RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00153
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080423

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Trainee, medically separated for “neurocardiogenic syncope…” with a disability rating of 10%.

CI CONTENTION:  The CI did not submit a contention in the application.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited 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.  Any conditions outside the Board’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 Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations 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 at the time of separation.  The Board 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 Board 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 - 20080404	No VA Claim in Evidence	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neurocardiogenic Syncope	8299-8210	10%		
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

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 condition began at the end of July 2007 after vigorous exercise during Basic Combat Training.  Her symptoms included dizziness, lightheadedness, and chest pain followed by blurred vision and passing out.  The CI underwent extensive cardiac work-up that included electrophysiology studies, Holter monitor, echocardiogram, CT scan of chest, angiogram and cardiac magnetic resonance imaging (MRI).  All were unremarkable and she was diagnosed with neurocardiogenic syncope.  

During the neurological examination on 26 February 2008, the CI reported a history of 4 syncopal events that began with heart racing, chest tightness, and feeling ill before passing out.  
This happened whenever she participated in vigorous activities.  The neurological examination was unremarkable.  The diagnosis of recurrent syncope unresponsive to treatment was recorded.  

During the MEB NARSUM examination on 9 March 2008, 2 months prior to separation, the CI reported recurrent episodes of exertional syncope.  She reported a pre-military history of playing competitive soccer and running regularly for exercise without difficulty.  Physical examination was unremarkable.  The examiner assessed neurocardiogenic syncope.  The STR demonstrated a history of 6 syncopal episodes with ER treatment on 3 occasions.

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

The higher rating of 30% under the 8210 code requires evidence that would support a severe disability.  The Commander’s Performance Statement (CPS) noted that the CI needed to rest periodically, and was able to perform administrative duties, but was usually at medical appointments.  Based on the history of 6 recorded episodes of syncope all related to vigorous exertional activities, 3 ER visit for syncope, normal cardiac studies and evaluations, and normal neurological examination, panel members agreed, the higher rating was not justified.  There were no additional codes to consider.

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 neurocardiogenic syncope condition.  

BOARD FINDINGS:  In the matter of the neurocardiogenic syncope condition and IAW VASRD §4.124a the panel 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 re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160201, with attachments
Exhibit B.  Service Treatment Record

AR20170014080, 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