RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02139
BRANCH OF SERVICE:  Army	BOARD DATE:  20150424
SEPARATION DATE:  20081003

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard E-6 (Cannon Fire Direct Specialist) 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 issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The MEB was entered into the Joint DoD/VA Disability Evaluation System (DES) Pilot Program.  Ventricular tachycardia (VT) and recurrent syncope or near-syncope, characterized as medically unacceptable, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded hypertension, chronic obstructive pulmonary disease (COPD), bilateral patellofemoral syndrome (PFS), left hearing and tinnitus, and hyperlipidemia, characterized as medically acceptable.  The Informal PEB adjudicated VT and recurrent syncope conditions as unfitting and accepted the Veteran Affairs rating of 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The remaining conditions were determined to be not unfitting.  An Administrative PEB was conducted that did not change the CI’s disposition or rating.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Veteran is currently 100% SC.  Please consider all conditions.”

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 Admin – Dated 20080807	VA* - (~5 Mos. Pre-Separation)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ventricular Tachycardia with Recurrent Syncope	7011	10%	Ventricular Tachycardia	7011	10%	20080515	
Hypertension	Not Unfitting	Hypertension	7101	NSC	20080515	
Chronic Obstructive Pulmonary Disease	Not Unfitting	Obstructive Pulmonary Disease	6604	NSC	20080515	
Bilateral Patellofemoral Syndrome	Not Unfitting	No VA placement	
Left Hearing and Tinnitus	Not Unfitting	Tinnitus	6260	10%	20080515	
Hyperlipidemia	Not Unfitting	No VA placement	
Other x 0 (Not in Scope)	Other x 0	
RATING:  10%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20080717 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Ventricular Tachycardia with Recurrent Syncope.  On routine physical examination (PE) in November 2003, the CI was found to have non-sustained ventricular tachycardia (abnormal extra heartbeats; aka, arrhythmia) which prompted an extensive cardiac work-up to include X-rays, nuclear stress tests, ultrasounds, and 24 hour heart monitoring; all which indicated either the previously known arrhythmia or normal parameters.  He was treated with a single medication and was found to be fully qualified for duty.  He deployed to Iraq in February 2004.  Six months into his deployment in August 2004 he developed a week’s duration of intermittent chest pain associated with rapid heartbeat, dizziness, short of breath, and excessive fatigue.  A second work-up performed in Germany (mid-deployment) again was free of any new or disabling cardio-pulmonary conditions.  He subsequently was returned to his area of responsibility to complete his deployment tour which ended in February 2005.  Due to the persistence of intermittent symptoms, the CI underwent two separate cardiac ablation treatments (closed heart procedure whereby radio-frequency energy is transmitted to destroy a small spot of heart tissue) in 2004 and 2005.  Exercise stress testing in 2006 revealed measured metabolic equivalents (METs) of 13.5 and similar METs in 2008.  In August 2008, he had a loop recorder (patient activated heart tracing monitor) implanted which did not provide any new correlating diagnostic findings.  He continued to experience symptoms to include feelings of near syncope as well as witnessed syncope which prompted the initiation of an MEB.

Under the DoD/VA DES Pilot Program the consolidated narrative summary (NARSUM) examination of 16 June 2008 (four months prior to separation), provided a comprehensive timeline of events leading up to the CI’s current status.  No new or additional symptoms were endorsed.  His medication use included Sotolotol (beta-blocker used for cardiac arrhythmia).  His PE performed on 15 May 2008 (a month prior to NARSUM and 5 months prior to separation), revealed normal cardiopulmonary function excepting occasional abnormal extra heartbeats.  His electrocardiogram tracing was normal.  His diagnosis remained sustained VT with syncope and near-syncope.  He was permanently profiled in February 2008.  Although the commander’s statement did not specify a medical condition, it did state that the CI was not able to perform his duties without an unreasonable number and duration of rest periods.

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated 10% impairment for the heart condition under the appropriate VASRD diagnostic code of 7011 (sustained VT); citing post-surgical procedures and “objective results” on the consolidated examination, respectively.  The unequivocal code for rating VT is 7011, and the VASRD §4.104 rating schedule rests heavily on the following parameters; METs workload, continuous medication, physical symptoms, cardiac hypertrophy and or dysfunction.  Board members first agreed that the CI’s use of anti-arrhythmic medication satisfied the 10% impairment rating supporting the criteria of “continuous medication.”  Absent structural heart abnormalities such as hypertrophy or chamber dilatation, or calculated METs below seven with associated symptoms, the higher 30% impairment level was not applicable.  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 VT condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that hypertension, COPD, bilateral PFS, left hearing and tinnitus, and hyperlipidemia were not unfitting.  The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  These conditions were not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed by the action officer and considered by the Board.  There was no performance based evidence from the record that any of these conditions significantly interfered with satisfactory duty performance.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the any of the contended conditions and so no additional disability ratings are recommended.

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 VT with recurrent syncope condition and IAW VASRD §4.104, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended hypertension, COPD, bilateral PFS, left hearing and tinnitus, and hyperlipidemia conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  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 20140506, 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 XXXXXXXXXXXXXXXXXXXX, AR20150014213 (PD201402139)

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						     
						         
CF: 
(  ) DoD PDBR
(  ) DVA