RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-01019
BRANCH OF SERVICE:  Army	 SEPARATION DATE:  20061230

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-4 (Aircraft Power Plant Repairer) medically separated for complete atrioventricular (AV) block.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  “Status post pacemaker placement” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “complete AV block manifested by syncopal episodes, dizziness and weakness…” as unfitting, rated 10%.  The CI made no appeals and was medically separated.

CI CONTENTION:  The CI contends that his condition inhibits his career opportunities and lowers his quality of life.  The 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 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 20061130	VA* - (~6 Mos. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Complete AV Block 	7015	10%	Third Degree AV Block 	7015	10%	20070629	
Other MEB/PEB Conditions x 0 (Not In Scope)	Other x 0	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20070727 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:

AV Block Condition.  After experiencing several weeks of intermittent dizziness, shortness of breath and fatigability, evaluation in August 2006 revealed the presence of complete atrioventricular block resulting in an erratic, abnormally slow heartbeat.  Prior to pacemaker placement an echocardiogram revealed minimally increased left ventricular posterior wall thickness and enlarged right ventricle.  There was no cardiac dilatation, and ejection fraction was 60%.  After permanent pacemaker placement the CI’s symptoms resolved.  A follow-up chest X-ray and EKG did not report cardiac enlargement.  Medication for treatment of the condition was not required.  The permanent profile allowed the CI to exercise at his own pace and distance.  The narrative summary (NARSUM) 2 months prior to separation reported “a very athletic history” prior to pacemaker insertion.

At the VA Compensation and Pension (C&P) exam performed 6 months after separation, the CI reported that he had no symptoms and remained active.  He was working as a roofer.  The examiner estimated that his exercise capacity was greater than 12 metabolic equivalents (METS).  Further cardiac testing was considered unnecessary.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and the VA assigned a 10% rating under the 7015 code (atrioventricular block).  The PEB cited normal ejection fraction as a rating rationale, while the VA noted the requirement for a pacemaker.  The Board agreed that the pacemaker requirement fulfilled a 10% rating stipulation, but considered if a higher rating was justified.  A 30% rating requires a MET level between 5-7, or evidence of cardiac hypertrophy or dilatation.  While a pre-pacemaker echocardiogram showed minimal cardiac hypertrophy, a later chest X-ray and EKG did not.  The MET level requirement for a 30% rating was also not satisfied; therefore, a higher rating was not justified using this code.  The 7005 (arteriosclerotic heart disease) and 7011 (ventricular arrhythmias) codes use the same 7015 coding criteria, and likewise provide no route to a higher rating.  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 complete AV block 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 complete AV block condition and IAW VASRD §4.104, 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 20140218, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXXXXXXX, AR20160002513 (PD201401019)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation and hereby deny the individual’s application.  
This decision is final.  The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA