RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00013
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20040401

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Ground Radio Communications Journeyman, medically separated for “status post aortic valve replacement…,” with a disability rating of 10%.

CI CONTENTION:  Heart impairment warrants at least a 30% rating.  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 - 20031113	VARD - 20050823	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Status Post Aortic Valve Replacement…	7000	10%	Residuals, S/P Mechanical Aortic Placement Valve…	7016	0%	20050429	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:

Status Post Aortic Valve Replacement.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was found to have a cardiac murmur in sick call in April 2003.  He also reported a history of periodic periods of rapid heart rate which was independent of activity.  An echocardiogram on 2 May 2003 showed a bicuspid aortic valve (BAV) and severe aortic regurgitation (AR).  Left ventricular hypertrophy (LVH) was also documented.  The medical officer observed that the BAV condition is a congenital abnormality in which two of the leaflets of the aortic valve (AV) fail to separate and the individual is left with one large and one small leaflet rather than three leaflets of equal size.  This condition is associated with complications including AR, a condition in which the AV fails to seal properly at the end of ventricular ejection and blood reenters the left ventricle.  Due to this volume overload, LVH is not uncommon.  The BAV was replaced with a mechanical valve on 14 May 2003, 11 months prior to separation.  An ejection fraction was noted to be 50% prior to surgery.  The CI was also placed on an anti-coagulant (Coumadin) to minimize the risk of a clot disorder (embolus), a risk from the mechanical valve.  He stabilized on the Coumadin and did well post-operatively.  

The MEB NARSUM examination on 05 August 2003, 8 months prior to separation, noted that the CI was doing well after surgery.  He denied dyspnea (shortness of breath) and angina (cardiac chest pain).  The symptoms of fatigue, dizziness, or syncope (faintness) were not documented.  The physical examination showed the expected findings (cardiac click and murmur) after a valve replacement with a mechanical valve.  He did well until 16 December 2003 when he was found to have supraventricular tachycardia (SVT, an elevated heart rate from a ‘pacemaker’ above the level of the ventricle).  On 8 March 2004, 3 weeks prior to separation, this was treated with radiofrequency ablation (RFA).  It was noted that the electrocardiogram was normal (no ventricular hypertrophy).  

The VA Compensation and Pension (C&P) General evaluation was performed on 29 April 2005, 13 months after separation and outside the normal 12 month window assigned higher probative value for rating at separation.  The CI reported that he could perform the activities of daily living and continued to work as an electronics technician.  The SVT condition was noted to have resolved after therapy (ablation).  On examination, the scar was noted to be well healed.  The examiner cited an echocardiogram done on 13 April 2005, just over 12 months after separation.  It showed normal left ventricular size with mild concentric LVH.  The ejection fraction was 51%.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the cardiac condition 10%, coded 7000 (valvular heart disease).  The VA rated the cardiac condition 0%, coded 7016 (heart valve replacement), based on the C&P examination 13 months after separation, noting that the exercise tolerance was good.

The panel considered the evidence.  The record shows that prior to the valve replacement, the left ventricle was dilated.  Following surgery, he did well other than a finding of SVT which was successfully treated prior to separation.  An electrocardiogram done during the procedure was normal implying that evidence of LVH was not present.  The evidence proximate to separation does not support a rating higher than the 10% rating adjudicated by the PEB and upheld on multiple reviews.  The panel noted that the 7016 code chosen by the VA better reflected the clinical condition, but provided no rating advantage over the code used by the PEB, 7000.  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 AVR condition.  

BOARD FINDINGS:  In the matter of the aortic valve replacement condition and IAW VASRD §4.104, 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 20160107, 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-2016-00013.

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.  The Board recommended no re-characterization or modification of your separation.

I 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.  I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings