RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-02421 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20080215

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Heavy Construction Equipment Operator, medically separated for “variant angina pectoris” with a disability rating of 10%.

CI CONTENTION: The applicant makes 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 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 - 20071113	VARD - 20080811	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Variant Angina Pectoris	7099-7005	10%	Prinzmetal’s Angina/Syndrome X	7099-7005	10%	20080103	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 10%	

ANALYSIS SUMMARY:

Variant Angina Pectoris. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s angina began in July 2006 after cholecystectomy surgery. An EKG was normal and echocardiogram showed a normal ejection fraction of greater than 55%, normal wall motion, no significant valve disease and a structural normal heart. Initial and repeat full Bruce exercise test showed 13.8 METS. During the repeat test, she complained of some chest pain but was able to continue. Imaging showed normal perfusion to the heart. Cardiac angiography and gastroenterology work ups were normal.

During the 2 May 2007 MEB NARSUM examination, 9 months prior to separation, the CI complained of chest pain that occurred randomly on a near-daily basis and was not associated with activity. Most episodes occurred at rest and lasted 15-30 minutes with mild shortness of breath, but no syncope. The CI reported beta blocker therapy and sublingual nitroglycerin helped with her symptoms but did not fully relieve them. Prognosis was good and she was considered to be at low risk. Physical examination showed normal vital signs and cardiopulmonary findings.

The 30 July 2007 MEB examination (recorded on DD Forms 2807-1 and 2808), 6 months prior to separation, revealed a regular respiratory rate and grade 2/6 mid-systolic “whosh-like” cardiac murmur. At the 3 January 2008 VA Compensation and Pension (C&P) examination, 1 month before separation, the CI reported constant chest pain. She denied shortness of breath, dizziness, syncope, fatigue and congestive heart failure. Current treatment was Toprol XL, Felodipine, and sublingual nitroglycerin. She was able to perform activities of daily living and remained employed in her usual occupation.  Physical examination was within normal limits.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the chest pain 10%, analogously coded 7099-7005 (arteriosclerotic heart disease), citing requirement for continuous medication. The VA also rated the chest pain 10%, analogously coded 7099-7005, based on the C&P examination, citing requirement for continuous medication. The panel agreed the CI’s angina, coded analogously to coronary artery disease, met the criteria for a 10% rating based on the requirement for continuous medication. Panel members considered a higher rating under code 7005, but there was no evidence to support the 30% rating. 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 chest pain.

BOARD FINDINGS: In the matter of the chest pain and IAW VASRD §4.71a, 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 20170227, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record
PD-2017-02421

AR20190015712, XXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

	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

2	PD-2017-02421