RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00558
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20040731

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

CI CONTENTION:  The CI contends that the rating for her condition of epilepsy, as it is classified now, should be changed.  She claims that she has grand mal seizures that occur twice a week. 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 - 20040623	VARD - 20050629	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Syncope	8299-8210	10%	Recurrent Syncope	8199-8108	10%	20041218	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Recurrent Syncope.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s syncope (fainting) began in February 2003.  The CI had a history of low blood pressure and became pregnant in January 2004.  Cardiac, neurology, and psychology work-ups were all reported as normal.  The STR did not indicate any specific seizure activity experienced by the CI prior to separation.  An internal medicine evaluation performed in January 2004 and a psychology evaluation performed in April 2004 both listed the CI’s syncopal episodes as having an unknown etiology.  At the 26 May 2004 MEB NARSUM examination, 2 months prior to separation, the CI endorsed continued episodes of syncope occurring 2-3 times per month with pre-syncopal symptoms of air hunger, shortness of breath and occasional associated headache.  Her physical examination (PE) was normal excepting muscle tenderness in her right upper back and again, the cause of her recurrent syncopal episodes remained unknown.  

At the 18 December 2004 VA Compensation and Pension (C&P) evaluation, 5 months after separation, the CI’s PE remained normal.  Her diagnosis was listed as, “History of recurrent syncope of undetermined etiology.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the syncopal episodes at 10%, coded 8299-8210 (analogous to paralysis of the 10th cranial nerve), citing incomplete/moderate paralysis occurring 2 to 3 times per month.  The VA also rated the syncopal condition at 10%, coded 8199-8108, (analogous to narcolepsy) based upon the C&P examination 5 months after separation, citing “a confirmed diagnosis of syncope with a history of episodes.”

Panel members extensively deliberated over the coding scheme in this case considering 8210 or analogous 8108 as recommended per Analogous Codes from Medical EPSS and rate a NOS [Not Otherwise Specified] syncope as epilepsy, petit mal.  All members agreed that the vast number of clinical encounters revealing an unknown etiology for the CI’s syncopal episodes would indeed be considered a condition that is “not otherwise specified” and therefore, appropriate to be rated by the recommendation within the EPSS under code 8108.  The 20% impairment rating under this code for petit mal seizure activity requires at least two minor seizures in the last 6 months.  The PEB, although not documenting actual seizures, did list the unknown syncopal episodes as occurring 2-3 times per month.  All panel members agreed that the unknown reasoning of the CI’s symptoms were synonymous with that of seizure activity and in accordance with the EPSS recommendation within the VASRD is rated as such.  The absence of at least five episodes occurring per week did not support the next higher rating of 40%.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 20% for the recurrent syncope condition.

BOARD FINDINGS:  In the matter of the recurrent syncope condition and IAW VASRD §4.124a, the panel unanimously recommends a disability rating of 20%, coded 8199-8108.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Recurrent Syncope	8199-8108	20%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160912, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170015814, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure