RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01659
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080801

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Helicopter Mechanic, medically separated for “vasovagal syncope” with a disability rating of 10%.  

CI CONTENTION:  The CI requests that all conditions be considered.  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 - 20080724	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vasovagal Syncope	8299-8210	10%	No VA Examination in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Vasovagal Syncope.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s vasovagal syncope condition began in Basic Training with passing out with rapid positional changes.  The CI was evaluated by cardiology with a positive tilt test and diagnosis of vasovagal syncope was confirmed by neurology.  Medication did not completely resolve the CI’s vasovagal episodes and the MEB forwarded “vasovagal syncope” for PEB adjudication.  

The 23 May 2008 MEB NARSUM examination, 2 months prior to separation, noted complaints of syncope.  History showed “about 10 episodes of passing out or near passing out” since Service entry.  Episodes of syncope were associated with positional changes or hot temperatures and observed episodes were brief (a few seconds) had no shaking, abnormal movements, or any postictal confusion.  Physical examination showed no focal neurologic or cardiac abnormalities.  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 vasovagal syncope condition 10%, coded 8299-8210 (tenth (pneumogastric, vagus) nerve paralysis), citing rated as moderate.  There was no evidence that the CI had any sensory or motor loss to organs of voice, respiration, pharynx, or stomach, and therefore insufficient evidence to approximate the next higher “severe” rating under code 8210.  Alternative rating IAW VASRD §4.20 (analogous ratings) analogous to narcolepsy (8108) or petit mal epilepsy (minor seizures - 8911) IAW VASRD §4.124a was considered given the CI’s periods of unconsciousness.  

Narcolepsy or petit mal epilepsy (minor seizures) are rated on the frequency, timing, and type of episodes.  As none of the CI’s episodes progressed to tonic-clonic activity, all of the CI’s syncopal episodes were considered equivalent to minor seizures IAW VASRD §4.124a (The Epilepsies).  The panel adjudged that the CI’s history of multiple episodes of passing out most closely approximated the 20% rating criteria of “at least 2 minor seizures in the last 6 months.”  The CI’s episodes did not more nearly approximate the next higher rating criteria of “averaging at least 5 to 8 minor seizures weekly” over the 6 months prior to separation.  The panel adjudged that there was no difference in analogous coding using either 8108 or 8911 as both used the same criteria (from 8911).  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 vasovagal syncope condition, coded 8210-8911.  

BOARD FINDINGS:  In the matter of the vasovagal syncope condition, the panel unanimously recommends a disability rating of 20%, coded 8210-8911 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	8210-8911	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150626, w/atchs
Exhibit B.  Service Treatment Record

AR20170008584, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	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