RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01687
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20050226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was a Reserve E7, Food Service Specialist, medically separated for “history of myocardial infarction due to arteriosclerotic heart disease x 2 status post angioplasty and stenting” with a disability rating of 10%.  

CI CONTENTION:  “Increasingly deteriation [sic] of symptoms.  Recently diagnoses of Gulf War Syndrome.”  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 - 20050119	VARD - 20050705	
Condition	Code	Rating	Condition	Code	Rating	Exam	
History of Myocardial Infarction due to Arteriosclerotic Heart Disease…	7005	10%	Myocardial Infarction Due To Arteriosclerotic Heart Attack	7006	10%	STR	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

History of Myocardial Infarction due to Arteriosclerotic Heart Disease….  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s cardiac condition began in 1997 with a myocardial infarction.  In April 1997 the CI underwent left heart catheterization and coronary artery angioplasty.  Two months later he underwent another cardiac catheterization.  Following an extensive cardiac work-up in February 2004 he was cleared to deploy to Iraq.  He reported that over the years he had experienced some episodes of chest pain and shortness of breath with peak exercise, worse in hot weather.  While in Iraq he had some shortness of breath while unloading trucks and moving heavy boxes and was subsequently medically evacuated in June 2004.  

At the 6 February 2004 pre-deployment Cardiolite treadmill exercise test, 12 months prior to separation, the CI noted no specific complaints.  Test results showed the CI exercised for 11 minutes and 15 seconds on the Bruce protocol with the last 2 minutes and 15 seconds being at Bruce stage 4 (4.2 miles per hour, 16% grade).  The CI reached a heart rate of 156 which was 83% of the maximal age predicted heart rate.  The test was stopped due to some hip discomfort, mild fatigue, and shortness of breath.  There was no chest pain during the test.  There were no ischemic ST segment changes and no arrhythmias.  Blood pressure rose from 122/80 standing at rest to 162/84 at peak exercise and then returned to baseline in the post exercise period.  Electrocardiogram (ECG) was unchanged from baseline post exercise.  

At the 19 August 2004 MEB NARSUM examination, 7 months prior to separation, the CI noted no complaints.  Physical examination showed a normal ECG.  His labs showed elevated cholesterol.  Results of a 25 August 2004 Cardiolite treadmill exercise test, 7 months prior to separation, showed a resting electrocardiogram that reflected sinus rhythm and was within normal limits.  Hyperventilation produced no significant change in the tracing.  The CI exercised for 12 minutes on the Bruce protocol achieving a maximum exercise intensity of 4.2 miles per hour on a 16% grade.  This approximated an MV02 of 10 METS.  Resting heart rate was 59 beats per minute and resting blood pressure was 118/78 mmHg.  The heart rate rose to 154 beats per minute which is 82% of the maximum predicted heart rate and blood pressure rose to 160/82 mmHg.  The CI had no chest pain and no arrhythmia.  The study was terminated because of leg fatigue.  Electrocardiogram at peak exercise and in the immediate recovery period demonstrated no ischemic ST segment changes.  The test was a symptom-limited submaximal exercise tolerance test with no symptomatic or electrocardiographic evidence for myocardial ischemia.  The Dual Isotope portion of the stress test revealed a moderate sized posterolateral transmural defect consistent with infarction in the distribution of the circumflex coronary artery.  The stress image showed no new defect in the anterior wall, interventricular septum, or inferior wall.  The gated analysis showed that the left ventricular chamber size was at the upper limits of normal.  The ejection fraction was at the lower limits of normal at 52%.  The inferolateral portion of the myocardium was akinetic but not well seen due to lack of perfusion.  The transient ischemic dilatation index on the CI was mildly abnormal.  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 cardiac condition 10%, coded 7005 (arteriosclerotic heart disease), citing treadmill test results of 10 METs without ischemia.  The VA also rated the cardiac condition 10%, coded 7006 (myocardial infarction), based on the STR, citing workload greater than 7 METs but not greater than 10 METs.  The panel agreed that a 10% rating, but no higher, was justified for arteriosclerotic (atherosclerotic) heart disease (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 7005.  There was no evidence of 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 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 cardiac condition.  

BOARD FINDINGS:  In the matter of the cardiac 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 20170304, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180005412, 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