RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-01312
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20060131

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Guard E4, Vehicle Mechanic, medically separated for “coronary artery disease,” “chronic right shoulder pain” and “obstructive sleep apnea, C-PAP required” rated 10%, 10% and 0% respectively, with a combined disability rating of 20%.

CI CONTENTION:  The CI elaborated no specific contention in his application.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (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 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:

SERVICE PEB - 20060105	VARD – 20060725	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Coronary Artery Disease	7005	10%	Coronary Artery Disease	7005	30%	20060605	
Chronic Right Shoulder Pain	5099-5003	10%	Chronic Right Shoulder Pain	5201	30%	20060605	
Obstructive Sleep Apnea	6847	0%	Obstructive Sleep Apnea	6847	50%	20060605	
COMBINED RATING:  20%	COMBINED RATING FOR ALL VA CONDITIONS: 100%	

ANALYSIS SUMMARY:

Coronary Artery Disease.  According to service treatment records the CI began having chest pain in April 2004.  He did well for a while after a stent was placed in his circumflex coronary artery in May 2004.  A repeat stent was required in October 2004 which helped control his angina (heart pain) with cardiac medications.  On 22 September 2005, the CI received a graded exercise test and myocardial scintigraphy to measure his heart’s response to exercise and blood flow to the heart respectfully.  He exercised for 8 minutes, attained an exercise level of 10.1 metabolic equivalents (METS), the scintigraphy was normal, reached a heart rate of 124 without chest pain or electrocardiogram changes (measures heart electric and muscular functions).  However, the test was stopped due to fatigue and weakness.  The Medical Evaluation Board (MEB) physical examination was performed on 2 December 2005.  The CI reported not having angina-like pains.  He was alert and in no acute distress during the exam.  His heart exam was normal as he continued to take cardiac medications to control heart condition.

A VA Compensation and Pension (C&P) examinaiton was performed on 5 June 2006 (4 months after separation).  He reported working fulltime as an electric motor tester experiencing monthly angina, fatigue and dizziness and took aspirin and Atenolol on a daily basis.  During his examination he was in no discomfort with a heart rate was 70 beats per minute.  His heart examination was normal.  ECG showed normal sinus rhythm with a nonspecific T-wave abnormality (possible abnormality).

On 19 June 2006, a repeat graded exercise test was performed for 6 minutes.  He reached a heart rate of 105 without chest pain or myocardial scintigraphy segment changes.  The test was stopped due to hip pain and shortness of breath.  The CI’s exercise capacity was moderately impaired.  The examiner wrote: “Graded exercise test negative for ischemia [inadequate blood supply to the body or heart muscle].”  Echocardiogram (ultrasound of heart) on 20 June 2006 showed normal left ventricular size and function.  Ejection fraction (percentage of blood leaving the heart per contractions) was estimated at 64%.

The Board directed attention to its rating recommendation based on the evidence.  At the September 2005 graded exercise test, the CI attained an exercise level of 10.1 METS.  Nine months later, at the June 2006 graded exercise test was stopped due to non-cardiac reasons (hip pain and shortness of breath).  Both graded exercise tests were negative for cardiac ischemia.  The Board determined that, it was more likely than not, that at the time of separation, the coronary artery disease best fit the 10% rating criteria, IAW VASRD §4.104, coded 7005 (arteriosclerotic (atherosclerotic) heart disease [Coronary artery disease]).  The 10% criterion states, “Workload of greater than 7 METs but not greater than 10 METs results….”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication of the coronary artery disease condition.

Right Shoulder Pain.  In February 2004, this right-handed CI developed pain in his right (dominant) shoulder.  He was evaluated and diagnosed with a torn rotator cuff.  He received surgery in May 2005 but continued to have right shoulder pain.  During the December 2005 MEB right shoulder exam he experienced tenderness to palpation of the anterior joint line and painful motion.  Range-of-motion (ROM) was measured and summarized in the chart below.

During the June 2006 C&P right shoulder examination the CI reported pain, stiffness and weakness.  The exam revealed tenderness to palpation, painful motion, and guarding of movement.  Right shoulder X-rays were normal.  

The Board directed attention to its rating recommendation based on the evidence.  The December 2005 MEB exam was performed 2 months before separation, and therefore had significant probative value.  This examinaiton revealed abduction to 85 degrees (barely shoulder level).  IAW VASRD §4.71a, code 5201 (arm, limitation of motion) warrants a 20% disability rating when the arm motion is limited to shoulder level.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the right shoulder condition.

Obstructive Sleep Apnea (OSA).  In 2004, this CI was diagnosed with OSA after a polysomnography study.  He was placed on nocturnal continuous positive airway pressure (CPAP).  The CPAP therapy caused a significant improvement in his OSA symptoms.  At his December 2005 MEB examination, his OSA was stable.  He was using nightly CPAP at a setting of 9cm. During the June 2006 C&P exam, the CI reported using nightly CPAP and doing well.  The examiner did not record any physical exam abnormalities related to the OSA condition.

The Board directed attention to its rating recommendation based on the evidence.  IAW VASRD §4.97, code 6847 (sleep apnea syndromes [obstructive]), a 50% disability rating is warranted when OSA requires use of a breathing assistance device such as CPAP.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 50% for the OSA condition.

BOARD FINDINGS:  In the matter of the obstructive sleep apnea condition, the Board unanimously recommends a disability rating of 50%, coded 6847, IAW VASRD §4.97.  In the matter of the chronic right shoulder pain, the Board unanimously recommends a disability rating of 20%, coded 5201, IAW VASRD §4.71a.  In the matter of the coronary artery disease 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.  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	
Obstructive Sleep Apnea, CPAP Required	6847	50%	
Chronic Right Shoulder Pain	5201	20%	
Coronary Artery Disease	7005	10%	
COMBINED	60%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140303, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

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 XXXXXXXXXXXXXXXXXXXX, AR20160005887  (PD201401312)

1.	Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to re­ characterize the individual's separation as a permanent disability retirement with the combined disability rating of 60% effective the date of the individual's original medical separation for disability with severance pay.

2.	I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

a.	Providing a correction to the individual's separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

b.	Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

c.	Adjusting pay and allowances accordingly.   Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 60% effective the date of the original medical separation for disability with severance pay.

d.	Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3.	I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF:
( ) DoD PDBR
( ) OVA