RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00803
BRANCH OF SERVICE:  army	SEPARATION DATE:  20040527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Automated Logistical Specialist, medically separated for “recurrent vasovagal syncope” with a 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 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 - 20040402	VARD - 20041102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Vasovagal Syncope	8299-8210	10%	Vasovagal Syncope	8199-8108	NSC	20040917	
RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10% 	

ANALYSIS SUMMARY:

Recurrent Vasovagal Syncope.  According to the service treatment record and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a history of multiple heat-related syncopal episodes (temporary loss of consciousness caused by a fall in blood pressure) through 2003 with negative workups and was hospitalized on 2 February 2004 for a recurrent syncopal episode.

The 9 March 2004 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of frequent fainting spells.  Evaluation showed abnormal muscle markers and normal cardiac evaluations (electrocardiogram, echocardiogram with a normal ejection fraction of 71%, and a normal cardiac catheterization).  The CI had mild dyspnea (difficult or labored breathing) on exertion with no chest pain or shortness of breath.  Physical examination showed no significant findings.  The CI was considered stable, with a permanent profile noting “extreme limitations in his duty performance…unable to run, march, jump, do heavy lifting, or work in outdoor field duty environment.”

At the 21 September 2004 VA Compensation and Pension (C&P) evaluation, 3 months after separation, the CI reported recurrent vasovagal syncope (fainting caused by body’s overreaction to certain triggers) from heat exhaustion during the summer (2001 to 2004) when he ran with his unit beyond six miles.  He also had substernal chest pain rated at 10/10 and hypertension controlled on medications.  Physical examination showed a blood pressure of 150/100 (elevated x3 measurements) and metabolic equivalent of task (METs) of 12-13.  Pulmonary and neurologic findings were normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the vasovagal syncope condition 10%, analogously coded 8299-8210 (tenth (pneumogastric, vagus) cranial nerve, paralysis), citing an analogous rating to moderate vagus nerve impairment.  The VA did not service connect the vasovagal syncope condition, coded 8108, (narcolepsy), based on the C&P examination 3 months after separation, citing the condition “failed to show a disability for which compensation may be established.”  Members agreed a 10% rating, but no higher under code 8210 was appropriate, since there was no sensory or motor loss to organs of voice, respiration, pharynx, or stomach; and the impact to the heart was only during times of high heat or exertion.  The CI was not diagnosed with narcolepsy (extreme tendency to fall asleep whenever in relaxing surroundings) or demonstrated any clinical symptoms of narcolepsy; therefore, an alternative rating under 8108 was not supported IAW VASRD §4.20 (analogous ratings).  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 vasovagal syncope condition.

BOARD FINDINGS:  In the matter of the recurrent vasovagal 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 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 20160916, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170017990, 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