RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01330
BRANCH OF SERVICE:  MARINE CORPS 	SEPARATION DATE:  20080215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Helicopter Mechanic, medically separated for “neurocardiogenic syncope,” with a disability rating of 10%

CI CONTENTION:  The CI made no specific contention in his application.  The CI’s complete submission is at Exhibit A.

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 based upon a 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 - 20071107	VARD - 20080415	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neurocardiogenic Syncope	8299-8210	10%	Neurocardiogenic Syncope…	7199-7000	10%	20080110	
RATING:  10%	RATING:  50%	

ANALYSIS SUMMARY:  

Neurocardiogenic Syncope.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had longstanding symptoms of lightheadedness when he first presented in December 1999, after passing out following a vaccination.  He was seen several more times for fainting over the next few years and was returned to duty.  He presented to a civilian emergency room on 10 June 2006, where an extensive evaluation begun, including multiple imaging studies, a neurology evaluation, and a cardiology evaluation, which were unremarkable other than a conduction defect on his electrocardiogram which was unrelated to the syncope condition. An echocardiogram was normal.  A tilt table test was positive for syncope.  He was begun on medications and given training to mitigate his symptoms.  On 18 July 2007, the CI requested medical separation.  Although he was adequately controlled on his current regimen, he was thought to be at risk of future episodes and MEB recommended.  The MEB forwarded syncope and collapse for PEB adjudication.  The MEB NARSUM examination was dated 30 August 2007, 6 months prior to separation.  It noted that the CI had not had a syncopal episode for several months and that the pre-syncopal symptoms (feeling faint without loss of consciousness) were controlled appropriate maneuvers.  The physical examination was unremarkable.  At the MEB examination (recorded on DD Forms 2807 and 2808) dated 15 October 2007, 4 months prior to separation, the CI reported recurrent vasovagal syncope.  The physical examination was unremarkable.  At the VA Compensation and Pension (C&P) evaluation performed on 10 January 2008, 1 month before separation, the CI reported that his symptoms were improved on medications.  The physical examination was unremarkable.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neurocardiogenic syncope condition 10%, coded 8299-8210 (analogous to incomplete, moderate paralysis of the vagal [tenth] cranial nerve).  The VA also rated the neurocardiogenic syncope condition 10%, but coded it 7199-7000 (analogous to valvular heart disease), based on the VA C&P examination 1 month prior to separation, noting there was not an exact code for the condition and that the METs level was 10.0.  The evidence shows that the neurocardiogenic syncope was adequately controlled at separation, but that the CI was at risk for future events.  The Board noted that the echocardiogram was normal and that there was not valvular disease.  The PEB code 8210 was determined to better describe the clinical condition.  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 neurocardiogenic syncope condition.  

BOARD FINDINGS:  In the matter of the neurocardiogenic 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.  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 20140521, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 19 Sep 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXXX, former USMC 

						   XXXXXXXXXXXXXXXXXXXX
 Assistant General Counsel		        (Manpower & Reserve Affairs)