RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00642
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20030929

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Aircraft Fuel Systems 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 - 20030808	VARD - 20031016	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neurocardiogenic Syncope	8210-8299 [sic]	10%	Neurocardiogenic Syncope	7099-7011	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Neurocardiogenic Syncope.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was admitted to the hospital on 20 January 2003 after passing out while talking to friends.  He was noted to have a syncopal (fainting) episode.  An echocardiogram showed normal heart structures and function.  A Holter monitor showed a normal rhythm.  A tilt-table test was initially normal, but positive with loss of consciousness when repeated.  The second tilt table test noted an abnormal ventricular rhythm (junctional) with a slow heart rate and low blood pressure.  A second syncopal episode occurred on 15 February 2003.  He was begun on a medication trial, but discontinued it due to the side effects.  He was then placed on a second medication.  As he was at risk for future episodes, he was referred for an MEB which forwarded “neurocardiogenic syncope” for PEB adjudication.

The MEB NARSUM examination on 23 June 2003, 5 months after the initial presentation and 3 months prior to separation, noted no further syncopal episodes after the 15 February 2003 occurrence.  The CI reported improvement on the second medication, but was still symptomatic when he rapidly changed positions.  Physical examination, including a cardiac evaluation, was unremarkable.  Cross training into an administrative position was recommended with limitations of no working at heights, no deployment, and access to a cardiologist at future assignments.

There was no VA Compensation and Pension evaluation performed.  The VA utilized the CI’s STRs.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the syncope condition 10%, analogously coded 8210-8299 [sic] (paralysis of the vagal nerve).  The VA also rated syncope condition 10%, analogously coded 7099-7011 (ventricular arrhythmias) based on the CI’s STR.  The Board agreed that the STR and VA evidence did not support a higher rating.  There was no evidence of an “incomplete, severe” paralysis of the vagal nerve under code 8299-8210 or workload greater than 5 METs but not greater than 7 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray under code 7099-7011, to support a 30% rating.  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 syncope condition and IAW VASRD §4.100 and §4.124, 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 20150604, w/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 XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-00642.

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,

XXXXXXXXXXXXXXXXXXXXX
Principal Deputy Assistant Secretary 
(Manpower and Reserve Affairs)

Attachment:
Record of Proceedings