RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00545
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080827

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

CI CONTENTION:  The CI contends for conditions not identified by either the MEB or PEB.  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 – 20080618	VARD - None	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vasovagal Syncope…	8299-8210	10%	No VA Claim	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  N/A	

ANALYSIS SUMMARY:  

Vasovagal Syncope.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first presented with on 4 September 2007 with a complaint of chest tightness, shortness of breath (SOB), and light headedness a few times a week over the past several months.  His symptoms resolved over the next 10-90 minutes.  An evaluation for atypical chest pain was begun.  Over the course of the following months, he was extensively evaluated by cardiology, neurology, pulmonology, endocrinology, and mental health.  Testing included an echocardiogram, exercise stress test, Holter monitoring (similar to an ambulatory EKG), a brain MRI, an EEG (brain wave study for seizures), and a sleep study.  These were all essentially normal and he was diagnosed with vasovagal syncope.  As noted in a 21 February 2008 family practice note, the CI declined behavioral modification and medical therapy (medications, increased salt intake, increased fluids, etc.).  It was also noted that he and his wife had a newborn and did not have much social support.  They regretted his recent re-enlistment.  He had been transferred to a rear unit as his was set to deploy in April.  The commander noted that the CI excelled in his alternate duties (webpage administrator) and requested that he be allowed to remain in the rear detachment and also that he be considered for another military specialty.  The MEB NARSUM examination was dated 25 April 2008, 4 months prior to separation.  The CI reported that his symptoms had begun in March the previous year and presented with intermittent lightheadness and tunnel vision when standing up after sitting.  These lasted a few seconds.  Over time, his symptoms had worsened.  He reported that recently he had about 4 episodes a week which lasted a couple of seconds and occurred with random movements (not just moving from supine/sitting to standing).  He denied recent loss of consciousness.  His physical examination was normal.  The MEB forwarded “recurrent syncope vasovagal” for PEB adjudication.  Following the MEB, the CI presented to the emergency room (ER) for near syncope (feeling faint without actual loss of consciousness) on several more occasions.  No VA Compensation and Pension (C&P) evaluation is in evidence.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the vasovagal syncope condition 10%, coded analogously 8299-8210 (paralysis of cranial nerve X [vagus]), citing moderate incomplete paralysis.  While the CI was seen in the ER several times in the months prior to separation, no actual loss of consciousness was reported.  This is consistent with a moderate level of impairment.  The Board also considered the codes 8108 (narcolepsy) and 8911 (petit mal epilepsy), but determined that the 8210 code better described the condition and was therefore more appropriate to use for rating purposes.  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 20150603, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018750 (PD201500545)

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