RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00193
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060323

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an Reserve E4, Hospital Food Service Specialist, medically for “syncope” and “headaches,” rated 10% and 0%, respectively, with a combined disability rating of 10%.

CI CONTENTION:  The CI made no specific contention.  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 conditions at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  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 - 20060223	VARD - 20130419	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Syncope	8299-8210	10%	Syncopal Episodes (Fainting)	8999-8910	NSC	20130308	
Headaches	8199-8100	0%	Headaches/Migraines	8100	NSC		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Syncope.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s syncope condition (fainting) was first noted in November 2003 after running.  The CI presented to the emergency room where his evaluation was normal.  Two weeks later, he was evaluated in family practice and reported a 1 year history of chest pain which was attributed to pain in the bone-cartilage junction of the ribcage and to gastro-esophageal reflux disease (GERD).  An evaluation for the chest pain was begun and included an echocardiogram, an exercise tolerance test (baseline as well as with nuclear medicine studies), a magnetic resonance imaging (MRI) of the brain, pulmonary function studies, and an electro-encephalogram (EEG).  All the studies were normal and an etiology for the chest pain and the syncope was not determined.  A possibility of vocal cord dysfunction was noted on the pulmonary function tests, but an evaluation by otolaryngology excluded this. 

The 25 February 2005 MEB NARSUM examination, 13 months prior to separation, noted the initial episode in November 2003 as well as a second episode in March 2004; no documentation is otherwise in evidence for the second episode.  The pain was primarily with exercise and both syncope and headaches were associated with it.  The physical examination was normal.  The frequency of these episodes was not recorded.  

The 8 March 2013 VA Compensation and Pension (C&P) evaluation, 7 years after separation, was too remote from separation to be probative for rating at separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the syncope condition 10%, analogously coded 8210 (paralysis of tenth (pneumo-gastric, vagus) cranial nerve), citing “incomplete, moderate.”  The VA did not service connect the syncope condition and analogously coded 8910 (grand mal epilepsy), citing the condition neither occurred in nor was caused by service.  

The panel observed that there was no record of emergency room visits or acute care for the syncope condition other than when initially seen in November 2003.  The frequency is not recorded nor was the loss of consciousness recorded other than in retrospect on two occasions.  The panel did not find evidence to support a higher 30% rating for a severe level of impairment.  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.  

Headaches.  According to STR and the MEB NARSUM, the CI’s headaches were associated with the chest pain condition.  There was no record of either emergency room visits or incapacitation for the headache condition.  

The 25 February 2005 MEB NARSUM examination, 13 months prior to separation, noted that the headaches followed the chest pain condition.  The headaches resolved more quickly if he could lie down and go to sleep, but it was not recorded that the severity was such that he was unable to function and had to lie down and sleep.  

Following the MEB NARSUM, the treating neurologist wrote, on 10 June 2005, that the headaches began in Basic Training and were associated with the chest pain (syncope) condition.  Incapacitation was not recorded although the CI stated that he wanted to lie down and sleep when they were severe.  The commander noted on 29 July 2005 that the CI had not drilled for over 6 months, but did a good job when he last did.  It was noted that the CI had not taken a physical fitness test for over 2 years.  No comment was made on lost duty time from the headache condition.  The VA C&P evaluation was remote from separation as noted above.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the headaches condition 0%, analogously coded 8100 (migraine), citing “non-prostrating.”  The VA did not service connect the headaches and coded 8100 (migraine), citing the condition neither occurred in nor was caused by service.  

The panel considered the evidence.  While the CI reported that he wanted to lie down and sleep with a severe headache, there was no record of emergency room visits or quarters to show time lost from duty.  In addition, there is no record that the CI was not able to continue to function when he did have a headache.  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 headache condition.  

BOARD FINDINGS:  In the matter of the syncope and headache conditions and IAW VASRD §4.124a, the panel unanimously recommends no change in the PEB adjudication.  There were 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 20160404, w/attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

AR20170014128, 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