RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01582
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20080606

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Response Force Member, medically separated “neurocardiogenic syncope,” with a disability rating of 10%.  

CI CONTENTION:  The CI continues to have ongoing issues with his condition.  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 - 20080421	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neurocardiogenic Syncope	8210	10%	No VA Exam in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Neurocardiogenic Syncope.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first seen for “neurocardiogenic syncope” symptoms in July 2006 after complaints of dizziness/lightheadedness and syncopal episodes for approximately 7 months.  At the 14 December 2007 neurology evaluation, 5 months prior to separation, the CI reported continued spells of presyncope and syncope.  They occurred at any time in the day, and typically occurred either when he went from seated to standing, or once he has been on his feet for a little while, without occurring while seated.  He would have sudden onset of light headedness, with some darkening of his vision.  The CI indicated that thought that he had frankly lost consciousness 11 times since he was last seen (on 24 July 2007 – average of 2-3 times a month).  The specialist indicated a prior tilt-test showing bradycardia with loss of consciousness and  

At the 4 February 2008 neurology evaluation the CI reported that he continued “to have occasional spells of presyncope, with a sensation that he might pass out, upon first arising.  These have been one or more times a day.  He has also had several more spells of frank syncope standing up, having a sensation that he is dizzy, and then passing out with a brief loss of consciousness.”  Interval testing indicated that the CI had no spells of syncope during Tilt-table testing and video electroencephalogram (EEG) showed drowsiness but was otherwise normal with no losses of consciousness.  Physical examination showed no neurologic deficits or abnormalities.  

The 8 February 2008 MEB NARSUM examination, 4 months prior to separation, noted complaints of 7 months of intermittent dizziness/lightheadedness and syncopal episodes.  The CI denied seizure activity, weakness, numbness, short-term memory problems, or difficulty with balance.  Physical examination showed no neurologic deficits or abnormalities.  

At the 28 February 2008 family practice clinic evaluation, 3 months prior to separation, the CI requested a profile change to allow him to drive on base.  He related blackouts with unconsciousness lasting only a few seconds occurring 2-3 times a day and that these were after a 5-10 second period of lightheadedness.  However, he admitted that sometimes the syncope “catches him off guard.”  The CI had a blackout the day prior and fell down the steps.  Physical examination was essentially normal and the profile change was denied.  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the “neurocardiogenic syncope” condition 10%, coded 8210 (tenth [pneumogastric, vagus] cranial nerve), citing non-capability with the rigors of service.  The panel considered alternative analogous coding IAW VASRD §4.20 (analogous ratings).  Both 8199-8108 (narcolepsy) and 8999-8911 (epilepsy, petit mal) aligned with the functions affected and symptomatology of the CI’s neurocardiogenic syncope.  Both analogous codes apply the rating criteria from 8911 for “minor seizures.”  Ratings above 10% are based on the frequency of episodes in the last six months with 20% for “at least 2 minor seizures in the last 6 months,” and 40% for “averaging at least 5 to 8 minor seizures weekly.”  

Although the single clinical encounter most proximate to separation indicated blackouts may have approximated more than 10 minor seizures weekly, the panel adjudged that the preponderance of the record supported blackouts averaging much less frequently.  The panel adjudged that the neurologist’s history (with an approximately 6 month timeframe and an average of 2-3 episodes per month) had the higher probative value.  Therefore the CI’s disability picture was best represented by the 20% criteria of at least 2 minor seizures, and that the CI’s disability did not more nearly approximate the higher 40% rating for “averaging 5 to 8 minor seizures weekly” over the last 6 months.  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 “neurocardiogenic syncope” condition, coded 8999-8911.  

BOARD FINDINGS:  In the matter of the “neurocardiogenic 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	
Neurocardiogenic Syncope	8999-8911	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150617, w/atchs
Exhibit B.  Service Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01582.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not appropriate under the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended modification of your assigned disability rating without re-characterization of your separation with severance pay. 

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding, accept their recommendation and direct that your records be corrected as set forth in the attached copy of a Memorandum for the Chief of Staff, United States Air Force.  The office responsible for making the correction will inform you when your records have been changed.

Sincerely,

XXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
1.  Directive 
2.  Record of Proceedings 

cc:
SAF/MRBR