RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXX	CASE:  PD-2014-02900
BRANCH OF SERVICE:  NAVY	BOARD DATE:  20141017
SEPARATION DATE:  20051202

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty FC3/E-4 (1334/Advanced Tomahawk Weapons System Technician) medically separated for a pericarditis condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his rating or satisfy physical fitness standards.  He was placed on limited duty (LIMDU) and referred for a Medical Evaluation Board (MEB).  The pericarditis condition, characterized as “Unspecified Disease of Pericardium,” was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E.  No other conditions were submitted by the MEB.  The Informal PEB (IPEB) adjudicated “recurrent pericarditis” as unfitting, rated 10% with likely application of the VA Schedule for Rating Disabilities (VASRD).  The CI requested reconsideration by the IPEB; and subsequently the IPEB maintained its prior finding for the unfit recurrent pericarditis, adjudicated at 10% disabling.  The CI made no further appeals and was medically separated.

CI CONTENTION:  “Please consider all conditions.  My pericarditis is chronic and has caused me to miss school work and even have to quit jobs that did not allow me to miss time off when I was having an episode.”  

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 pericarditis condition is addressed below; and, 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 Naval Records.

RATING COMPARISON:

Service Recon PEB – Dated 20051006	VA - (5 & 6 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Pericarditis	7003	10%	S/P Mediastina Splitting for Pericarditis	7099-7002	10%	20050519 & 20050627	
Other x 0  (Not in Scope)	Other x 8 (Not in Scope)	20050519 & 20050627	
Combined:  10%	Combined:  60%	
Derived from VA Rating Decision (VARD) dated 20051209 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:  The Board acknowledges the sentiment expressed in the CI’s application regarding the significant impairment with which his service-incurred condition continue to burden him as well as its impact on his quality of life.  It is a fact, however, that the Disability Evaluation System (DES) has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  This role and authority is granted by Congress to the Department of Veterans Affairs (DVA).  The Board’s authority as defined in DoDI 6040.44, resides in evaluating the fairness of DES fitness determinations and rating decisions at the time of separation.  

Pericarditis.  The CI’s cardiac symptoms of spontaneous chest pain, dyspnea and weakness began in May 2004.  Hospitalized for definitive testing, a sonogram revealed a large pericardial effusion (fluid around the heart) with right-sided heart compression.  He underwent a pericardiocentesis (tapping off the fluid from around the heart) on 2 June 2004 resulting in an improvement of both symptoms and cardiac output.  However, approximately 5 weeks later he again developed similar symptoms with worsening shortness of breath.  A magnetic resonance image performed on 9 July 2004 revealed another large pericardial effusion.  He then underwent an open chest procedure for a pericardectomy on 14 July 2004.  The surgical report specified the presence of “dense adhesions” in the pericardium.  Cardiology follow-up on 1 October 2004 noted the CI doing well overall, but still with decreased activity.  He was continued on two cardiac medications and placed on 8 months LIMDU.  At the narrative summary dated 20 June 2005 (5 months prior to separation and 11 months after surgery) the CI endorsed no new or current complaints.  His “present status” noted him as “asymptomatic” on two medications.  The summary further reported borderline right ventricular enlargement and borderline right atrial enlargement on a repeat echocardiogram on 2 June 2005.  His left ventricular function was normal.  The physical examination was normal.  The diagnosis was recurrent pericarditis.  The commander’s non-medical assessment clearly indicated the recommendation that the CI be found unfit for duty due to his physical restrictions and inability to perform all the duties required by his military rating.  Although the original VA C&P examinations of 19 May and 27 June 2005 were absent, a subsequent VARD indicated a 10% impairment rating was adjudicated for the continuous use of medication after a cardiac stress test revealed an achievable workload of 12.9 METS (metabolic equivalents).

The Board directs attention to its rating recommendation based on the above evidence.  Although the service and VA titled the unfitting cardiac condition slightly differently, they both utilized similar primary codes of 7003 (pericarditis) and analogous 7002 (pericardial adhesions) respectively.  Board members first considered and agreed that either code (7002 or 7003) could be appropriate in this case.  The condition itself was “pericarditis,” but as depicted in the surgical report, there were dense pericardial adhesions present.  From a practical standpoint, it becomes a moot point for the rating criteria for both codes remains identical for 10, 30, 60, and 100 per cent.  The graded rating criteria is based upon medication use, measured MET levels with associated symptoms, ventricular dysfunction as measured by ejection fraction, or evidence of cardiac hypertrophy (heart enlargement) or dilatation on electro-cardiogram (electrical tracing), echocardiogram (sonogram) or X-ray.  Clearly, the required continuous use of medication near the time of separation supports the PEB’s 10% rating.  Absent evidence of congestive heart failure, compensable metabolic work equivalents, or poor cardiac output, the 60% rating level was not applicable.  Board members extensively deliberated if the CI’s condition is supported at the 30% level.  Cardiac hypertrophy is defined as an abnormal enlargement or thickening of the heart muscle and such enlargement can be attributed to the entire heart or just certain locations (chambers) within the heart.  The VASRD is not specific in defining the extent or confines of hypertrophied heart muscle.  In this case, the reported echocardiogram done near the time of service separation clearly reported the entire right side of the heart as “borderline” enlargement.  The action officer opined that cardiac “enlargement” of any degree (borderline or severe) is considered a condition of hypertrophy and therefore, this condition is supported at the 30% level.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 30% for the cardiac (pericarditis) 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 pericarditis condition, the Board unanimously recommends a disability rating of 30%, coded 7003 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; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Recurrent Pericarditis	7003	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140515, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
		   DEPUTY COMMANDANT, MANPOWER & RESERVE AFFAIRS
	                          
Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS          

Ref:   (a) DoDI 6040.44
       (b) PDBR ltr dtd 29 Mar 15 ICO XXXXXXXXXXXXXX   
	 (c) PDBR ltr dtd 25 Mar 15 ICO XXXXXXXXXXXXXX
	 (d) PDBR ltr dtd 23 Mar 15 ICO XXXXXXXXXXXXXX
	 (e) PDBR ltr dtd 29 Mar 15 ICO XXXXXXXXXXXXXX
	 (f) PDBR ltr dtd 29 Mar 15 ICO XXXXXXXXXXXXXX

1.  Pursuant to reference (a) I approve the recommendations of the Physical Disability Board of Review set forth in references (b) through (f).

2.  The official records of the following individuals are to be corrected to reflect the stated disposition:

     a. XXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a disability rating of 30% effective date of discharge.

     b. XXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a disability rating of 30% effective date of discharge.

     c. XXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a disability rating of 30% effective date of discharge.

     d. XXXXXXXXXXXXXX, former USN: Placement on the Permanent Disability Retired List with a disability rating of 30% effective date of discharge.

     e. XXXXXXXXXXXXXX, former USMC: Placement on the Permanent Disability Retired List with a disability rating of 30% effective date of discharge.
 
3.  Please ensure all necessary actions are taken to implement these decisions, including the recoupment of disability severance pay, if warranted, and notification to the subject members once those actions are completed.