RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00573
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20041129

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Electrical Systems Journeyman, medically separated for “atypical chest pain with exertional dyspnea” with a disability rating of 10%.  

CI CONTENTION:  “Review all conditions.”  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 - 20040922	VARD - 20051116	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Atypical Chest Pain with Exertional Dyspnea	5321	10%	Atypical Chest Pain with Exertional Dyspnea	5321*	NSC*	20050518	
Migraine Headaches	Cat II	Tension Headaches	8100*	NSC*	20050518	
Tobacco Abuse	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	
*On appeal, Decision Review Officer (DRO) VARD dated 20060829 changed 5321 NSC [not service connected] to 7010 at 10% effective the day after discharge, based on C&P heart examination dated 20060615; VA also retroactively service connected and rated code 8100 at 10% on the same examination/appeal including testimony.  

ANALYSIS SUMMARY:  

Atypical Chest Pain with Exertional Dyspnea.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s atypical chest pain began in December 2002 and entailed prolonged duty restrictions.  He underwent numerous specialty evaluations and attempted therapeutic interventions, without significant improvement.  A 2 February 2004 cardiologist evaluation of the CI’s Holter (portable cardiac monitoring device) readings in January 2004 noted mild ectopy (rare premature atrial contractions) and a “run of supraventricular tachycardia [SVT]” with “activity level not well correlated.”  Repeat Holter monitoring in March 2004 was essentially normal.

At the 29 April 2004 MEB NARSUM examination, 7 months prior to separation, the CI reported atypical chest pain with continuing exertional dyspnea (shortness of breath) and palpitations.  The examiner noted previous complaints of heartburn, dizziness, headaches, left-sided numbness, lower back pain, fatigue, and generalized weakness.  While the CI had received numerous documented diagnoses, the examiner stated “duty profile issues have been driven primarily by exertional atypical chest pain with or without exertional dyspnea.”  Detailed specialty testing was summarized in the NARSUM and physical examination showed normal chest and cardiovascular findings.  Tenderness was only noted along multiple points in the lower back.  

During a 5 May 2005 cardiology visit, the specialist documented that the CI’s stress test “did not show significant arrhythmia or symptoms” and stated that another treadmill test could not reproduce the CI’s occasional chest pain, which was possibly due to “an imbalance of sympathetic tone which was either biological or cerebral induced.”  The specialist elected treatment with increased medication rather than accomplishing an evoked potential study.  

At the 18 May 2005 VA Compensation and Pension (C&P) general medical evaluation, 6 months after separation, the CI reported SVT with some dizziness and occasional dyspnea but denied chest pain or syncope.  The examiner referenced and summarized the 5 May 2005 cardiologist note.  Physical examination showed normal lung sounds and heart rhythm without murmurs.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chest pain 10%, coded 5321 (muscles of respiration), citing “all tests/exams by cardiology, pulmonology, gastroenterology, orthopedics, rheumatology, neurology, physical therapy, and psychiatry noted normal findings.”  The VA did not rate the chest pain, but rather determined it to be not service-connected, used PEB coding and cited lack of evidence due to the CI’s failure to report for a scheduled heart examination.  The CI’s chest pain was later (by Decision Review Officer effective day after separation) rated 10%, coded 7010 (supraventricular arrhythmias), citing Holter monitor evidence of SVT on 2 February 2004.  

The 10% rating adjudicated by the PEB for the CI’s atypical chest pain equates to a “moderate” muscle injury.  There was insufficient evidence of “severe or moderately severe” muscle injury IAW VASRD §4.55 (principles of combined ratings for muscle injuries) and §4.56 (evaluation of muscle disabilities) for any higher muscle disability rating under VASRD §4.73.  Alternative rating using code 7010 under VASRD §4.104 (schedule of ratings–cardiovascular system) was considered; however there was insufficient evidence of paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by ECG or Holter monitor to support any higher rating than 10%, and therefore of no benefit to the CI.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the atypical chest pain condition.  

Contended PEB Condition: Migraine Headaches.  The panel’s main charge is to assess the fairness of the PEB’s determination that migraine headaches were not unfitting.  The migraine headaches were not profiled, implicated in the commander’s statement nor judged to fail retention standards.  There was no performance-based evidence from the record that the migraines significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for migraine headaches and so no additional disability rating is recommended.  

Contended PEB Condition:  Tobacco Abuse.  The panel’s main charge is to assess the fairness of the PEB’s determination that tobacco abuse was not separately unfitting and not compensable or ratable.  Tobacco abuse is a condition not constituting a physical disability IAW DoDI 1332.38.  Therefore, the panel has no basis for recommending it as unfitting.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended tobacco abuse and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the chest pain condition and IAW VASRD §4.73 and §4.104, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended migraine headaches condition, the panel unanimously recommends no change from the PEB determination as not unfitting.  In the matter of the contended tobacco abuse condition, the panel unanimously agrees that it cannot recommend it for additional disability rating.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends 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 20160912, with attachments
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-2016-00573.

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.  Tthe 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,

Attachment:
Record of Proceedings