RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01172
BRANCH OF SERVICE:  Coast Guard 	SEPARATION DATE:  20051104

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

CI CONTENTION:  The CI made no specific contention.  His 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 - 20050804	VARD - 20061116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vasovagal Syncope Rated as Paralysis of the Tenth Cranial Nerve. Incomplete, Moderate	8299-8210	10%	Neurogenic Hypotension	6299-6204	NSC	20060823	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Vasovagal Syncope Rated as Paralysis of the Tenth Cranial Nerve.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had an initial episode of near-syncope (fainting) in July 1997.  This occurred during urination and resulted in loss of consciousness (LOC) and hit his chest on a cabinet as he fell.  Following this, he had no further episodes and enlisted in 2002.  The history of syncope was not disclosed at accession.  A second episode occurred in March 2005, again during urination and resulted in LOC and a mild closed head injury (CHI) manifested by a bruise.  The evaluation showed a normal brain MRI, normal EEG (by report), normal Holter monitor study (an evaluation for abnormal rhythms; noteworthy in that the CI had a normal rhythm multiple times while symptomatic), and normal echocardiogram.  He had a positive tilt table test which lead to the diagnosis of neurally mediated syncope (vaso-vagal syncope).  Treatment with a beta-blocker was recommended; this medication was not permitted for his military occupation and the CI was referred for an MEB.  The report of the MEB (NARSUM), accomplished on 22 June 2005, recorded that the CI reported an increasing frequency of episodes.  At the VA Compensation and Pension (C&P) evaluation performed on 23 August 2006, 10 months after separation, the CI reported that since his presentation in March 2005 he had several more episodes of feeling lightheaded during urination, but had not actually had LOC.  His cardiac and neurological examinations were normal.  It was observed that the cardiologist had not made a formal diagnosis, but based this on a note prior to the tilt table test upon which the diagnosis of neurally mediated syncope was made.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the syncope condition 10%, analogously coded 8299-8210 (paralysis of the tenth cranial nerve [vagus]).  The VA, based on the VA C&P examination 10 months after separation, did not service-connect the syncope condition, analogously coded 6299-6204 (peripheral vestibular disorder), citing that the medical evidence of record failed to show that there was a confirmed diagnosis.  The panel considered the evidence.  At the VA C&P examination, the CI reported several episodes a week of near-syncope without LOC.  No specific code exists for syncope (a symptom), but it can be coded as analogous to petit mal seizure (8999-8911).  A frequency of at least 2 minor episodes a week corresponds to a 20% rating.  The code 8210 used by the PEB supported a 10% rating for a moderate level of disability; the severity did not rise to “severe” which would support a 30% rating.  The code used by the VA, 6204, is for an inner ear disorder which was not the diagnosis given to the CI.  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 syncope condition, coded 8999-8911.  

BOARD FINDINGS:  In the matter of the syncope condition, the panel unanimously recommends a disability rating of 20%, coded 8999-8911 IAW VASRD §4.124a.  There were no other conditions within the panel’s scope of review for consideration.  The panel 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	
Vasovagal Syncope	8999-8911	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150608, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXX
Dear XXXXXXXXXXXXXXXXXXX,
I am the Designated Decision Authority for the Coast Guard on applications submitted to the Department of Defense Physical Disability Board of Review (PDBR).  Under the authority of Title 10, United States Code, section 1554a, I accept the PDBR’s recommendation in your case (Case Number PD-2015-01172) and recommend your rating be changed from 10% to 20% but with no re-characterization of the separation. 

Enclosed for your information are a copy of the PDBR’s recommendation and a copy of the record of proceedings. 

A copy of this decision has also been provided to Coast Guard Enlisted Personnel Management Branch, the PDBR, and the Department of Veterans Affairs. 

If you have any further questions, please contact the Coast Guard Personnel Service Center at XXXXXXXXXXXXXXXXXXX. 
	Sincerely,
2 Enclosures		
	
Copy:	CG Personnel Service Center (EPM-1)
DoD Physical Disability Board of Review
Department of Veterans Affairs