RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00415
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE: 20070724 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Pavements and Construction Equipment Journeyman, medically separated for “neurocardiogenic syncope,” with a disability rating of 10%.

CI CONTENTION:  “Review all conditions.”  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 on 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 - 20070601	VARD - 20100813	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neurocardiogenic Syncope	8210	10%	Heart Condition	7005	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Neurocardiogenic Syncope.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neurocardiogenic syncope condition began in August 2006 after passing out in the middle of the night.  He was seen in the emergency room with complaints of feeling dizzy and having a headache.  He underwent a complete work-up in the emergency room that was negative.  He subsequently underwent a comprehensive cardiac evaluation which was also negative.  The cardiologist diagnosed neurocardiogenic syncope (syncope caused by abnormal function of nerve related to cardiac function) which was confirmed by tilt table testing.  The CI was treated with appropriate medications and within a few months he reported complete resolution of his dizziness and no syncopal episodes since the initial one in August.  The MEB forwarded “neurocardiogenic syncope” for PEB adjudication.  At the MEB NARSUM examination on 13 April 2007, 3 months prior to separation, physical examination was normal.  
The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neurocardiogenic syncope condition 10%, coded 8210 (incomplete paralysis of the vagus nerve).  The original VA Rating Decision dated 13 August 2010, 3 years after separation, did not service-connect a claim for a heart condition because the CI did not attend scheduled VA C&P examinations.  At the time of separation, the CI was without symptoms and had not experienced recurrent syncope since being placed on appropriate medication.  There is no path to a higher rating than 10% as adjudicated by the PEB.  There was no evidence to support characterizing the incomplete vagus nerve paralysis as “severe” based on the extent of sensory or motor loss to the heart.  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 neurocardiogenic syncope condition.  

BOARD FINDINGS:  In the matter of the neurocardiogenic condition and IAW VASRD §4.71a, 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 20150530, 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

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00415.

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,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings