RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-00399
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20150227
SEPARATION DATE:  20050614

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Senior Force Protector) medically separated for recurrent vasovagal syncope.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty.  He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The “recurrent vasovagal syncope” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB adjudicated recurrent vasovagal syncope as unfitting, rated 10%, citing application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions”

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 conditions 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/Naval 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 Veterans Affairs Schedule for Rating Disabilities (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:

IPEB – Dated 20050407	VA* - (~3 Mos Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Vasovagal Syncope	8210-8299	10%	Recurrent Neurocardiogenic Syncope	8199-8108	10%	20050827	
Other x 0 (Not In Scope)	Other x 0 	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20051005 (most proximate to date of separation (DOS).
VARD 20071022 increased DC 8199-8108 to 80% effective 20050615.

ANALYSIS SUMMARY:

Recurrent Vasovagal Syncope Condition.  Review of the service treatment record revealed the CI first experienced an episode of syncope (loss of consciousness) in 1997 while standing guard duty.  He experienced three additional syncopal episodes, and in August 2001 an evaluation surmised the cause could be due to low blood sugar levels.  However, another episode of syncope lasting 2-3 minutes occurred on 31 October 2004.  An extensive evaluation was negative until a tilt-table test on 15 February 2005 conclusively determined that autonomic nervous system dysfunction was present.  During this provocative test there was loss of consciousness for 60 seconds, after which he remained confused and slow to answer questions for 20 minutes.

The narrative summary on 22 February 2005 noted that the most recent episode of syncope was in October 2004.  The CI’s treatment consisted of increased hydration, high salt diet, wear of lower extremity compression stockings, leg exercises, and a medication (beta blocker).  Physical examination was normal.  At a separation examination on 2 May 2005 (a month prior to separation) the CI confirmed that there had been no further episodes of syncope.  On 8 September 2005 (3 months after separation) the CI was seen for “TSA Clearance” (i.e. a physical exam for work).  There was no mention of ongoing or recurrent symptoms.

The VARD on 5 October 2005 was based on a Compensation and Pension exam performed 2 months after separation that was not in evidence.  The CI reportedly was taking the beta blocker medication.  There was no mention of interim symptoms.  Physical examination was normal.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB coded recurrent vasovagal syncope analogously to 8210 (paralysis of tenth cranial nerve) and rated at 10% for moderate, incomplete paralysis.  The VA arrived at a 10% rating by analogously coding to 8108 code (narcolepsy, which is rated as per code 8911: epilepsy, petit mal).  Vasovagal syncope is not specifically identified as such in the VASRD.  The 8210 code (tenth cranial nerve – vagus) specifies that a rating is “dependent upon the extent of sensory and motor loss to organs of … heart.”  In this case syncope was clearly due to dysfunction of the vagus nerve, and the consequent temporary reduction in blood flow to the brain caused by a transient low heart rate.  Board members concluded therefore that the condition was precisely and accurately captured by this code, that “severe, incomplete paralysis” did not correctly depict the condition at the time of separation, and the next higher 30% rating was thus not justified.  The Board discussed the 8108 rating option, which defaults to the VASRD §4.124a (General Formula For Major and Minor Seizures); and debated if the self-limited syncopal episodes which the CI suffered could be fairly compared with the disability attendant to minor or major seizures.  It was agreed however that the condition at the time of separation was not adequately reflected by seizure analogy.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the recurrent vasovagal syncope condition.

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 recurrent vasovagal syncope condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.
RECOMMENDATION:  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140529, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

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

Dear XXXXXXXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2014-00399.

	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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings