RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX		CASE:  PD-2015-00436
BRANCH OF SERVICE:  Army		SEPARATION DATE:  20080831

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4, Intelligence Analyst, medically separated for “vasovagal syncope” (fainting due to a drop in blood pressure and heart rate), with a disability rating of 10%.    

CI CONTENTION:  The applicant requests all conditions be reviewed.  The CI’s complete submission, with attachments, 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 - 20080602	VARD - 20090323  	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vasovagal Syncope…	8299-8210	10%	Migraine Headaches with Vasovagal Syncope Episodes	8100	0%	20090127	
Migraine Headaches	Not Unfitting 					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Vasovagal Syncope.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first noted dizziness and then fainting in the fall of 2005.  Over the course of the next few years, she was extensively evaluated by otolaryngology, neurology, and cardiology.  She was diagnosed with neurocardiogenic syncope.  In December 2005, a tilt test was subjectively positive but objectively negative.  Other testing was essentially normal.  She was able to mitigate her symptoms by sitting down, drinking water, and resting when she became symptomatic.  She became symptomatic with prolonged standing.  She was then referred to an MEB.  The MEB forwarded vaso-vagal syncope of unknown etiology for PEB adjudication.  The MEB NARSUM examination on 26 March 2008, 5 months prior to separation, noted complaints syncope (fainting) with prolonged standing and that her threshold was reduced when ill or exposed to heat.  The physical examination remained unremarkable.  At VA Compensation and Pension (C&P) evaluation performed on 27 January 2009, 5 months after separation, the CI reported that she had two episodes a week.  She had been employed as an office worker for the previous 6 months.  Her examination was unremarkable.  No diagnosis was rendered as there was no pathology in evidence upon which to make one.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the vasovagal syncope at 10%, coded 8299-8210 (analogous to incomplete, moderate paralysis of the vagal nerve) noting a frequency of once every 3 weeks the previous 3 months despite treatment.  The VA did not rate the CI for the syncope condition, but incorporated the symptoms into the migraine condition (below).  The Board considered the evidence.  It noted that while the CI remained symptomatic despite therapy, she was able to control her symptoms by behavioral modifications and had been working in an office.  The evidence supported an impairment at the moderate rather than severe level.  The Board considered the code 8911 for petit mal epilepsy, but determined that the 8210 code chosen by the PEB provided a better clinical description of the diagnosis.  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.  

Contended PEB Conditions:  Migraine Headaches.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended migraine headache condition was not unfitting.  Migraines were not profiled, implicated in the commander’s statement, or judged to fail retention standards.  She reported to the neurologist that these were low grade and that she had “learned to live with them.”  She was on no medications for the headache condition.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

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.  In the matter of the contended migraine headache condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140521, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

8 Feb 2017

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20170000101 (PD201500436)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA