RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01344
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070509

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 “vasovagal syncope”, with a disability rating of 10%.  

CI CONTENTION:  “TBI headaches mood changes PTSD back injury shoulder injury…see medical records; Review all conditions.”  The CI’s 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 - 20070409	VARD - 20140517	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vasovagal Syncope	8299-8210	10%	No VA Placement	20140505	
Cerebral Contusion with Brief Period of Unconsciousness	Not Unfitting	No VA Placement		
Common Migraine Without Aura		No VA Placement		
Right Upper Extremity Benign Positional Hypoesthesia		Right Shoulder Condition	5201	NSC		
Occupational Problems		PTSD	9411	70%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Vasovagal Syncope.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s vasovagal syncope condition began in October 2005 after being injured in an altercation which involved being struck on the head with a bottle.  Magnetic Resonance Imaging (MRI) in February 2006 revealed evidence of prior trauma (bilateral frontal contusion with gliosis) and was otherwise normal.  The MEB forwarded “vasovagal syncope” for PEB adjudication.  

The MEB NARSUM examination on 21 February 2007, 3 months prior to separation, noted chief complaints head trauma.  Following recovery from initial hospitalization for intracranial bleeding, the CI reported episodes of loss of consciousness occurring roughly 3 times per month.  Episodes were seemingly unrelated to activity, but worsened with physical activity.  

Neurology evaluation (in February 2007) provided a detailed history of the CI’s fainting with unconsciousness lasting for 15 seconds occurring 2-3 times a month.  There was no convulsive activity reported.  Cardiology evaluation noted rare isolated premature atrial contractions with no pathologic pauses on sustained monitoring (Holter) and a normal echocardiogram.  The assessment was “fainting (syncope).”  Physical examination was essentially normal.  

There was no VA examination proximate to separation.  At the 5 May 2014 VA Compensation and Pension (C&P) evaluation, performed 7 years after separation, there was no evaluation for syncope or loss of consciousness.  The rating determination noted VA treatment for headaches and possible residuals of head injury or TBI and recommended the CI be invited to submit a claim.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the vasovagal syncope condition 10%, coded 8299-8210 (tenth [pneumogastric, vagus] cranial nerve, incomplete paralysis), citing rated as “analogous to paralysis of the vagus nerve, incomplete, moderate.”  

There was no seizure activity associated with the CI’s vasovagal episodes and therefore alternative rating analogous to 8911 (epilepsy, petit mal) was not supported.  There was no evidence of vagus nerve sensory or motor loss to organs of voice, respiration, pharynx, or the stomach to support any rating higher than the 10% (moderate incomplete paralysis) awarded by the PEB.  

After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the vasovagal syncope condition.  

Contended PEB Conditions:  Cerebral Contusion with Brief Period of Unconsciousness, Common Migraine Without Aura, Right Upper Extremity Benign Positional Hypoesthesia, and Occupational Problems.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  

…..Cerebral Contusion with Brief Period of Unconsciousness:  The profile included fainting spells and the commander’s statement implicated head injury with blackouts.  The condition was not judged to fail retention standards.  There were no other unfitting symptoms from the cerebral contusion.  Even if the unfitting syncope condition and fainting spells were attributed to sequelae of the cerebral contusion, members agreed that there were not separate conditions which could be reasonably justified as separately unfitting; nor would separate ratings be achievable without violation of VASRD §4.14 (avoidance of pyramiding).  

…..Right Upper Extremity Benign Positional Hypoesthesia:  The right shoulder was profiled U2.  It was not implicated in the commander’s statement or judged to fail retention standards.  Exam showed no loss of range of motion or strength.  There was no performance-based evidence from the record that the shoulder condition significantly interfered with satisfactory duty performance at separation.  

…..Occupational Problems:  No mental health condition was profiled, implicated in the commander’s statement or judged to fail retention standards.  There was no performance-based evidence from the record that any mental health condition significantly interfered with satisfactory duty performance at separation.  

After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the vasovagal syncope condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended cerebral contusion with brief periods of unconsciousness, common migraine without aura, right upper extremity benign positional hypoesthesia, and occupational problems conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  

The panel, 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 20150618, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170012855, 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,