RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01572
BRANCH OF SERVICE:  Army	BOARD DATE:  20150206
SEPARATION DATE:  20091231

SUMMARY OF CASE:  The evidence of record indicates this covered individual (CI) was an active duty SGT/E-5 (13M/Multiple Launch Rocket System Crewmember) medically separated for a heart condition.  This condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty (MOS) or physical fitness standards, so he was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The heart condition, characterized as “myopericarditis,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded eight other medically acceptable conditions for PEB adjudication.  The PEB adjudicated “pericarditis…” as unfitting, rated 0%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  The CI appealed to the Formal PEB (FPEB), which affirmed the PEB findings and rating.  The CI made no appeals and was medically separated.

CI CONTENTION:  “The doctor found an issue in the beginning of treatment and then right before my Med Board he changed my diagnosis showing nothing wrong.  It took him 18 months to change my diagnosis for no reason.”

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting heart condition is addressed below.  The asthma, obstructive sleep apnea, refractive error, thoracic scoliosis w/chronic back pain, gastroesophageal reflux disease, left knee pain, dizziness and bilateral foot numbness conditions, identified as not unfitting by the PEB, were not requested for review and thus is are not within the defined scope.  No additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application or otherwise outside the Board’s defined scope of review remain eligible for future consideration by the Board for Correction of Military Records.

The Board acknowledges the CI’s assertions that his diagnosis was changed.  It is noted for the record that the Board has no jurisdiction to investigate or render opinions in reference to such allegations.  These issues may be addressed by the Board for the Correction of Military Records and/or the United States judiciary system.

RATING COMPARISON:

Service FPEB – Dated 20091022	VA - (~1 Mo. Post-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pericarditis…	7002	0%	Myopericarditis	7099-7002	NSC	20100119	
Other x 0 (in Scope)	Other x 8	
Rating: 0%	Rating:  60%	
Derived from VA Rating Decision (VARD) dated 20100413.

ANALYSIS SUMMARY:

Heart Condition.  The treatment record indicated the CI went to the emergency room on 10 April 2008 for chest pain, chest tightness, shortness of breath (SOB), light-headedness and a rash with facial and lip swelling.  There was no history of asthma.  Chest X-ray and magnetic resonance imaging (MRI) were unremarkable.  The electrocardiogram initially showed non-specific St-T wave changes that resolved.  An allergist conducted pulmonary function tests which were normal.  An exercise treadmill test in April 2008 showed the CI was able to perform maximal (metabolic equivalents) METS of 13.7, an evaluation of functional capacity.  He was diagnosed with pericarditis due to a smallpox vaccine he had received on April 1.  A formal echocardiogram on 1 May 2008 was normal with an ejection fraction of 75%.  He was treated with anti-inflammatory medication (indomethacin and colchicine), with no resolution of symptoms.  He had a positive methacholine challenge test in October 2008, prompting a diagnosis of asthma.  The CI reported the SOB and chest tightness abated with the initiation of asthma medications.  Repeat MRI demonstrated subclinical myocardial inflammation affecting less than 50% of the cardiac muscle and scarring.  The cardiologist diagnosed chronic pericarditis in November 2008.  The cardiologist noted in April 2009 the CI was not deployable, should not be exercising strenuously, needed periodic assessment of left ventricle function and possible arrhythmias and needed a P3 profile.

At the narrative summary dated 7 July 2009, 5 months prior to separation, the CI reported SOB and lightheadedness associated with a fast heart rate when moving 40 lb. boxes with two soldiers on each box.  He has to sit and rest or he would faint.  He was not able to perform Army Physical Fitness Test activities or other duties of his MOS. He was taking two asthma medications and one medicine for gastroesophageal reflux.  Physical exam showed normal cardiac function and clear lungs, with no swelling in the lower extremities and no distension of the jugular vein.  Pulses were normal.  A diagnosis of post smallpox myopericarditis was rendered.

A Holter test on July 2009 for palpitations and dizziness showed isolated ventricular contractions and 55 isolated premature atrial contractions but the symptoms did not correlate to cardiac arrhythmia.  The PEB proceedings were discontinued in August 2009 to obtain data regarding METS and other factors for disability rating.  At a repeat stress test dated 31 August 2009, the CI reported no palpitations, chest pain, SOB at rest or when lying down.  His cardiac and pulmonary exam was normal.  The test was stopped secondary to fatigue and leg cramping and METS were 11.10.  Echocardiogram was normal with no evidence of cardiac hypertrophy or dilation.

At the VA Compensation and Pension exam, dated 19 January 2010, performed a month after separation, the CI reported chest pain episodes that included tightness, occurrence with exertion, and an element of substernal pain without radiation, lightheadedness, sometimes occurring at rest.  His heart rate increased with exercise when he felt SOB.  He was short of breath after climbing two flights of stairs.  He had no walking limits but could not run without SOB and chest tightness.  He used two asthma medications four times per day and noted he had quite a difference in breathing if he did not take his medications.  Examination of the lungs and cardiovascular systems were normal.  His blood pressure and pulse were normal.  The echocardiogram showed normal chambers, normal left ventricular function, with an ejection fraction of 60-65% with no evidence of residual cardiac function.  The exam did not show evidence of ongoing active disease and echocardiogram did not indicate residual problems.  The examiner noted that the CI developed mild asthma, also after the smallpox vaccination.  The VARD noted there was “no permanent residual or chronic disability subject to service connection is shown by the treatment records or demonstrated by evidence following service.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 0% rating under the 7002 code, while the VA rated the condition non service-connected, coded 7099-7002.  The 7002 (pericarditis) code attaches to a condition which clearly was no longer active; and, that notwithstanding, the minimal compensable rating would require an exercise tolerance under 10 METs. No other code available in VASRD §4.104 (cardiovascular rating schedule) was relevant.  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 pericarditis condition.  The Board concluded therefore that this condition could not be recommended for additional disability rating.

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 myopericarditis 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 no re-characterization of the disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140401, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review

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 XXXXXXXXXXXXXXX, AR20150009946 (PD201401572)

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:

Encl		     XXXXXXXXXXXXXXX
			     Deputy Assistant Secretary of the Army
			          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA