RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01290
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060515

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Intelligence Analyst, medically separated for “history of exertional syncope,” with a disability rating of 0%.  

CI CONTENTION:  The CI requests 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 20060404	VARD - 20061211	
Condition	Code	Rating	Condition	Code	Rating	Exam	
History Of Exertional Syncope	8299 8210	0%	Exercise Induced Neuro-Cardiogenic Syncope (Claimed as Heart Condition)	7099-7005	0%	20060808	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

History of Exertional Syncope.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s syncope condition began in June 2004.  The CI experienced chest pain, lightheadedness, and confusion with running 2 to 3 miles and, if he did not stop, would pass out briefly.  The CI underwent a comprehensive cardiac evaluation and was diagnosed with neurocardiogenic syncope by exercise treadmill electrocardiography and echocardiography tests which reproduced his symptoms at high heart rates and high MET (standardized units used to assess exercise capacity) levels.  The CI was tried on various medications without full resolution of his symptoms.  

The 6 February 2006 MEB NARSUM examination, 3 months prior to separation, noted complaints of passing out while running.  The CI was taking daily beta blocker medication for the syncope condition and reported it helped.  The NARSUM noted the CI had experienced 10 to 20 episodes of exertional syncope in the preceding 20 months.  He reported that it took less time to recover from symptoms with exercise.  However, the examiner indicated the CI continued to have syncope if he ran for more than approximately 20 minutes.  Physical examination was normal, including normal examination of the heart and lungs.  

At the 8 August 2006 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported that he had lost work time in the last 12 months due to medical appointments and two emergency room visits.  He reported that with physical activity during which his heart rate got above 160-170 beats per minute he became dizzy and disoriented, had chest pains and would eventually pass out.  He remained on the daily beta-blocker medication and he reported that it did not prevent episodes.  Occasionally he could sit down with symptoms and avoid syncope and he did not have any symptoms if he avoided exercise.  Physical examination was completely normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the syncope condition 0%, coded 8299-8210 (vagus nerve, incomplete paralysis), an analogous code for syncope.  The VA rated the syncope condition 0%, coded analogously to 7005 (coronary artery disease), based on the VA C&P examination 3 months after separation.  At the time of separation, the CI was on appropriate medication for the exertional syncope with reported continued pre-syncopal symptoms with exercise, and he was able to avoid syncope by cessation or avoidance of strenuous activity.  The panel first considered rating the condition analogously to 8210.  The evidence of continued pre-syncopal symptoms with exercise despite medication supports a 10% rating for “moderate” incomplete paralysis of the vagus nerve under 8210 and no higher.  The panel next considered if rating the syncope condition analogously under 8108 (narcolepsy), another analogous code for syncope, supported a higher rating.  Narcolepsy is rated according to the criteria for rating petit mal seizures.  A 20% rating for petit mal seizure (8911) specifies “at least 2 minor seizures in the last 6 months.” The last contemporaneous documentation of ongoing syncopal episodes was in January 2006.  Following the diagnostic exercise tress testing in early February 2006, the CI reported continued symptoms with exercise, but as noted above he reported he could avoid symptoms and syncope if he did not exercise strenuously.  Therefore, the panel concluded that the threshold for an analogous 20% rating under 8108 was not met because there was no evidence of ongoing (uncontrollable) episodes of syncope.  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 exertional syncope condition, coded 8299-8210.  

BOARD FINDINGS:  In the matter of the exertional syncope condition, the panel unanimously recommends a disability rating of 10%, coded 8299-8210 IAW VASRD §4.124a.  There are 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	
Exertional Syncope	8299-8210	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150615, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170009040, 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