RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01678
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060113

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E8, General Engineering Supervisor, medically separated for “coronary artery disease with an acute myocardial infarction” with a disability rating of 0%.  

CI CONTENTION:  The CI listed an additional condition not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20051205	VARD – NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Coronary Artery Disease w/ an Acute Myocardial Infarction	7005	0%	No VA Examination in Evidence Proximate to Separation	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Coronary Artery Disease with an Acute Myocardial Infarction.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s coronary artery disease (CAD) with an acute myocardial infarction (AMI) condition began on 1 June 2005.  Electrocardiogram changes and cardiac isoenzyme tests confirmed an AMI.  The CI underwent cardiac catheterization and stent placement in the left anterior descending artery.  He participated in cardiac rehab.  A 13 September 2005 cardiac stress test showed the CI completed 9 minutes (10 METs) and achieved 78% of maximal heart rate.  He had an ejection fraction of 55% at rest and 59% during the test compared to a January 2004 cardiac echo that showed an ejection fraction of 60%.  The CI was placed on the following daily medications specifically for his heart condition: aspirin, Clopidegrel, and Toprol XL.  The 25 September 2005 MEB NARSUM examination, 4 months prior to separation, noted complaints of occasional right arm discomfort with moderate exertion.  Physical examination showed a normal cardiac function.  There was no VA examination proximate to separation in evidence.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the CAD with AMI condition 0%, coded 7005 (coronary artery disease), citing an ejection fraction of 55% and 11 METs.  The VA initially determined the CAD with AMI condition was not service connected in February 2007.  In 2010 the VA rated the CAD with AMI condition 10%, coded 7006 (myocardial infarction).  

The panel agreed that a 10% rating, but no higher, was justified for myocardial infarction (workload of greater than 7 METs but not greater than 10 METs that results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required) coded 7006.  There was no workload of greater than 5 METs but not greater than 7 METs that results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray; thus the next higher 30% rating was not justified on this basis.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the CAD with AMI condition, coded 7006.  

BOARD FINDINGS:  In the matter of the CAD with AMI condition, the panel recommends a disability rating of 10%, coded 7006 IAW VASRD §4.104.  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, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Coronary Artery Disease with Acute Myocardial Infarction	7006	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170302, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180008636, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	A copy of this decision has also been provided to the Department of Veterans Affairs. 

Sincerely,					      
Enclosure