RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-02523
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20040809

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve O2, Surface Ship Nuclear Propulsion Plant Supervisor, medically separated “syncope, unexplained” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  The CI’s 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 - 20040513	VARD - 20050211	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Syncope, Unexplained	8299-8210	10%	No VA Placement	
Specific Phobia, situational Type	Cat II	Specific Phobia Situational Type	8199-8108	NSC	20041210	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NSC	

ANALYSIS SUMMARY:  

Syncope, Unexplained Diagnosis.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s syncope condition began during adolescence.  The CI experienced syncopal episodes lasting seconds associated with blood draws or contact lens fittings.  During active duty the CI experienced syncopal episodes associated with stressful situations approximately once a year, with one documented episode in August 2002 and the next in July 2003.  The CI was referred for evaluation to neurology and cardiology and comprehensive evaluations did not identify the cause of the syncopal episodes, which were thought to be vasovagal and/or anxiety related.  In July 2003 the CI was evaluated by psychiatry and the determination was that the CI experienced syncopal episodes which correlated with elevated levels of stress, but the CI did not have a mental health Axis I or II disorder.  The psychiatrist noted that the CI was able to cope with negative evaluations in a training environment and therefore had some coping skill.  The MH examiner determined the CI was fit for duty.  The CI was recommended some reading on anxiety and encouraged to participate in stress management and assertiveness training.  The CI was offered an implantable heart monitor (in place for several months) to see if a previously unidentified abnormal heart rhythm was causing the syncopal episodes.  The CI declined the intervention and this was thought reasonable based on the negative work-up to that point.  

The May 2004 JDETS indicated the CI was unfit due to syncopal episodes and that the CI’s length of service voided the EPTS designation.  The Non-Medical Assessment (NMA) indicated the CI’s performance was exemplary.  The CI was described as experienced and mature with a “solid track record of sustained superior performance throughout his career.”  Serious consideration of retaining the CI was recommended despite his current medical condition.

The 29 January 2004 MEB NARSUM examination, 7 months prior to separation, noted complaints of recurrent syncope.  A full physical examination was normal.  

The 13 April 2004 MEB psychiatric addendum, 4 months before separation, noted complaint of unexplained syncope.  Syncopal episodes since early adolescence in response to blood draws and contact lens placement (by others) were noted.  The psychiatrist indicated that since these episodes the CI had learned to manage his stress and anxiety with breathing and relaxation techniques.  A third stressor noted with the episodes in 2002 and 2003 was fear for his career.  The psychiatrist noted that during the PEB process itself, the CI had not had any recurrent syncope.  The diagnosis given was specific phobia, situational type, existed prior to entry, mild severity, and service aggravated.  The psychiatrist determined that the CI’s condition “may preclude his rendering any further useful military service.”  

At the 10 December 2004 VA Compensation and Pension (C&P) psychiatric evaluation, performed 4 months after separation, the CI reported four episodes of syncope associated with being “screamed at” while standing in boot camp, blood draws and contact lens visits.  He denied any other episodes of unconsciousness, panic attacks or suicide attempts.  The CI had not been in combat.  He was married with two children and reported a close family.  The CI had been working full time for the past five months.  The mental status examination, was completely normal.  The diagnosis was specific phobia situational type, with a global assessment of functioning assignment of 75, which reflects minimal, if any, impairment on this scale.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the syncope condition 10%, coded analogously to 8210 (vagus nerve paralysis).  The PEB also adjudicated “specific phobia situational type” as a related Category 2 condition.  The VA did not service connect “specific phobia situational type” based on the VA C&P examination months 4 after separation, citing the absence of a diagnosis of chronic disease due to “specific phobia situational type” and therefore the VA did not consider this a disability for compensation purposes.  

The PEB provided a 10% rating and there was no evidence in record to provide a higher rating than 10% for the syncopal condition coded analogously to either 8210 or 8108 (narcolepsy-another analogous code for syncope).  The panel agreed the evidence did not support characterizing the syncope condition as moderate under 8210, and there was no evidence of at least 2 episodes of syncope in the last six months in the 6 months before separation for a higher analogous rating using 8108.  As noted above “specific phobia situational type” was adjudicated as a Category 2 condition.  There was no mental health evidence in record that the specific phobia condition conferred any impairment of the CI’s performance of his duties other than the infrequent syncopal episodes.  Psychiatric evaluations during AD and after separation at the VA noted the CI was fully functional from a psychiatric standpoint.  The NMA noted the CI’s performance was exemplary in all aspects and suggested retraining which supported, other than the syncopal episodes, the CI’s was fit for duty.  Therefore, in this case the two diagnoses of syncope, unexplained and specific phobia situational type, refer to the same disability and are not separate conditions for which a rating may be assigned (§4.14 avoidance of pyramiding). 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 syncope condition.  

BOARD FINDINGS:  In the matter of the syncope, unexplained 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 , 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