RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-02297
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090728

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Contracting Journeyman, medically separated for “vasovagal syncope” with a disability rating of 20%.  

CI CONTENTION:  No specific contention was made.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in Do DI 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 - 20090507	VARD - 20100308	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vasovagal Syncope	8199-8108	20%	Vasovagal Syncope	7099-7011	10%	20091119	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Vasovagal Syncope.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s vasovagal syncope condition began in March 2007 after she began to complain of dizziness with change of position following an upper respiratory infection.  The CI reported severe dizziness with exercise that sometimes caused her to “go down and nearly pass out.”  These symptoms specifically occurred when running but she also felt light headed when standing from a sitting position (orthostatic symptoms).  Cardiology evaluation for structural cardiac problems was negative but the head tilt table test was positive (blood pressure dropped to 80mg systolic) and the CI was diagnosed with vasovagal syncope.  The CI received standard treatment medications for this condition but did not tolerate well to any of them, including Zoloft (anti-depression) for longer than a month.  Medication was stopped but the CI remained on profile with restrictions to light, self-paced exertional exercise 3-5 times per week.  

The 27 February 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of near syncopal episodes and dizziness 2-3 times per week where she caught herself before falling and waited until symptoms passed.  Episodes were worsened by physical exercise, lasted several minutes, and resolved on their own.  There appeared to be no significant impact on her job performance, although she did not have the ability to meet fitness standards.  Cardiology labeled the CI intolerant of medications.  She was 18 weeks pregnant.  Physical examination was unremarkable, including vital signs and examination of ears, heart, lungs and neurological systems.  At the 19 November 2009 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported balance problems which occurred 1-2 times per week, lasting 5 to 10 minutes, provoked by orthostatic symptoms and exertion and relieved by rest.  Physical examination was unremarkable.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the vasovagal syncope condition 20%, citing weekly symptoms of dizziness and near syncope.  The VASRD does not have a specific code for this diagnosis, thus the Medical [EPSS] recommends an analogous code, 8199-8108.  The VA rated the vasovagal syncope condition 10%, analogously coded 7011 (ventricular arrhythmias), based on the C&P examination, citing prescribed medication for the condition.  

According to the VASRD, syncope analogizes to 8108 code (narcolepsy, rate as petit mal), allowing for rating under the General Rating Formula for Minor Seizures.  The NARSUM noted 2-3 episodes weekly.  There was no evidence of episodes of at least 5 to 8 episodes of syncope per week that would analogously meet criteria for a higher rating of 40% disability under the 8108 code.  Nor was there evidence of an arrhythmia that resulted in dyspnea, fatigue, angina, dizziness or syncope, or evidence of cardiac enlargement to meet criteria for 30% disability under the 7011 code.  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 vasovagal condition.  

BOARD FINDINGS:  In the matter of the vasovagal syncope condition and IAW VASRD §4.124, 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 20170221, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-02297.

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,

		

Attachment:
Record of Proceedings