RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02493
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070709

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Infantryman, medically separated for “recurrent syncopal episodes” with 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 - 20070525	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Syncopal Episodes	8299-8210	10%	No VA Examination in Evidence	
Anxiety Disorder	Not Adjudicated
Not Unfitting		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Syncope.  According to service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s syncope condition began in September 2006 while standing in formation.  He had several other episodes that were initially treated with re-hydration and rest.  Followed by cardiology which diagnosed postural orthostatic tachycardia syndrome after a positive tilt test.

During the 20 April 2007 MEB NARSUM examination, 3 months prior to separation, the CI reported he kept passing out.  He had a history of nine syncopal episodes that responded to IV re-hydration and rest.  The CI underwent a Holter monitoring (heart) test in February 2007, which showed paroxysmal supraventricular tachycardia (EKG changes) associated with lightheadedness, and asymptomatic conduction abnormality.  In March 2007 the CI was prescribed medication to control his blood pressure, increased fluid and salt consumption, which improved his condition significantly.  His medication prevented full syncopal episodes (passing out), but the CI still had dizzy spells which the CI reported to be minor and manageable.  Physical examination was unremarkable.  The examiner assessed recurrent syncope secondary to postural orthostatic tachycardia syndrome requiring the use of medication for control.

There was no VA examination in evidence for the panel to review.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the syncope condition 10%, analogously coded 8299-8210 (Tenth (pneumogastric, vagus) cranial nerve), citing moderate partial paralysis of the vagal nerve.

A higher 30% rating under code 8210 requires evidence that supports an “incomplete, severe” nerve impairment.  The commander’s statement noted that the CI presented to work on time and was always willing to work.  He had become the “go to guy” for leadership when last minute details came up.  He was unable to perform his infantry duties because he may pass out.  The commander statement documented the CI’s with light headedness on 28 January 2007, 7 months prior to separation.  Based on the CI’s recurrent syncope secondary to postural orthostatic tachycardia syndrome diagnosis, commander’s statement, syncope history and prescribed medication preventing full syncopal episodes, the panel agreed that a higher 30% rating was not justified.  The panel also considered code 7010 (supraventricular arrhythmias) for a higher rating.  Panel members found STR evidence that supports a 10% rating based on a diagnosed supraventricular tachycardia documented by Holter monitor; however, this rating provides no advantage to the CI.  There was no evidence of more than four episodes per year documented by an ECG or Holter monitor to support a 30% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the recurrent syncopal episodes condition.

Contended PEB Condition:  Anxiety Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The contended condition was not profiled or implicated in the commander’s statement or 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 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 recurrent syncopal episodes condition and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the contended anxiety disorder condition, the panel recommends no change from the PEB determination as not unfitting.  There were no other conditions within the Board’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 20151026, w/atchs
Exhibit B.  Service Treatment Record

AR20170013261, XXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.

Sincerely,					      
						      					
Enclosure