RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXX  	            CASE:  PD-2014-03998
BRANCH OF SERVICE:  AIR FORCE  	SEPARATION DATE:  20080418

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, E-3, Biomedical Equipment Helper, medically separated by the Informal Physical Evaluation Board (IPEB) for “vasovagal syncope” with a disability rating of 10%. 

CI CONTENTION:  “The applicant has asked for consideration of all conditions in his application.  The applicant’s 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 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 - 20071217	VARD - 20081009	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vasovagal Syncope with Chest Pain	8299-8210	10%	Chronic Vasovagal Syncope with Atypical Chest Pain…	6299-6204	10%	20080703	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Vasovagal Syncope with Chest Pain Condition.  In May 2007 the CI experienced exertional and non-exertional chest pain associated with sweating and radiation pain into his lower neck.  He also reported a single episode of ‘syncope’ (fainting).  He underwent a complete cardiology workup and was diagnosed with chest pain and syncope.  A week long continuous heart monitoring test conducted in June 2007 did not correlate the CI’s symptoms to any abnormal or pathologic heart rhythm.  A tilt-table test was positive and the CI was definitively diagnosed with vasovagal syndrome [syncope] (sudden drop in heart rate and blood pressure resulting in a brief loss of consciousness).  Due to intermittent episodes of continued symptoms, he was referred to a MEB.  At the MEB narrative summary (NARSUM) examination (28 August 2007; eight months prior to Service separation), the CI’s chief complaint was listed as chest pain, nausea, dizziness, and syncope.  The physical examination (PE) was detailed and normal.  The final diagnosis remained as vasovagal syncope and chest pain.  At the VA Compensation and Pension (C&P) examination (3 July 2008; three months after Service separation), the CI reported a short duration of dizziness with position changes from supine to standing.  Additionally, he endorsed a dull mid-sternal chest pain that occurred anytime without identified aggravators.  The VA’s PE was normal.  The diagnosis was listed as, ‘chronic vasovagal syncope with atypical chest pain, stable without residual disability.  This is a non-cardiac condition per full cardiac work-up during active service.’ 

The Board directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated 10%, under different analogous codes of 8210 (incomplete paralysis; [moderate] Vagus nerve) and 6204 (peripheral vestibular disorders; occasional dizziness), respectively.  The PEB cited extensive physical and duty limitations whereas the VA cited occasional dizziness for their rating.  Board members first considered and deliberated over the appropriateness of the various coding schemes used by the PEB and VA for rating purposes.  The action officer explained that the pathology in this case involved symptom mediation from a ‘central’ versus a ‘peripheral’ nerve and therefore, the PEB’s code of 8210 (Vagus nerve…a ‘central’ nerve) is most appropriate.  All Board members agreed and continued deliberation as to the level of impairment under code 8210 for incomplete paralysis.  The available impairment levels under this code include moderate at 10% and severe at 30%.  Members concluded that in light of having normal PE’s coupled with short duration of symptoms in a condition listed as ‘stable, without residual disability’, did not support an impairment level greater than the PEB’s current 10%.  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 vasovagal syncope condition. 

BOARD FINDINGS:  In the matter of the vasovagal syncope condition and IAW VASRD §4.124a, 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 20140604, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear XXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-03998.

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,

Attachment:
Record of Proceedings