RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXXX	CASE: PD-2015-00622
BRANCH OF SERVICE:  ARMY	SEPARATION DATE:  20051105

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Radio Microwave Transmission Specialist Operator and Maintainer, medically separated for “neurocardiogenic syncope” with a disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned 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 or non-compensable.  Any conditions outside the panel’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 panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination 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(s) at the time of separation.  The panel 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 panel 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 - 20050824	VARD -  NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neurocardiogenic Syncope	8299-8210	10%	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Neurocardiogenic Syncope.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s cardiac condition began in July 2003.  At a cardiology evaluation dated 10 March 2005 the CI reported recurrent episodes of syncope (short loss of consciousness and muscle strength, characterized by a fast onset, short duration, and spontaneous recovery).  A tilt table test showed decreased blood pressure and heart rating resulting in lightheadedness and visual changes followed by loss of consciousness.  The CI was diagnosed with neurocardiogenic syncope. 

The 26 April 2005 MEB NARSUM examination, 7 months prior to separation, noted complaints of lightheadedness when getting up from a sitting position with visual changes and then loss of consciousness.  The CI stated that he had two episodes of syncope in the last 2 weeks and 12 episodes in the last year and a half.  He stated that loss of consciousness ranged in duration from “10 minutes to the longest being an hour and a half.”  Physical examination showed the CI’s sitting blood pressure was within normal limits and his pulses were equal bilaterally.  The examiner noted that tilt table testing, performed in March 2005, was consistent with neurocardiogenic syncope.  There was no VA examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the cardiac condition 10%, coded 8299-8210 (vasovagal), citing “positive tilt table testing, not requiring medication. Rated as incomplete moderate paralysis.”  There was no evidence of heart rate lower than 40 beats per minute or severe orthostatic to support a 30% rating for a condition analogous to severe vagal nerve incomplete paralysis.  The VASRD defines a minor seizure as a brief interruption in consciousness or loss of postural control. There was documentation of 15 syncopal episodes (brief interruption in consciousness, loss of postural control) over 18 months (two occurring within 2 months prior to separation) for a 20% rating analogous to 8108 (narcolepsy).  The evidence did not support a 40% rating for an average of 5 to 8 “minor seizures” weekly.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the neurocardiogenic syncope condition, coded 8199-8108.  

BOARD FINDINGS:  In the matter of the neurocardiogenic syncope condition, the panel unanimously recommends a disability rating of 20%, coded 8199-8108 IAW VASRD §4.124a.  There are no other conditions within the panel’s scope of review for consideration.  
The panel recommends the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Neurocardiogenic Syncope	8199-8108	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 4/23/2020 w/atchs
Exhibit B.  Service Treatment Record

AR20170008977, XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure