RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00790
BRANCH OF SERVICE:  Navy	SEPARATION DATE:  20040802

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Information Systems Technician, medically separated for “chronic orthostatic intolerance” with a disability rating of 10%. 

CI CONTENTION:  “My condition is a lifelong disease, with difficulties that was brought on by military service.”  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 – 8299-8210	VARD - 20050706	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Orthostatic Intolerance	8299-8210	10%	POTS	7999-7911	20%	20041006	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Chronic Orthostatic Intolerance.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a history of two syncopal episodes (fainting) when she was 16 years old.  Although there were no further episodes of syncope, the CI endorsed frequent episodes of dizziness.  She first presented for treatment in September 2001 and began an extensive evaluation by both cardiology and neurology.  Her laboratory studies were normal as was her heart rhythm on multiple ambulatory 24-hour EKGs (electrocardiograms).  A tilt test was consistent with orthostatic intolerance (decreased ability to tolerate the upright position).  The CI was diagnosed with orthostatic intolerance as she did not meet the diagnostic criteria for postural orthostatic tachycardia syndrome (POTS) which consist of either a pulse rate increase of 30 beats/minute or a maximum heart rate of greater than or equal to 120 beats per minute.  It was noted that her symptoms were somewhat abated with medications, increased fluids, and gradual position changes.  The 1 April 2004 MEB NARSUM examination, 4 months prior to separation, noted the CI had been symptomatic primarily when bending over or when getting out of a chair.  She reported 6 events over the prior 2 weeks.  The physical examination was unremarkable.  

At the 6 October 2004 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported that she was symptomatic with mild “light headedness” daily and became more symptomatic with prolonged standing.  However, this did not interfere with her work or physical capabilities.  On examination, her blood pressure dropped from 120/80 lying down to 100/60 standing.  Her pulse increased from 60 to 80 from lying down to sitting, but was not recorded for standing.  She met the criteria for POTS although she was not symptomatic during the examination.  At a cardiology evaluation on 16 November 2004 the CI was thought to have orthostatic hypotension which was “fairly well controlled” with medications.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic orthostatic intolerance condition 10%, coded analogously as 8210 (incomplete moderate paralysis of the vagal nerve).  The VA rated the chronic orthostatic intolerance condition 20%, coded analogously as 7911 (Addison’s disease), citing similar symptoms.  The panel noted that while Addison’s disease can have orthostatic hypotension, the conditions are otherwise unrelated.  The panel determined that 7911 was not an applicable code from a clinical perspective and there was not a specific diagnostic code in the VASRD for either orthostatic intolerance or POTS.  The panel also considered coding options for the cardiovascular system (VASRD §4.104), but found none that were a better clinical fit for the unfitting condition.  Given the fact the CI never actually fainted, aside from two episodes prior to service, the impairment chosen by the PEB, incomplete moderate paralysis, was determined by the panel to best fit the evidence.  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 chronic orthostatic intolerance condition.  

BOARD FINDINGS:  In the matter of the orthostatic intolerance 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.  Therefore, the panel recommends 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 

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44

      In accordance with reference (a), I have reviewed the cases listed below and approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN