RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX	CASE:  PD-2014-04067
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080421

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Air Traffic Control Craftsman, medically separated for “pre-syncope syndrome,” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  The CI’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 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 based upon a 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 - 20080306	VARD - 20080807	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pre-syncope Syndrome	8210	10%	Vasovagal Syncope	6204	10%	20080610	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Pre-syncope Syndrome.  The CI was first evaluated for dizziness on 9 August 2002 when she was evaluated for a cold.  It apparently resolved with the resolution of the cold.  She was next evaluated on 9 October 2007 during an initial clearance for controlling duties at a new base of assignment.  She reported a spinning sensation and was found to have fluid in the left ear (serous otitis media).  Her symptoms improved with decongestants and she was returned to duty 1 week later.  However, a week after that, she presented with symptoms of pre-syncope (feeling like one will black out) upon standing.  An MRI of the brain was normal other than an unrelated finding in a sinus.  An evaluation by an otolaryngologist excluded an inner ear (VIIIth cranial nerve) problem.  She was then referred to cardiology where a tilt test confirmed the diagnosis of pre-syncope.  The cardiac examination was otherwise unremarkable.  She was initially treated with fluids and salt.  Later, compression stockings and medications were added to her treatment regimen.  Pre-syncope is a condition for which an MEB is required and this was then initiated.  The narrative summary (NARSUM) was dated 9 January 2008, just over 3 months prior to separation.  It noted that she had been symptomatic for several years prior to separation.  The Board observed that a post-separation VA noted dated 17 December 2008 documented that the CI had a 30-35 pound weight loss in the months prior to her presentation in October 2007.  Her physical examination was unremarkable.  Testing of the cranial nerves was normal.  

At the VA Compensation and Pension (C&P) examination performed on 10 June 2008, 2 months after separation, the CI reported dizziness and syncope attacks.  The examiner did not detail if these episodes were vertiginous (spinning and a problem with the VIIIth nerve) or pre-syncope (in this case, a problem with the vagal nerve, the Xth cranial nerve).  Her neurological and cardiac examinations were normal.  She was diagnosed with vaso-vagal syncope.  

The Board directed its attention to its rating recommendation based on the above evidence.  The PEB rated the pre-syncope at 10%, coded 8210 (incomplete, moderate paralysis of the Vagal Nerve).  The VA also rated the condition at 10%, but used the code 6204 (peripheral vestibular disorders with occasional dizziness).  The Board noted that a vestibular problem had been excluded by the otolaryngologist and pre-syncope definitively diagnosed by the cardiologist.  The 6204 code is clearly the more accurate of the two codes used, but this did not affect the rating assigned.  The Board found no better coding option for the pre-syncopal condition.  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 pre-syncope condition.  

BOARD FINDINGS:  In the matter of the pre-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 /atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

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

Dear 

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-04067.

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