RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00986
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071227

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “syncope, vasovagal,” with a disability rating of 0%.  

CI CONTENTION:  “Review all conditions.”  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 - 20071025	VARD - 20011115	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Syncope, Vasovagal	8299-8210	0%	No VA Claim in Record	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Syncope, Vasovagal.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s syncope condition began in 2005 after experiencing recurrent blackouts.  Episodes occurred without seizure, disorientation, or chest pain.  Cardiac rhythm (electrocardiogram) and ultrasound (echocardiography) showed no evidence of heart dysfunction.  Tilt table testing resulted in a drop in blood pressure that caused sudden loss of consciousness (vasovagal syncope).  

At the 26 September 2007 MEB NARSUM examination, 3 months prior to separation, the CI reported 15 episodes of syncope with 1 that resulted in a car accident.  Physical examination was normal including the cardiac examination.  There was no VA Compensation and Pension (C&P) examination in evidence within 12 months of separation.  

The panel directed attention to the rating recommendation based on the above evidence.  The PEB rated 0% for the syncope condition, analogously coded 8299-8210 (paralysis of the tenth [pneumogastric, vagus] cranial nerve), citing normal neurologic examinations.  

The panel considered the evidence for rating and noted that there is no specific VASRD diagnostic code for the syncopal condition and therefore considered the rating recommendation using several VASRD analogous codes in accordance with VASRD §4.20 (analogous ratings).  

The episodes were characterized by light headedness and dizziness with acute loss of consciousness.  There were no cognitive findings in the record, and no documentation of head injury, and therefore, no clinical documentation to support any neurocognitive deficits.  There was no evidence of heart disease resulting in dyspnea, fatigue, angina, dizziness, or syncope.  There was no evidence of tachycardia, tremor, increased pulse or blood pressure for rating under the cardiovascular codes.  There were no abnormal lab investigations, or evidence of persistent “end organ” damage.  However, there was evidence of a drop in blood pressure that resulted in syncope and a requirement for continuous medication (for blood pressure stabilization) that would support a 10% rating using analogous coding (IAW VASRD §4.104) under the cardiovascular code 7099-7020 (cardiomyopathy) or 7999-7900 (hyperthyroidism).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the vasovagal syncope condition, coded 7099-7020.  

BOARD FINDINGS:  In the matter of the syncope condition, the panel unanimously recommends a disability rating of 10%, coded 7099-7020 IAW VASRD §4.104.  There were no other conditions within the panel’s scope of review for consideration.  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Syncope, Vasovagal	7099-7020	10%	
COMBINED	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150607, w/atchs
Exhibit B.  Service Treatment Record

AR20170007906, XXXXXXXXXXXXXXXXXXXXX

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