RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX		CASE:  PD-2014-03250
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050914

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (13P, Multiple Launch Rocket System Operations/Fire Direction Specialist) medically separated for a vasospastic angina condition.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The “angina pectoris” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other conditions were submitted by the MEB.  The Informal PEB adjudicated “vasospastic angina” as unfitting, rated 10%, with application of the Veterans Affairs 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 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:  

IPEB – Dated 20050819	VA* - (~2 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vasospastic Angina	7099-7005	10%	Cardiomyopathy	7020	30%	20050726	
Other x 0 (Not In Scope)	Other x 6 	
RATING:  10%	RATING:  40%	
*Derived from VA Rating Decision (VARD) dated 20050930 (most proximate to date of separation (DOS)).  

ANALYSIS SUMMARY:  Vasospastic Angina Condition.  The CI had a history of chest pain on exertion.  An echocardiogram and pulmonary function testing performed in June 2004 were normal.  An exercise stress test performed on 24 June 2004 demonstrated ischemic heart disease. A chemical (Cardiolite) stress test performed 29 June 2004 was normal.  The CI underwent a cardiac catheterization study 29 September 2004 which showed non plaques or coronary narrowing.  The CI was evaluated by cardiology and diagnosed with atypical chest pain.  A consultation note from the cardiologist dated 17 February 2005 documented that it was “unclear” whether the chest pain was related to a cardiac or non-cardiac etiology.  On 27 April 2005, the CI was diagnoses with chest pain syndrome consistent with vasospastic/variant angina.  The examiner noted that the pain was refractory to medication.  The narrative summary (NARSUM) examiner documented a normal heart examination and a diagnosis angina pectoris (chest pain caused by ischemia of the heart).  At the VA Compensation and Pension (C&P) exam performed 2 months before separation, the CI reported shortness of breath and fatigue due to coronary artery disease with continued use of nitroglycerin spray for his chest pain.  The cardiac examination was normal.  An echocardiogram performed 26 July 2005 demonstrated left atrial enlargement, an ejection fraction of 52%, and metabolic equivalents of task (METS) of 6+.  A diagnosis of cardiomyopathy was rendered. A repeat stress test performed 04 August 2005 demonstrated a METS of 8+ with reports of 6/10 chest pain which spontaneously resolved; however this test was inadequate because the CI failed to reach 85% of the predicted heart rate ( the CI reached 74%) prior to the onset chest pain and lightheadedness resulting in termination of the test.

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated that chest pain condition at 10%; coded 7099-7005 (Coronary artery disease, CAD).  VA coded the condition 7020 (cardiomyopathy) and rated it at 30% for workload greater than 5 METs but not greater than 7 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope; or evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray.  The Board considered whether the evidence supported a higher than 10% rating.  The Board noted that multiple treatment notes documented chest pain on exertion.  The placed higher probative value on the echocardiogram findings two months prior to separation because the stress test most proximate to separation was inadequate due to cardiac symptoms resulting in termination of the test.  Board members agreed that criteria was met for a 30% rating based on METS of 6+ on echocardiogram.  

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 vasospastic angina condition, the Board unanimously recommends a disability rating of 30%, coded 7099-7005 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 re-characterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:  

CONDITION	VASRD CODE	RATING	
Vasospastic Angina	7099-7005	30%	
COMBINED	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140708, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20160004421, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board's recommendation and record of proceedings for your information.

The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.

The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information .on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXXX.

A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,

 
XXXXXXXXXXXXXXXXXXX
Deputy Assistant Secretary of the Army

Enclosure