RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03065
BRANCH OF SERVICE:  AIR FORCE	BOARD DATE:  20141028
SEPARATION DATE:  20081028

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-5 (3E671/Operations Management Craftsman) medically separated for a heart condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued a temporary L2 profile, was placed on restricted duty and referred for a Medical Evaluation Board (MEB).  The heart condition, characterized as “coronary artery disease,” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB adjudicated “myocardial infarction, status post coronary artery stent placement,” as unfitting, rated 10%, referencing the Department of Defense Instruction (DoDI) and the VA Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “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 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; 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.

RATING COMPARISON:

Service IPEB – Dated 20080806	VA - (4 Mos. Post-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Myocardial Infarction	7006	10%	Coronary Artery Disease	7005	10%	20090304	
Other x 0  (Not in Scope)	Other x 2	
Rating:  10%	Combined:  60%	
Derived from VA Rating Decision (VARD) dated 20090528 (most proximate to date of separation [DOS]).

ANALYSIS SUMMARY:

Heart Condition.  The CI first presented with chest pain in July 2004.  He was hospitalized for one day due to mildly elevated cardiac enzymes.  His stress test at that time was normal.  He was discharged with a diagnosis of “chest pain, no compelling evidence of coronary artery disease.”  On 26 November 2007, the CI presented to the emergency department with reports of severe left chest pain, left arm pain, sweating, nausea, vomiting and shortness of breath.  His cardiac examination was normal except for mild tachycardia.  Laboratory tests revealed elevated d-dimer indicative of clot break down and elevated cardiac enzymes.  The CI was admitted and diagnosed with a heart attack (septal anteroseptal myocardial infarction).  He underwent a cardiac catheterization on 27 November 2007 with findings consistent with a complete occlusion of the one of the arteries of the heart (left anterior descending artery) due to a clot (thrombus).  The clot was removed and a stent was placed with documentation of excellent angiographic result.  The CI underwent a second catheterization on 28 November 2007 to ensure the patency of the stent due to continued reports of chest pain.  The stent was noted to be widely patent.  The CI underwent cardiac rehabilitation.  Perfusion imaging performed on 16 March 2009, approximately a year and a half after cardiac catheterization, demonstrated an ejection fraction of 55% (low normal), no evidence of scarring and questionable mild left ventricular dilatation.  The narrative summary examination dated 23 January 2008 noted that the CI was doing well and without recurrence symptoms.  The cardiac examination was normal except for sinus bradycardia (slow heart rate).  An addendum dated 30 July 2008 noted an ejection fraction of 65% (normal) and mildly decreased movement (hypokinesis) of septal and anterior wall.  At the VA Compensation and Pension examination performed 4 months after separation, the CI reported that he was asymptomatic and could walk a mile.  The cardiac examination was normal.

The Board directs attention to its rating recommendation based on the above evidence.  The PEB adjudicated the myocardial infraction, status-post coronary artery stent placement condition as unfitting with a disability rating of 10%, coded 7006 (myocardial infarction).  The VA rated the condition at 10%, coded 7005 (coronary artery disease).  The Board considered whether there was evidence for a higher than 10% disability rating.  There were no further cardiac hospitalizations, no emergency department visits for cardiac issues, and the CI was asymptomatic with stent placement and anticoagulation/cardiac medications.  Although there was evidence of decreased muscle movement at the site of the infarction and mention of questionable mild left ventricular dilatation, the ejection fraction (blood pumped out of the left ventricle to supply the body) was normal and the CI was asymptomatic.  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 myocardial infraction, status-post coronary artery stent placement 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 myocardial infraction, status-post coronary artery stent placement 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 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 20140627, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

		
XXXXXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-03065.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings