RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01760
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060522

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Aerospace Medical Service Journeyman, medically separated for “hypertension” with a disability rating of 10%.

CI CONTENTION:  “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 progression or complications of service-connected conditions after separation.  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 - 20060405	VARD - 20070920	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Hypertension	7101	10%	Hypertension	7101	0%	STR	
Tobacco Habituation	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Hypertension.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s hypertension condition began in March 2005.  She had an extensive workup to include treadmill stress test, Holter monitor, and echocardiogram, without finding a cause.  Her condition was treated with medication with suboptimal control.  The 2 November 2005 MEB cardiology consultation report, 6 months prior to separation, documented the CI’s history of uncontrolled hypertension with visual disturbance and headaches.  The CI also noted she felt chest pressure with elevated blood pressure (BP) that was associated with shortness of breath.  She denied fainting and swelling of feet.  Her maximum blood pressure recorded was 176/106 mmHg which responded to medication with either dramatic effect or no effect.  The CI’s echo revealed normal left ventricular function and mild mitral and tricuspid regurgitation.  Diastolic dysfunction was also demonstrated.  Physical examination recorded pulse rate of 87 and regular BP of 142/104mmHg.  No other abnormality of the cardiac examination was demonstrated, to include absence of a heart murmur.  The diagnosis of malignant hypertension was recorded.  The 17 January 2006 MEB NARSUM examination, 4 months prior to separation, noted complaints of uncontrolled hypertension and palpitations.  The CI noted that she had palpitations now at least weekly and was currently taking two medications.  It was noted that she had also experienced chest discomfort and shortness of breath with palpations. Physical examination documented the presence of tachycardia and a Grade II systolic murmur over mitral area, and no S3or S4.  BP was not recorded.  There was no VA Compensation and Pension (C&P) evaluation proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the hypertension condition 10%, coded 7101 (hypertensive vascular disease), citing not currently well controlled.  The VA rated the hypertension condition 0% coded 7101, based on the PEB’s decision, citing the CI’s failure to report for a scheduled VA C&P examination.  The panel undertook a careful review of the available evidence and noted the majority (7/8) BP recording in the 6 months prior to separation justified the PEB’s 10% rating under the 7101 code.  The CI had normal stress test and normal Holter monitoring, therefore, a rating under the 7007 (hypertensive hear disease), 7010 or 7011 (arrhythmias) was not justified.  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 hypertension condition.  

Contended PEB Condition:  Tobacco Habituation.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  There was no performance-based evidence from the record that the 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 the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the hypertension condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  In the matter of the contended tobacco habituation condition, the panel recommends no change from the PEB determination 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 modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150623, w/attachments
Exhibit B.  Service Treatment Record

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

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01760.

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 appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings