RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01215
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060310

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Infantryman, medically separated for “aortic regurgitation” with a disability rating of 10%.  

CI CONTENTION:  The CI requests that all conditions be considered.  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 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 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 - 20060119	VARD - 20060616	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Aortic Regurgitation … Bicuspid Aortic Valve… 	7000	10%	S/P Aortic Valve Repair…	7015	0%	20060425	
			Scar, Chest…	7805	0%		
Adjustment Disorder…	Not Unfitting	Adjustment Disorder…	9440	10%	20060417	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

Aortic Regurgitation.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s bicuspid aortic valve with aortic regurgitation condition began in mid-October 2004 after a diagnosis of MRSA.  A buttock abscess in August 2004 and left arm cellulitis in September 2004 were positive for MRSA.  He began to experience palpitations in October and the cardiac studies showed moderate to severe aortic insufficiency and a congenital bicuspid aortic valve.  He showed signs of anxiety which was treated.  It was not clear that MRSA and/or the exertional activities by the army, contributed to the need for surgical repair.  He underwent surgical repair of the valve December 2004.  Post surgically he continued to have shortness of breath.  The MEB forwarded aortic insufficiency for PEB adjudication.  
The MEB NARSUM examination on 2 June 2005, 9 months prior to separation, noted complaints of breathing problems during and after any exercise and anxiety problems, sleeping problems and palpitations.  He was limited to walking.  He was restricted from performing the Fitness Test (APFT.)  He had problems lifting heavy objects and low exercise tolerance.  His commander noted his illness precluded him from performing his primary MOS duties, including required training. One of the cardiac studies November 2004 showed and ejection fraction of 60-65%.  Stress test March 2005 showed excellent exercise tolerance.  He was married and reported leisure activities as golf, running and his wife.  The physical examination showed an elevated systolic blood pressure.  He was calm and in no distress.  He had a prominent murmur which radiated to the arteries in the neck.  Lungs were clear and there was no swelling or blueness of the extremities. Electrocardiogram (EKG), dated February 2006, was normal.  

At the 25 April 2006 VA Compensation and Pension (C&P) evaluation, performed 2 months after separation, the CI reported difficulty breathing when he exercises and before going to bed.  He could not run or walk longer than a mile.  He has palpitations with a little dizziness.  Albuterol inhaler helps a little bit.  X-rays showed normal heart and lungs.  The physical exam showed normal vital signs, clear lungs, and 2/6 heart murmur.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the bicuspid aortic valve with aortic regurgitation condition 10%, coded 7100 (valvular heart disease), noting it was undetermined whether a preexisting condition (bicuspid valve) was a factor, and citing need for continuous medication.  The PEB noted permanent service aggravation by required physical training.  The VA rated the status post aortic valve repair condition 0% coded 7015 (atrioventricular block), based on the VA C&P examination 2 months after separation, citing no disabling residuals.  The Board noted there was no evidence of an enlarged heart on EKG, X-ray or echocardiogram to meet criteria for 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 aortic regurgitation condition.  

Contended PEB Conditions:  Adjustment Disorder.  Adjustment disorder is a condition that does not constitute a physical disability.  The contended condition was not profiled or implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the aortic regurgitation condition and IAW VASRD §4.100, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder condition and IAW VASRD §4.71a, 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 20150611, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170011791, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,