RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-01420
BRANCH OF SERVICE:  MARINE CORPS	BOARD DATE:  20150219
SEPARATION DATE:  20090629

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Warehouse Clerk) medically separated for a heart condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was placed on limited duty three times and then referred for a Medical Evaluation Board (MEB).  The heart condition, characterized as “aortic valve disorders” and “heart valve replaced by transplant,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  The Informal PEB (IPEB) adjudicated “bicuspid aortic valve” as unfitting, but a pre-existing condition (EPTS).  The IPEB also adjudicated “moderate aortic regurgitation,” and “s/p aortic valve replacement w/homograft tissue valve,” as Category II diagnoses, conditions that contribute to the unfitting condition.  The CI appealed to the Formal PEB with a reconsideration PEB adjudicating the same conditions as the IPEB; however, rating the bicuspid aortic valve at 0% using the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI concurred with the reconsideration PEB and was medically separated.

CI CONTENTION: The CI writes: “I have not received any compensation for the heart condition which manifested during my time on active service, and was the ultimate reason why I was separated.  The other reason being, that the open heart surgery procedure which was done while I was on active service, will have to be conducted again in the near future.  The valve they replaced was replaced with a temporary valve which will only last ten years.  This will lead to long term disabilities and a second surgery.”

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 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 Recon PEB – Dated 20090424	VA - (26 Mos. Post-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bicuspid Aortic Valve	7000	0%	Congenital Bicuspid Valvular Disease	7000	NSC	20110825	
Moderate Aortic Regurgitation	Category II	No VA Entry				
S/P Aortic Valve Replacement w/Homograft Tissue Valve	Category II	No VA Entry				
Other x 0 (Not in Scope)	Other x 2	20120222	
Combined:  0%	Combined:  40%	
Derived from VA Rating Decision (VARD) dated 20120409 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Bicuspid Aortic Valve.  Review of the treatment record showed that the CI was well until 2004 when he developed palpitations and chest pain.  Evaluation led to the diagnosis of a bicuspid aortic valve (a heart valve with two leaflets instead of the usual three).  Although initially associated with only a moderate degree of regurgitation of blood backwards through the abnormally closed valve (aortic insufficiency), acute worsening manifested by fainting occurred in June 2007 requiring emergent valve replacement surgery.

At the narrative summary evaluation on 24 December 2008 (6 months prior to separation) the CI complained of shortness of breath on moderate exertion, such as climbing two flights of stairs.  He also endorsed fatigue, but denied any syncopal events (i.e. fainting).  Medication consisted only of one aspirin per day, although a dose of antibiotic was required prior to certain procedures (e.g. dental work).  Recent studies included an exercise treadmill test, which showed good exercise capacity reflected by a measured MET (metabolic equivalent) level of 17.2.  A chest X-ray was normal.  Echocardiography showed a normal ejection fraction (60%) and normal left ventricular dimensions.  Although the aortic valve was observed to be intact, moderate regurgitation was present, indicating the possible need for future replacement.  The VA exam performed was over 2 years after separation.

The Board directed attention to its rating recommendation based on the above evidence.  A 0% rating was assigned under the 7000 code (valvular heart disease).  The VA concluded that the condition could not be service-connected because it pre-existed service, and was not aggravated by service.  Board members agreed that the PEB properly subsumed the Category II conditions (moderate aortic regurgitation and status post aortic valve replacement) as related conditions under the bicuspid aortic valve condition, but considered if a higher rating was warranted.  There was no evidence of left ventricular dysfunction to support a 60% rating under the 7000 code or 7016 code (heart valve replacement [prosthesis]).  There was likewise no cardiac hypertrophy or dilatation to warrant a 30% rating.  A 10% rating under these codes stipulates “Workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required.”  The CI’s exercise capacity easily exceeded 10 METs.  However, the Board also concluded that the “continuous medication required” stipulation was met on the basis of the need for daily aspirin.  Therefore, the next higher 10% rating was justified.  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 bicuspid aortic valve 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 bicuspid aortic valve condition, the Board unanimously recommends a disability rating of 10%; coded 7000 IAW VASRD §4.104.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Bicuspid Aortic Valve	7000	10%	
COMBINED	10%	

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

			XXXXXXXXXXXXXXXXXXXX
President 
DoD Physical Disability Board of Review

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION 
Ref:	(a) DoDI 6040.44
(b) CORB ltr dtd 16 Jun 15

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

XXXXXXXXXXXXXXXXXXXX
Assistant General Counsel (Manpower & Reserve Affairs)