medication, an MEB was initiated.  The MEB narrative summary (NARSUM) was dated 7 March 2005 (5 months pre-separation) documented her heart with regular rate and rhythm with no murmurs, gallops, or rubs.  The lungs were clear to auscultation bilaterally, with no rales, rhonchi, or wheezes.  The NARSUM examiner diagnosed symptomatic PVCs requiring Atenolol (beta-blocker).

The VA Compensation and Pension (C&P) exam dated 1 December 2005 (5 months post-separation) showed she was taking Metoprolol (beta blocker) every day.  She reported that she would feel her heart “skip” on occasion.  The PVCs did not increase with exercise.  The CI denied chest pain, dyspnea, fatigue, or dizziness.  Physical exam of the heart and lungs was normal.  The C&P examiner diagnosed arrhythmia normal sinus rhythm with multiple PVCs.

The Board directed attention to its rating recommendation based on the evidence.  Both the PEB and VA utilized code 7011 (Ventricular arrhythmia, sustained).  The PEB rated it 0% while the VA rated it 10%.  The Board noted continuous medication was required for control.  IAW VASRD §4.104, code 7011, a 10% rating is warranted when there is satisfactory evidence that continuous medication is required.  Thus, the Board members agreed that a disability rating of 10% was appropriate in this case.  The Board tried to find a path to a higher rating using other codes but there was no evidence of a seriously disabling heart abnormality which would justify a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Reasonable doubt), the Board recommends a disability rating of 10% for the PVCs, controlled by beta blockers.

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 premature ventricular contractions, the Board unanimously recommends a disability rating of 10%, coded 7099-7011, IAW VASRD §4.104.  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, effective as of the date of her prior medical separation:

CONDITION	VASRD CODE	RATING	
Premature Ventricular Contractions, Controlled by Beta Blockers	7099-7011	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131128, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-00020.

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 modification of your assigned disability rating without re-characterization of your 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 direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

Sincerely,

Attachment:
1.  Directive 
2.  Record of Proceedings  

cc:
SAF/MRBR