DEPARTMENT  OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS
720 KENNON STREET SE STE 309 WASHINGTON  NAVY  YARD  DC 20374-5023

IN REPLY REFER TO

1850
CORB:003
12 Feb 20

From: To:

Director, Secretary of the Navy Council of Review Boards 
PD-2017-00892

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr of 15 Nov 18

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy for  appropriate
·action.

2.	On 31 January 2020, the Assistant Secretary of the Navy took action in your case by accepting the correct recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Physical Evaluation Board from 10 to 30 percent with assignment to the Permanent Disability Retired List.

3.	

The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the office of the Deputy Commandant, Manpower and Reserve Affairs, for correction of your records as stated above.	You will be notified once those changes are complete.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXX	CASE: PD-2017-00892
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20050315

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Motor Transport Operations Chief, medically separated for “intercostal neuropathy” with a disability rating of 10%.

CI CONTENTION:  Review all conditions.  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 - 20050127	VARD - 20060113	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Intercostal Neuropathy	8799-5321	10%	Costochondritis & Intercostal Neuropathy	8799-5321	10%	

20051109	
Obstructive Sleep Apnea (OSA)	Cat III	OSA	6847	50%		
Migraine Headaches	Cat III	Migraine Headaches	8100	0%		
Vasodepressor Syncope	Cat III	Vasodepressor Syncope	7099-8910	20%		
Gastroesophageal Reflux Disease (GERD)/Hiatal Hernia	Cat III	Gastritis and GERD	7346-7318	10%		
Multiple Neurologic Symptoms	Cat III	No VA Placement	
Obesity	Cat IV	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 90%	

ANALYSIS SUMMARY:

Intercostal Neuropathy. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s chest pain began in May 2002 after a go-cart accident. He required

hospitalization and emergency room treatments for chest pain and oxygen desaturation attributed to pain. The CI had an iatrogenic pneumothorax following an intercostal nerve block in November 2002 without relief from the block, or sequelae from the pneumothorax. Numerous specialty evaluations led to a diagnosis of intercostal neuropathy, but neuroactive medication was not effective in relieving the chest pain.

The 7 June 2004 MEB NARSUM examination, 9 months prior to separation, noted complaints of chest pain. Physical examination showed normal cardiac and pulmonary findings.  Gait showed a moderately decreased arm swing on the right. An 8 September 2004 emergency room evaluation for chest pain diagnosed non-cardiac chest pain.

At the 9 November 2005 VA Compensation and Pension (C&P) examination, 8 months after separation, the CI reported “horrible chest pains,” that were sharp and electric-type. He was taking pain medications including Flexeril, Dilaudid and Neurontin. Although the examiner found a normal chest examination, he diagnosed pleuritic intercostal neuropathy.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chest pain 10%, analogously coded 8799-5321 (neuralgia – muscle group XXI, thoracic muscle group). The rating determination was upheld by the Secretary of the Navy Council of Review Boards. The VA also rated the chest pain 10%, analogously coded 8799-5321, based on the C&P examination, citing electrical-type chest pain with use of Neurontin. Alternative rating analogous to 8719 (long thoracic nerve) was considered; however, since there were no organic changes or partial paralysis (scapula or shoulder motion) rating IAW VASRD
§4.123 (neuritis) or §4.124 (neuralgia) would be no higher than 10%. There were insufficient aspects of muscle injury IAW VASRD §4.56 (evaluation of muscle disabilities) for the next higher moderately severe (20%) rating. 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 chest pain.

Contended PEB Condition: Vasodepressor Syncope. The panel’s main charge is to assess the fairness of the PEB’s determination that vasodepressor syncope (loss of consciousness – LOC) was not unfitting. The vasodepressor syncope was noted on limited duty forms and implicated in the non-medical assessment. There was clear performance-based evidence from the record that the vasodepressor syncope significantly interfered with satisfactory duty performance at separation. Although episodes had decreased on medications by separation, they still occurred episodically and were unpredictable. The panel agreed that the preponderance of evidence showed that the vasodepressor syncope was unfitting at the time of separation.

According to the STR and MEB NARSUM, the CI’s first LOC was in August 2002, preceded by diaphoresis and light-headedness without seizure or shaking activity. He described feeling as if "he was going to pass out" and described post-event confusion for approximately 1.5 hours after the event. He had a hospital admission proximate to that event (23 August 2002) with overnight observation of unexplained hypoxia down to 88%, with exercise, which was felt to be related to pain from his chest. At the NARSUM examination, the CI complained of continuing intermittent LOC approximately 1-2 times per month associated with daily intercostal pain. He was later started on a beta-blocker (atenolol) which decreased the LOC events. The 5 October 2004 cardiology NARSUM Addendum (5 months prior to separation) indicated the CI had one LOC after being on the medication. A tilt test that day was positive with blood pressure dropping to undetectable levels and the CI suffering LOC. The assessment was vasodepressor syncope and the examiner recommended continued daily medication use “as the patient had great response to this and very limited number of syncopal episodes since initiating this treatment.” At the C&P examination he reported his last LOC was in March 2005 (the month of separation).

Regarding appropriate rating, the CI did not have generalized tonic-clonic convulsion with unconsciousness, but the panel agreed the syncope was analogous to narcolepsy (8108) or petit mal (minor) seizures (8911). Given the cardiologist’s addendum and the VA history, the panel adjudged that at separation the CI’s disability picture most nearly approximated the 20% criteria for at least two minor seizures in the last 6 months. After due deliberation, the panel agreed the preponderance of the evidence with regard to the functional impairment of vasodepressor syncope favors its recommendation as an additionally unfitting condition for disability rating. It is appropriately coded 8999-8911 and meets the VASRD §4.124a criteria for a 20% rating.

Other Contended PEB Conditions: OSA, Migraine Headaches, GERD/Hiatal Hernia, Multiple Neurologic Symptoms and Obesity. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. None of the conditions were noted on limited duty forms or implicated in the non-medical assessment. There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the chest pain and IAW VASRD §4.124a and §4.73, the panel recommends no change in the PEB adjudication. In the matter of the contended vasodepressor syncope, the panel agrees it was unfitting and recommends a disability rating of 20%, coded 8999-8911 IAW VASRD §4.124a. In the matter of the contended OSA, migraine headaches, GERD/hiatal hernia, multiple neurologic symptoms and obesity, the panel recommends no change from the PEB determinations as not unfitting.

There are no other conditions within the panel’s scope of review for consideration. The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Intercostal Neuropathy	8799-5321	10%	
Vasodepressor Syncope	8999-8911	20%	
	COMBINED	30%