RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02241
BRANCH OF SERVICE:  Army	BOARD DATE:  20160525

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5, Military Police, medically separated for “vasovagal syncope” with a disability rating of 10%.

CI CONTENTION:  He was given a higher rating for his condition by the VA and the condition continues to worsen negatively impacting daily activities.  His 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 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 - 20081120	VARD - 20090702	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vasovagal Syncope Evaluated as Epilepsy, Petit Mal	8999-8911	10%	Vasovagal Syncope	7099-7010	NSC	20090604	
Mild PTSD	Not Unfitting	Post-Traumatic Stress Disorder (PTSD) and Depressive Disorder, Not Otherwise Specified	9411	30%	20090604	
COMBINED RATING:  10%	COMBINED RATING FOR ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:

Vasovagal Syncope.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM) the CI first experienced problems with syncope after returning from his first deployment in May 2004 and passed out while running.  He felt like he could not breathe.  He had four or five episodes during his second deployment to Iraq in July 2007 to March 2008.  They usually occurred with exercise, usually running, although one episode occurred when he was in the shower.  He was medically evacuated to the United States.  Evaluations by cardiology, pulmonary, and neurology were negative.  He had three or four episodes in 2007.  There were no seizure symptoms.  About 75 percent of the time they were associated with exercise like running.  There was no prior history of these episodes.  An electroencephalogram (EEG) in March 2007 was negative.  Despite treatment, the CI’s syncope condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and he was referred for an MEB.  The MEB forwarded “vasovagal syncope” for PEB adjudication.

During the MEB NARSUM in October 2008, 4 months prior to separation, the CI reported his last syncope like episode occurred in June 2008 when he was jogging and began to experience a warm sensation, he couldn’t breathe and his vision began to blur so he stopped jogging and did not pass out.  The CI’s last reported syncope episode occurred in February 2008 while running during his deployment to Iraq.  The physical examination was performed on the DD Form 2808 (Report for Medical Examination) which documented the CI with insomnia and rendered a diagnosis of vasovagal syncope with follow up to cardiology as the cause had not been determined.

At the VA Compensation and Pension examination in June 2009, 4 months after separation, the CI reported multiple joint pain but cardio and neurological symptoms were not reported.  The examination documented the CI with a history of two to three episodes/month at onset and currently two vasovagal episodes per year.  The CI tested normal for:  tilt table test (to find the cause of fainting spells), echocardiogram (ultrasound of the heart) and cardiac stress test.  The CI reported having syncope episodes after heavy physical activity but the syncope had improved over time due to reduced physical activity.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating analogous coded 8999-8911 code (epilepsy, petit mal,) citing a confirmed analogous diagnosis.  The VA did not service-connect the condition which was analogously coded 7099-7010 (supraventricular arrhythmias) based on the VA C&P examination 4 months after separation, citing the vasovagal syncope as not an actually disabling condition but a symptom.

The Board determined the CI had 2 syncopal episodes analogous to petit mal epilepsy in the past 12 months from separation which did not support a higher 20% rating (code 8911), which required 2 episodes in the past 6 months.  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 vasovagal syncope condition.

Contended PEB Condition:  Mild PTSD.  The Board’s main charge is to assess the fairness of the PEB’s determination that PTSD condition was not unfitting.  A psychiatric evaluation in September 2008, 5 months before separation, noted the CI with no history of anxiety or depression.  The syncope episodes were not associated with anxiety/panic disorders.  He had a past diagnosis of adjustment disorder in April 2007 and took medicine for depression for 1 week with no psychiatric treatment since that time.  He later endorsed some PTSD symptoms and was diagnosed with mild PTSD which was sent to the PEB as meeting retention standards.

The PTSD condition was not profiled or implicated in the commander’s statement and were not judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance based evidence from the record that the PTSD condition 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 contended condition and thus no additional disability ratings are recommended.
BOARD FINDINGS:  In the matter of the vasovagal syncope condition and IAW VASRD §4.124, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended PTSD condition, 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.  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 20140518, 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 XXXXXXXXXXXXXXXXXXXXXXX AR2016001 0906 (PD201402241)

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:

Enclosure

CF:
( ) DoD PDBR
( ) DVA