RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX 	CASE:  PD-2016-00650
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20041004

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Security Forces Journeyman, medically separated for “syncope” with a disability rating of 10%.   

CI CONTENTION:  The CI contends his condition continues to worsen and negatively impacts his daily activities.  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 - 20040630	VARD – 20131108	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Syncope	8210-8299	10%	Syncope and Passing Out 	6299-6204	NSC	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  0%	

ANALYSIS SUMMARY:  

Syncope.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was first seen for syncope (fainting) in February 2003 when he reported three previous episodes of feeling faint, the most recent of which was associated with subsequent loss of consciousness (LOC).  He then began an extensive evaluation for the etiology of his syncopal episodes.  This included a tilt table test which was negative.  The symptoms abated and the CI was allowed to move to a new duty location.  On New Year’s Eve 2003 he had another episode, this one associated with three alcoholic drinks 4 hours previously.  He fell and fractured his left orbit (eye socket), which caused secondary subjective visual loss.  The CI noted that “my vision isn’t quite right,” but he did not have double vision (diplopia).  This was evaluated by both ophthalmology and otolaryngology, but no further evaluation was needed as the vision was objectively normal and the fracture minimally displaced with no need for repair.  A 72-hour Holter monitor (an ambulatory electrocardiogram) was normal.  He was again evaluated in neurology and no etiology determined.  He was referred for neuropsychological testing to provide a baseline and to evaluate his current level of function.  He was noted to have a mild impairment in some areas consistent with a mild closed head injury and improvement was expected.  An electroencephalogram was accomplished on 3 March 2004 to evaluate for a possible seizure disorder.  It was normal as was an echocardiogram (not in evidence).  The CI was seen in neurology on 1 June 2004 and it was noted that the etiology of the syncopal episodes had not been determined, but that he had been stable (symptom free) for 6 months.  His neurological examination was normal.  At the 1 June 2004 MEB NARSUM examination, 4 months prior to separation, the CI reported no further episodes since New Year’s Eve 2003, 5 months earlier.  It was noted that his evaluation had been negative and that his physical examination was unremarkable other than some scarring from the head trauma on New Year’s Eve.  While the CI was referred for MEB, a return to full duty was recommended and desired by the CI.  The tilt table test was repeated on 9 July 2004 and remained negative (normal).  There was no VA examination in evidence proximate to separation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the syncope condition 10%, coded 8210-8299 (paralysis of the tenth cranial nerve, incomplete and moderate).  The VA did not service-connect the syncope condition, citing no permanent residual or chronic disability was in evidence in the STR or following service.  Members noted that the VA determination was remote from separation.  The VA used an analogous code for peripheral vestibular disorders, 6299-6204.  The panel considered the evidence.  The CI reported the initial syncopal episode in February 2003 with a second event in December 2003, over 9 months prior to separation.  The code 8210 supported the 10% rating adjudicated by the PEB.  The panel noted that a seizure disorder was not diagnosed and the use of the codes 8910 (grand mal epilepsy) and 8911 (petit mal epilepsy) was not supported.  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.  

BOARD FINDINGS:  In the matter of the syncope condition and IAW VASRD §4.124a, 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 20160913, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00650.

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,

Attachment:
Record of Proceedings