RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-00932
BRANCH OF SERVICE:  AIR fORCE	SEPARATION DATE:  20060206

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Precision Measure Equipment Journeyman, medically separated for “mild mitral value prolapse” with a disability rating of 10%.   

CI CONTENTION:  “I was forced to leave a planned 20 yr career in the USAF.”  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 - 20051227	VARD - 20060721	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mild Mitral Valve Prolapse	7000	10%	Mitral Valve Prolapse with Trivial Mitral Regurgitation	7099-7005	0%	20060404	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Mild Mitral Valve Prolapse.  According to service treatment record and MEB narrative summary (NARSUM), the CI was evaluated in June 2005 for a 6-7 month history of left-sided chest pains, hand numbness when running at a very fast pace, dizziness and tachycardia.  No symptoms were reported at rest or with a slower pace while running or on the job.  An echocardiogram showed mitral valve prolapse and he was started on Tenormin (beta-blocker) as well as aspirin.  Holter monitoring was unremarkable and exercise treadmill tests showed 14 METS (metabolic equivalents) of exercise.    
  
The undated MEB NARSUM examination noted the CI was asymptomatic since he was avoiding excessive physical activity.  Tenormin had been discontinued due to intolerance of side effects.  Physical examination showed blood pressure of 113/75 with clear lungs and normal heart rate and rhythm, and no blueness or swelling in the extremities.  The examiner referenced an electrocardiogram (EKG) on 23 May 2005 which showed sinus slowing with arrhythmia, possible left atrial enlargement, an incomplete right bundle-branch block and a rightward axis.  An echocardiogram the same day showed mild prolapse of anterior mitral valves in midsystole and trivial mitral regurgitations.  Pulmonary function tests in November 2005 revealed mild obstructive disease.  Symptomatic mitral valve prolapse was diagnosed and the examiner noted the CI could not participate in “extreme exertional activities” due to symptoms of chest pains, dizziness and shortness of breath.

At the 4 April 2006 VA Compensation and Pension (C&P) evaluation, 2 months after separation, the CI reported chest discomfort lasting about a minute and intensified with mild exercise, showering and walking upstairs; with rest, symptoms subsided in a minute.  He had no nighttime shortness of breath or ankle swelling and reported no more than 2 days of lost time from work for health reasons.  Physical examination showed normal gait and station.  The CI could lie flat without difficulty and vital signs were within normal limits.  The examiner opined that obstructive lung disease was due to cigarette smoking.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the mitral valve prolapse condition 10%, coded 7000 (valvular heart disease), citing restriction from vigorous exercise only.  The VA rated the mitral valve prolapse with trivial mitral regurgitation condition 0%, coded 7005 (arteriosclerotic heart disease), citing a non-compensable rating without evidence of a workload greater than 7 METS but not greater than 10 METS, or requirement for continuous medication.  The panel noted there was no evidence of an enlarged heart on EKG, X-ray or echocardiogram to meet criteria for a 30% rating.  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 mild mitral valve prolapse condition.  

BOARD FINDINGS:  In the matter of the mild mitral valve prolapse condition and IAW VASRD §4.104, 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 20170222, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-00932.

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,

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings