RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00897
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20040503

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Fuels Specialist, medically separated for “neuro-cardiogenic syncope” with a disability rating of 10%.

CI CONTENTION: “Because everything is getting worse.” 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 - 20040227	VARD - 20050208	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neuro-Cardiogenic Syncope	8299-8210	10%	Neuro-Cardiogenic Syncope	7099-7011	10%	20040909	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Neuro-Cardiogenic Syncope.  According to the service treatment record (STR) and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s “neuro-cardiogenic syncope” condition began in the 2000-2001 timeframe without definitive origin, with 8-10 syncopal episodes during the previous 3-4 years.  He reported pre-syncopal symptoms of light-headedness and nausea, without vomiting.  The cardiologist placed him on medication.  

The 27 January 2004 MEB NARSUM examination, 4 months prior to separation, noted the medication had not relieved his symptoms.  He had modified activities to include no standing still and avoidance of certain activities during exercise.  He has had no syncopal episodes with exercise as long as he ate frequent meals.  He continued to take the medication every morning and modified his activities during exercise; he was unable to stand still or participate in formations.  Physical examination showed normal vital signs and cardiac function.  A thyroid function study was normal.

On 9 September 2004, 4 months after separation, the CI had both a General VA Compensation and Pension (C&P) evaluation and a Neurological C&P evaluation. During the General C&P evaluation, the CI reported continued medication use and fewer episodes of syncope although he still had them.  During tilt table testing he lost consciousness during a period of asystole (absence of heartbeat) that lasted 6 seconds. The exercise treadmill test was normal.  Electrocardiogram showed a sinus bradycardia (slowing) with marked sinus arrhythmia (uneven rhythm.)  Physical examination revealed marginally low blood pressure and a resting heart rate of 48 beats per minute with regular rhythm.  Cardiac examination was otherwise unrevealing.  During the neurological C&P evaluation, the CI reported he might pass out in any situation where he had a sudden painful condition, surprise or anxiety.  The most recent episode had occurred as he was going to the bathroom; he fell and the syncope lasted about 10 seconds. He was disoriented for about a minute and then it passed.  Often he had a terrible stomachache afterward and would lie down.  He described other episodes, stating he has had too many to count.  In the previous 6 months he had 5 episodes but before that had not had one in 6-7 months.  Prior to each episode warning signs were that he felt flushed, the room faded and he became very lightheaded.  No serious injuries had occurred during the episodes, although he had bruises and twisted his neck on one occasion.  He tended to run a low pulse rate.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the “neuro-cardiogenic syncope” condition 10%, coded analogously as 8210 (incomplete moderate paralysis of tenth cranial nerve).  The VASRD notes that vasovagal syncope analogizes to code 8210.  The VA also rated the neuro-cardiogenic syncope condition 10%, coded analogously as 7011 (ventricular arrhythmias (sustained), based on the C&P examination 4 months after separation, citing a need for continuous medication used to help control the condition.  

The panel noted that under the VASRD 8210 code, the higher 30% rating required incomplete, severe paralysis of the tenth cranial nerve.  The VASRD noted the determination of severity depended upon the extent of sensory and motor loss to organs of voice, respiration, pharynx, stomach and heart.  According to the NARSUM examination, syncopal attacks were relieved by eating frequent meals.  At the C&P examination, the CI reported the syncopal episodes had decreased with the use of medication.  Neither the NARSUM nor the C&P examinations showed evidence of damage to vital organs.  The panel noted that heart rates may vary among individuals and can go as low as 40 beats per minute depending on variables.  The commander noted he had not missed work because of his condition and he was able to perform full shifts without a problem.  Panel members agreed there was no rating higher than the 10%, adjudicated by the PEB.  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 “neuro-cardiogenic syncope” condition.  

BOARD FINDINGS:  In the matter of the neuro-cardiogenic syncope condition and IAW VASRD §4.124, 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, w/atchs
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-2016-00897.

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.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have 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.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings