RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01843
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20070627

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a National Guard E5, Motor Transport Operator, medically separated from the Temporary Disability Retired List (TDRL) for “coronary atherosclerosis” with a disability rating of 10%.  

CI CONTENTION:  The CI made no specific contention.  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 - 20070530	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Coronary Atherosclerosis	7005	10%	No VA Examination Proximate to Separation in Evidence	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Coronary Atherosclerosis.  According to the service treatment record, the CI was placed on the TDRL in February 2004 for “arteriosclerotic heart disease” with a 30% rating.  The 12 January 2006 exercise scan resulted in 12.5 METS and a heart rate of 79% of predicted value.  The test was clinically positive with chest pain but electrically negative.  There was no significant motion of soft tissue attenuation.  The heart was enlarged with left ventricular (LV) end diastolic volume of 132 ml (normal 120 ml) with ejection fraction of 57%.  There was no evidence of ischemia (decreased blood flow) but stress was suboptimal due to failure to achieve 85% of maximal, age-predicted heart rate.  There was a small, mild fixed anterior wall defect and mild septal hypokinesis (weakly contracting muscle) consistent with a history of CABG.
During the 27 September 2006 TDRL evaluation, 9 months prior to TDRL removal, the CI reported mild angina with exertion.  He was taking five cardio-related medications daily in addition to folate and Lipitor (anti-cholesterol) daily.  Physical examination showed heart rate of 61 and blood pressure of 136/84.  The remainder of examination was unremarkable.  The EKG showed a normal sinus rhythm.  An exercise stress test showed 10.4 METS, resting HR of 61 which rose to 107, which was 62% of the maximal age-predicted HR.  The exercise was stopped due to right-sided chest pain.  There were no ST-segment changes.  The examiner noted his condition was clinically worse since September 2003 due to recurrent class II angina.  

The 19 January 2007 memo to the commander noted the CI’s exercise stress test was negative and showed no evidence of myocardial ischemia (MI) and noted that his chest pain may not be due to MI and that coronary atherosclerosis could no longer be unfitting.  His chest pain appeared non-cardiac.  The 12 March left cardiac catheterization with ventriculography showed a normal LV fraction with no significant articular ischemia or mitral regurgitation seen.  LV end diastolic pressure was 20-23.  A diagnosis of significant coronary artery disease with open stents to the left and right coronary arteries was rendered.  Continued medical management for coronary artery disease was recommended.  There was no VA C&P examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the heart condition 10%, coded 7005 (arteriosclerotic heart disease), citing a requirement for continuous medication.  The TDRL NARSUM noted the CI began to have Class II angina.  The clinical examination showed chest pain.  The examiner noted his condition was clinically worse due to recurrent class II angina. The March 2007 ventriculography showed a normal left ventricle fraction.  Continued management with medication was recommended by cardiology in March 2007.  There was no METS between 5-7 or echocardiogram, EKG, or X-ray evidence of hypertrophy or dilatation to achieve a higher rating of 30%.  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 heart condition.  

BOARD FINDINGS:  In the matter of the heart 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 there be 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 20170308, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20180005426, 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