RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX 	CASE:  PD-2017-00027
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040402

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Radar Repairer, medically separated for “vasopressor syncope with one to two episodes per week” with a disability rating of 10%.  

CI CONTENTION:  “I have not been able to drive due to this medical condition and therefore not able to have gainful employment.”  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 Medical Evaluation Board (MEB), but determined by the PEB 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.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for 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, which operates 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 disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20040310	VARD - 20040910	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vasopressor Syncope…	8299-8210	10%	Vasopressor Syncope (Hypotension)	7199-7011	10%	20040618	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Vasopressor Syncope.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s syncope condition began in October 2003 after she experienced dizziness with running which progressed to loss of consciousness (fainting).  The 17 December 2003 nuclear stress test demonstrated a workload of 16.3 METS or excellent exercise capacity.  The 27 January 2004 tilt table test was consistent with vasodepressor syncope (sudden loss of consciousness as a result of a drop in blood pressure).  The 19 February 2004 MEB NARSUM examination, one month prior to separation, noted complaints of daily dizziness and one to two episodes of syncope per week.  Physical examination was normal. 

 At the 18 June 2004 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported continued episodes of syncope.  Cardiovascular examination was normal.  Blood pressure readings were of 90/60, 90/62, and 88/64 (hypotensive).

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the vasodepressor syncope condition 10%, analogously coded 8299-8210 (incomplete, moderate vagus nerve paralysis), citing one to two episodes of syncope a week.  The VA also rated the vasodepressor syncope condition 10%, analogously coded 7199-7011 (ventricular arrhythmias) based on the C&P examination, citing dizziness or syncope.  Panel members noted that the CI’s syncopal episodes decreased with medication and activity modification.  Panel members agreed the evidence did not support severe vagus nerve paralysis.  The panel also noted the nuclear stress test demonstrated that the CI achieved 16.3 METS workload and did not meet criteria for a 30% rating workload greater than 5 METS, but not greater than 7 resulting in dizziness or syncope.  After due deliberation, considering all 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 vasodepressor syncope condition.  

BOARD FINDINGS.  In the matter of the vasodepressor syncope condition and IAW VASRD §4.124a, the panel 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 20161101, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180014203, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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