RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02754
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070314

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Field Artillery Meteorological Crewmember, medically separated for “recurrent syncope,” with a disability rating of 10%.

CI CONTENTION:  The applicant has request consideration of all conditions in his application.  He also contends other conditions were not discovered.  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 - 20070301	VARD - 20070717	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Syncope	8299-8210	10%	Recurrent Syncope	8911	NSC	STR	
Anxiety NOS	Not Unfitting	Anxiety Disorder	9400	NSC		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Recurrent Syncope.  According to service treatment records (STR), the CI deployed to Kuwait from March 2004-September 2004.  At Post Deployment Health Assessments (PDHA) in 2004, he reported seeing someone wounded, killed, or dead, but never felt in great danger of being killed and denied nightmares, avoidance, hypervigilance or detached feelings over the previous month.   
The February 2007 Medical Evaluation Board (MEB) narrative summary (NARSUM), noted the CI’s condition began in October 2004.  He had a loss of consciousness while visiting his mother.  He had three episodes associated with bladder incontinence 3 months later while in a bar.  He was treated with seizure medications based on abnormal electrocardiogram (EKG).  They were not helpful, caused significant side effects, and were discontinued.  Evaluations by cardiology and neurology did not identify a cause for his syncope.  He was receiving two medications for depression and one medication for sleep from psychiatry to treat obsessive compulsive disorder and anxiety, well after the syncope began.  They did not decrease the frequency or severity of the episodes.  The CI reported shortness of breath and rapid shallow breaths associated with the syncope.  He also had sweating and fidgets with his hands and had rapid heartbeat during these times.  Sometimes he could not see or hear as the episode developed.  They occurred at any time and happened about three times per month, frequently occurring in restaurants.  He had one episode while mowing his lawn.  He had been advised to avoid vigorous physical activities and did not drive.  He could not run, carry and fire a rifle or carry his ruck 2 miles.  Neurology suggested the possibility of dissociation or anxiety although seizures could not be totally excluded.  The CI failed to report for the VA Compensation and Pension (C&P) examinations.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating under the 8299-8210 code (Paralysis of vagus nerve, incomplete, moderate) noting it was likely due to hyperventilation, dissociative spells or anxiety and occurring only in public.  The VA assigned a non-service connected (NSC) for recurrent syncope under 8911 code (epilepsy petit mal), citing failure to appear for the C&P examination.  The Board considered whether a higher 30% rating, denoting incomplete, severe paralysis of the vagus nerve was appropriate.  The NARSUM examination indicated the attacks could occur at any time and had occurred in restaurants and while mowing the lawn.  He could not drive because of the unpredictability of the episodes.  Based on these findings, the Board determined that his disability was severe.  The episodes occurred three times per month.  There had been no emergency room visits in the past 2-3 years for the syncope attacks or hospitalizations related to the attacks.  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 recurrent syncope condition.  

Contended PEB Conditions.  

Anxiety NOS:  The Board’s main charge is to assess the fairness of the PEB’s determination that anxiety NOS was not unfitting.  The psychiatric evaluation, dated 7 February 2007, noted the CI had a history of anxiety with additional OCD-like symptoms, manifested by repeated cleaning and anxiety.  There were no social limitations and no significant limitations to duty.  He did not have a psychiatric condition and did not warrant a psychiatric addendum to the MEB.  The anxiety NOS condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  There was no performance based evidence from the record that this 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 anxiety NOS contended condition and so no additional disability ratings are recommended.

BOARD FINDINGS:  In the matter of the recurrent syncope condition and IAW VASRD §4.124, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended anxiety NOS condition, the Board recommends no change from the PEB determination 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 20140609, 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 AR20160010988 (PD201402754)

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