RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03350
BRANCH OF SERVICE:  NAVY  	SEPARATION DATE:  20040113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E4, Boatswain’s Mate, medically separated for “paroxysmal atrial fibrillation,” with a disability rating of 10%.  

CI CONTENTION:  “Please consider all conditions.”

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:  

IPEB – Dated 20030925	VA* – (~2 Mos. Pre-Separation)  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Paroxysmal Atrial Fibrillation	7010	10%	Paroxysmal Atrial Fibrillation	7010	10%	20031125	
Other MEB/PEB Conditions x 0 (Not in Scope)	Other x 2 	
RATING:  10%	RATING:  10%	
*Derived from VA Rating Decision (VARD) dated 20031209 (most proximate to date of separation [DOS])  

ANALYSIS SUMMARY:  

Paroxysmal Atrial Fibrillation.  During 2001, this CI started having episodes of chest pain.  Initially, no cardiac abnormality was found.  Treadmill stress test and myocardial scintigraphy were both normal.  Then in April 2003, he was diagnosed with atrial fibrillation (AF), which is a cardiac dysrhythmia that causes irregular heartbeat.  He was started on Diltiazem, a medication to control the heartbeat.  On 20 May 2003, he had an echocardiogram.  The CI was in normal sinus rhythm.  There was good overall left ventricular systolic function.  Ejection fraction was 65% (normal).  Due to the chronic nature of the cardiac dysrhythmia, a Medical Evaluation Board (MEB) was initiated.  The MEB narrative summary was dated 18 June 2003.  At that exam, the CI was asymptomatic.  He had no complaints.  The physical examination was normal.  His heart was in normal sinus rhythm, with a rate of 76-78 beats per minute.

As noted above, the CI was found unfit for naval service due to Paroxysmal AF.  He was medically separated on 14 January 2004.  Seven weeks before separation, on 25 November 2003, he had a VA Compensation and Pension (C&P) exam.  His medication had been changed from Diltiazem to Lisinopril.  He was alert, cooperative, and in no apparent distress.  His pulse was 84 and regular.  No cardiac murmurs were heard.  Peripheral pulses were present and equal, and there was no edema. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and the VA both used VASRD code 7010 (Supraventricular arrhythmia), and both assigned a disability rating of 10%.  For the reader’s convenience, the VASRD §4.104 language for the 10% and 30% ratings (diagnostic code 7010) is excerpted below:

Paroxysmal atrial fibrillation or other supraventricular tachycardia, with 
more than four episodes per year documented by ECG or Holter 
monitor ……………………………..…………………………......................................................30 

Permanent atrial fibrillation (lone atrial fibrillation), or; one to four
episodes per year of paroxysmal atrial fibrillation or other
supraventricular tachycardia documented by ECG or
Holter monitor ………………………………………………………………………………….................10

Following a thorough review of the treatment record, the Board could not find sufficient evidence of more than four paroxysmal AF episodes per year, documented by ECG or Holter monitor.  Therefore, a rating of 30% was not warranted.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board found insufficient cause to recommend a change in the PEB adjudication for the unfitting heart condition (Paroxysmal AF).

BOARD FINDINGS:  In the matter of the Paroxysmal AF 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.  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 20140707, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 18 Apr 16

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXX, former USN