RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02274
BRANCH OF SERVICE:  Marine Corps 	SEPARATION DATE:  20011009

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Personnel Clerk, medically separated for “chronic hypertension” with a disability rating of 10%.

CI CONTENTION:  The CI contends his service rating should have included hypertensive heart disease and hyperaldosteronism with hypokalemia.  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 - 20010730	VARD - 20020430	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Hypertension	7917-7101	10%	Hypertension with Left Ventricular Hypertrophy	7199-7101	10%	20010911	
Left Ventricular Hypertrophy	Cat II					
Hyperaldosteronism 	Cat II	Hyperaldosteronism with Hypokalemia	7917	0%	20010911	
Tendency for Hypokalemia	Cat III					
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Chronic Hypertension.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was referred to internal medicine on 21 August 2000 for controlled hypertension.  

At the 2 May 2001 MEB examination (recorded on DD Forms 2807 and 2808), 5 months prior to separation, the CI reported problems controlling his blood pressure (BP).  Physical examination showed BP of 142/88.  During the 8 May 2001 MEB NARSUM examination, 5 months prior to separation, the CI reported he had high BP.  There was no report of any hypertensive associated symptoms other than the report of exertional chest pain which was believed to be of non-cardiac origin.  Physical examination showed BP of 164/80 with a pulse of 94.  Left arm pressure was 180/118.  Eye and cardiovascular exams were normal.  On 1 June 2001, 4 months prior to separation, the CI was seen in the emergency room complaining of headache associated with his high BP of 193/102, and was given medication.  At the 11 June 2001 internal medicine appointment, 4 months prior to separation, physical examination was unremarkable with the exception of BP 150/100 laying down, 158/98 sitting and 140/102 standing.  One week later (17 June 2001) the MEB NARSUM addendum noted the CI underwent extensive workup in search of possible etiology of his hypertension, which included abdominal CT scan, hormone levels, blood chemistry and heart echocardiogram.  The heart echocardiogram showed borderline left ventricular hypertrophy while the other evaluations were unremarkable with the exception of elevated aldosterone level.  It was noted that the condition of hyperaldosteronism was not the product of a renal adenoma.

At the 11 September 2001 VA Compensation and Pension (C&P) evaluation, performed 1 month before separation, the CI denied any symptoms secondary to his hypertension condition.  Physical exam showed BPs of 140/90, 140/80 and 140/86 taken at the examination.  The CI had a stress test that showed 10 METs and an echocardiogram that showed normal ventricular function.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the hypertension 10%, coded 7917-7101 (hyperaldosteronism and hypertensive vascular disease).  The VA rated the hypertension 10% coded 7199-7101 (analogous to hypertensive vascular disease), based on the VA C&P examination 1 month before separation.

The higher rating of 20% under the 7101 code is justified when diastolic pressure is predominantly 110 or more, or systolic pressure is predominantly 200 or more.  The STR showed the majority of BP readings did not meet the 20% level, including the NARSUM addendum and the C&P BP readings.  Panel members therefore agreed the 20% rating was not justified.  The panel noted there was no path to a higher rating under the hypertensive heart disease code 7007, and there were no alternative codes to consider.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded there was insufficient cause to recommend a change in the PEB adjudication for the hypertension.  

Contended PEB Condition:  Left Ventricular Hypertrophy and Hyperaldosteronism.  It is first clarified that these conditions are intrinsic to the rated condition and a separate rating cannot be supported without pyramiding (VASRD §4.14); they are appropriately subsumed in the disability rating for chronic hypertension.

Contended PEB Conditions:  Tendency for Hypokalemia.  The panel’s main charge is to assess the fairness of the PEB’s determination that this contended condition was not unfitting.  This condition did not carry attached duty limitations, was not implicated in the non-medical assessment and was not judged to fail retention standards.  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 there was insufficient cause to recommend a change in the PEB fitness determination for this contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the hypertension and IAW VASRD §4.104 the panel recommends no change in the PEB adjudication.  In the matter of the contended hyperaldosteronism and left ventricular hypertrophy, the panel recommends no change from the PEB determinations as CAT II conditions.  In the matter of the contended tendency for hypokalemia, the panel agrees that it cannot recommend it for additional disability rating.  There are 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 20150824, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
	 	- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC

		
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