RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2016-01366
BRANCH OF SERVICE:  NAVY 	SEPARATION DATE:  20041126

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

CI CONTENTION:  “I was found unfit for duty in 2004 for Hypertensive vascular disease 20% and major depressive disorder 30%.” 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 (VA), 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 - 20040518	VARD - 20050414	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Essential Hypertension	7101	10%	Hypertension	7101	10%	STR	
Adjustment Disorder with Depressed Mood	Cat IV	Adjustment Disorder with Depressed Mood	9499-0434	30%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Essential Hypertension.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI was diagnosed with essential hypertension in August 2001.  Treatment was initiated and he was later referred to internal medicine in October 2002 for poorly controlled hypertension.  He also reported complaints of occasional lightheadedness, palpitations and shortness of breath.  Work-up was completed that included aldosterone levels, which were within normal limits.  An EKG showed left atrial enlargement.  Despite trials with various anti-hypertensive medications, his blood pressure (BP) remained elevated.  The CI underwent an echocardiogram that showed normal left ventricle size and systolic function, mild left ventricle hypertrophy, with normal left ventricle blood flow, normal left atrium, and normal right heart.  During the 17 February 2004 MEB NARSUM examination, 10 months prior to separation, the CI reported he took his medications daily but his BP remained high.  He reported occasional chest tightness and palpitations.  Physical examination showed BP of 168/95, on repeat, 170/100, with heart rate of 96.  The remainder of the examination was recorded as “within normal limits.”  At the 21 April 2004 MEB examination (recorded on DD Forms 2807-1 and 2808), 8 months prior to separation, the CI reported he experienced non-exertional shortness of breath, dizziness, headache, numbness in his arms, chest pain and palpitations, which he contributed to his high blood pressure.  Physical examination showed BP of 164/104.  Clinic entries dated 1 and 18 November 2004, 1 month before separation, respectively, recorded BPs of 150/104 and 150/110.  There was no VA Compensation and Pension (C&P) examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the hypertension 10%, coded 7101 (hypertensive vascular disease).  Likewise, the VA rated the hypertension 10%, based on STR using the same code.  The higher rating of 20% under the 7101 code is justified when diastolic pressure is predominantly 110 or more, or systolic pressure is predominantly 200 or more.  The STR showed the majority of BP readings did not meet the 20% level, including the NARSUM and the MEB history and physical examinations.  Therefore, panel members agreed, the 20% rating was not justified.  The panel noted there was no path to a higher rating under the hypertensive heart disease code 7007 and there were no additional codes appropriate to consider.   After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the hypertension.  

Contended PEB Condition:  Adjustment Disorder with Depressed Mood.  The PEB noted that the adjustment disorder with depressed mood was a condition that did not constitute a physical disability.  At the time of separation IAW DODI 1332.38, E5.1.3.9.4, the condition of adjustment disorder was considered a condition not constituting a physical disability, and therefore, was not compensable.  Additionally, the contended condition was not profiled, nor judged to fail retention standards.  There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the essential hypertension condition and IAW VASRD §4.104, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder with depressed mood 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.  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 20161003, 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 USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN