RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00665
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20091026

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, German Cryptologic Linguist, medically separated for “vasovagal syncope,” with a disability rating of 20%.

CI CONTENTION:  The CI described numerous issues and requested a review of 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 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 - 20090921	VARD - 20130103	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vasovagal Syncope	8199-8108	20%	Vasovagal Syncope	8199-8111	0%	20121208	
COMBINED RATING: 2 0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Vasovagal Syncope.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI reportedly had fainted (syncopal episode) four times during the period between late 2008 and 2009, with the latest occurring while standing at attention in formation.  Cardiology work-up included a vascular tilt-table test that was positive for positional (vasovagal) syncope (sudden drop in heart rate and blood pressure resulting in a brief loss of consciousness).  Her permanent profile contained restrictions that would not allow unrestricted duty.  The MEB forwarded “vasovagal syncope” for PEB adjudication.

At what appeared to be the NARSUM examination performed by cardiology on 8 May 2009 (5 months prior to separation), indicated that witnesses of the CI’s fainting episodes included “…seizure-like activity after the CI fell to the ground.”  Her physical examination (PE) revealed the CI to be alert and oriented to time, place and person.  She was well nourished and in no acute distress.  Her cardiovascular status was normal, both clinically as well as by echocardiogram analysis.  The VA Compensation and Pension (C&P) evaluation was performed over 3 years remote from separation and thus outside the time parameters for this review.  Therefore, any impairment rating recommended by this Board was based upon the STR and MEB-driven documentation.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the vasovagal syncope condition at 20%, analogously coded under 8108 (Narcolepsy), citing a duty restriction of no standing >5 minutes and four syncopal episodes within the past year.  The VA rated the same condition at 0% coded 8910 (epilepsy, grand mal) based on the C&P examination 38 months after separation, citing no compensable symptoms.  The CI had not seen a provider for vasovagal syncope since discharge from the service.  The Board first considered the coding options in this case and concluded that according to VASRD guidelines, “Syncope NOS (not otherwise specified) and syncope (vasovagal) is analogized to 8210 (tenth [Vagus] cranial nerve) per Alphabetical Listings of Analogous Code, June 25, 2004.”  VASRD code 8210 has only two ratings for incomplete paralysis of the vagus nerve; 10% for “moderate” and 30% for “severe”.  This code additionally contains a special note stating…“Dependent upon extent of sensory and motor loss to organs of voice, respiration, pharynx, stomach and heart.”  In consideration of the special note under 8210, all Board members agreed that the few episodes of positional syncope did not rise to a level of “severe” impairment; therefore its rating under 8210 would be supported only at the 10% level. IAW DoDI 6040.44, the Board may not recommend a rating lower than that received prior to application.  Therefore, 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’s adjudication for the vasovagal condition.   

BOARD FINDINGS:  In the matter of the vasovagal 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 modification or 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-2015-00665.

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,

Attachment:
Record of Proceedings