RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00354
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060821

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Petroleum Supply Specialist, medically separated from the Temporary Disability Retired List (TDRL) for “history of paroxysmal atrial fibrillation” with a disability rating of 0%.  

CI CONTENTION:  The rating for the paroxysmal atrial fibrillation was inaccurate. 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 - 20060728	VARD - 20060901	
Condition	Code	Rating	Condition	Code	Rating	Exam	
…Paroxysmal Atrial Fibrillation	7010	0%	Paroxysmal Atrial Fibrillation	7011	60%	20060818	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Paroxysmal Atrial Fibrillation.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI had a history of intermittent episodes of atrial fibrillation dating back to the early 1990’s, but was not seen in cardiology until 2003.  The atrial fibrillation caused palpitations, shortness of breath and chest pain, and he also had a history of hypertension and a transient ischemic attack.  The CI was separated and placed on TDRL on 8 March 2005. 

In April 2006, an EKG performed in the ER recorded sinus bradycardia of 58 without arrhythmia. 
The 31 May 2006 TDRL evaluation, 3 months prior to TDRL removal, noted decreased frequency of palpations and rare episodes of “skipped beats” since the CI started using a new medication.  Physical examination revealed blood pressure of 138/84, heart rate of 69 and respiratory rate of 14 (all within normal range).  Heart sounds were normal without S2, S3 or S4 gallop, and an EKG the same day was normal.  The examiner stated the CI had tolerated his new medication well, and even though he reported intermittent episodes, he was symptom-free in terms of progressive atrial fibrillation.  

During the 29 July 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 1 month before TDRL removal, the CI reported experiencing pain and pressure in the chest and frequent palpitations after physical exertion.  Physical examination showed normal heart rate and rhythm, no murmurs and clear lungs.  There was no evidence of cardiovascular compromise.  

At the 18 August 2006 VA Compensation and Pension (C&P) examination for arrhythmias, 3 days prior to TDRL removal, the CI reported he was able to work but unable to exercise.  He had not experienced atrial fibrillation since he was converted with electrical shock in March 2005.  Physical examination revealed no murmurs and normal lungs, and an EKG the same day showed normal sinus rhythm.  While the examiner noted a metabolic equivalent of task (MET) level of 4, there was no evidence of any recent MET testing in the record.  At an ER visit on 15 September 2006 for intermittent chest pains (lasting a few seconds at a time), the provider recorded normal heart rate and rhythm, with no murmurs or gallops, and clear lungs and assessed possible atypical chest pain.

The panel directed attention to its rating recommendation based on the above evidence.  The CI was removed from TDRL with a permanent disability disposition of separation with severance pay at 0%.  The PEB cited a normal EKG in May 2006 and no evidence of permanent atrial fibrillation.  The VA rated paroxysmal atrial fibrillation 60%, coded 7011 (ventricular arrhythmias), based on the C&P examination citing “MET’s level of 4.”   Members noted that a rating of 10% under code 7010 (supraventricular arrhythmias) requires EKG or Holter monitor evidence of 1-4 episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia.  However, all EKGs noted in the STR showed normal sinus rhythm with no evidence of atrial fibrillation in the year prior to TDRL removal.  The CI had not suffered atrial fibrillation since being cardio converted in March 2005, and the VA examiner stating his condition was in remission.  Thus, the panel agreed that a 10% rating under code 7010 was not justified.  Members also observed that code 7011 was not applicable because there was no STR evidence or diagnosis of ventricular arrhythmias.  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 paroxysmal atrial fibrillation at the time of TDRL removal.  

BOARD FINDINGS:  In the matter of the history of paroxysmal atrial fibrillation and IAW VASRD §4.104, the panel recommends no change in the PEB adjudication at the time of TDRL removal.  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 20170209, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20180013145, 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.