RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  pd-2015-02451
BRANCH OF SERVICE:  Air force	SEPARATION DATE:  200901228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Integrated Avionics System Heavy Journeyman, medically separated for “neurocardiogenic syncope” 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 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 - 20091005	VARD - 20100514	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neurocardiogenic Syncope	8299-8210	10%	Neurocardiogenic Syncope	7099-7020	0%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0% 	

ANALYSIS SUMMARY:  

Neurocardiogenic Syncope.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neurocardiogenic syncope (passing out/fainting) condition occurred twice, each time precipitated by getting her blood drawn during routine and yearly laboratory work.  An extensive neurologic and cardiac work-up was essentially normal, except for a positive table-tilt (vascular response) test.  

The 14 April 2009 MEB NARSUM examination, 8 months prior to separation, noted complaints of occasional dizziness, but no syncopal episodes during the previous 9 months.  Her physical examination (PE) was complete and normal.  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%, analogously coded 8299-8210 (paralysis of tenth [pneumogastric, vagus] cranial nerve), citing measures taken as to avoid future syncopal episodes.  The VA rated the same condition 0%, analogously coded 7099-7020 (cardiomyopathy), based on the STR.  Panel members first considered and agreed that the finding of a positive table-tilt test was indicative of, and intimately related to, a neuro-vascular response that is directly mediated via the 10th cranial nerve; and therefore, the condition was best correlated to VASRD code 8210; incomplete paralysis of either moderate (10%) or severe (30%) impairment.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel members agreed that the frequency, duration, and severity of the CI’s original symptoms were not significantly repetitious, or of worsening pathology, to support a “severe” level of intensity.  Therefore, the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the neurocardiogenic syncope condition.  

BOARD FINDINGS:  In the matter of the neurocardiogenic syncope condition and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  There are 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 20151014, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs 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-2015-02451.

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