RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02517
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20070228

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Aviation Boatswain’s Mate Launch and Recovery Equipment, medically separated for “permanent atrial fibrillation with thromboembolic risk factors to include structurally abnormal heart and hypertension” with a disability rating of 10%.

CI CONTENTION:  The CI contends his atrial fibrillation and hypertension (HTN) as well as other conditions not identified by the MEB/PEB.  His 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 - 20060314	VARD - 20070926	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Permanent A Fib…	7010	10%	Atrial Fibrillation	7011-7010	30%	20070607	
HTN	Cat III	HTN	7101	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Atrial Fibrillation.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s atrial fibrillation (A Fib) condition began in 1993 when he experienced an episode of paroxysmal A Fib.  This apparently spontaneously to normal sinus rhythm (NSR).  The CI next came to attention for A Fib in 2001 when he was found to be in A Fib on an overseas clearance physical.  He was asymptomatic and had a normal examination, including an echocardiogram (ECHO), other than the A Fib.  He was treated with medications and returned to full duty.  He subsequently stopped one of the medications due to fatigue.  For a while, he remained in NSR, but then had A Fib again and was placed on LIMDU for 8 months in 2004.  At the time of the cardiology evaluation on 10 June 2004 the CI was thought to have been in A Fib for 2 years.  A repeat ECHO showed a slight increase in the size (hypertrophy) of the left ventricle (LVH).  The CI was offered both cardioversion (to change the rhythm back to NSR) and also Coumadin (an anti-coagulant) if he remained in A Fib.  He declined both.  He was returned to full duty for the A Fib condition, but also reported atypical chest pain.  A cardiac perfusion stress test was normal on 12 January 2006.  However, he was not able to perform his duties and was referred for an MEB/PEB at the request of his command.  

The MEB Report was dated 6 February 2006, 13 months prior to separation.  It was noted that the CI was asymptomatic from an A Fib standpoint.  He was noted to be in A Fib on examination.  He was determined to be at increased risk of a thromboembolic event (at increased risk of a stroke) due to the chronic A Fib and structurally abnormal heart (slight LVH).  The CI declined Coumadin therapy.  

In cardiology on 8 September 2006, the CI reported that he remained asymptomatic and declined Coumadin.  His examination remained unremarkable other than the chronic A Fib.  He was noted to be fighting the PEB recommendation of separation and wanted to remain on active duty until 20 years.  

At the VA Compensation and Pension (C&P) general evaluation performed on 18 April 2007, 2 months after separation, the CI reported that he could climb stairs, take out the trash, walk, garden, and push a lawn mower.  He was noted to be in no distress and to have an irregular heartbeat (consistent with A Fib).  Six weeks later at the internal medicine C&P on 7 June 2007, the CI reported that he was unable to perform heavy work.  On examination, he had an irregular heartbeat.  An exercise tolerance test was stopped at 2 ½ minutes into stage II secondary to fatigue.  This corresponded to a MET (metabolic equivalent) level of 7.0.  There was no evidence of ischemia.  

The panel directed attention to its rating recommendation based on the above evidence.  

The PEB rated the atrial fibrillation condition 10%, coded 7010 (supraventricular arrhythmias).  
The VA rated the atrial fibrillation condition 30% coded 7011-7010 (ventricular arrhythmias - supraventricular arrhythmias), based on the VA C&P examination 3 months after separation, citing paroxysmal atrial fibrillation.  The panel noted that the CI actually had chronic A Fib.  The panel considered the evidence.  The CI was separated for chronic A Fib.  It was noted that the structurally abnormal heart (LVH) and HTN were additional risk factors for a thromboembolic event; these were not found to be separately unfitting conditions themselves though.  The code 7010 is used for chronic A Fib.  A 10% rating is supported by chronic A Fib which is what the CI had; a 30% rating would be supported by a paroxysmal A Fib which the CI did not have.  Under the code 7011, a 30% rating is supported by both the LVH and the exercise intolerance found on the VA stress test.  However, this code is for a ventricular arrhythmia which the CI did not have.  This is a much more serious condition than an atrial arrhythmia.  No route to a rating higher than 10% was found for the chronic A Fib condition.  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 atrial fibrillation condition.  

Contended PEB Conditions:  Hypertension (HTN).  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.  It was well controlled on medications without complications.  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 atrial fibrillation condition and IAW VASRD §4.104, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended HTN condition, the panel unanimously 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20151103, 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:

		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXXX, former USMC

		
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	     				  Acting