RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxxxxxxxxx	CASE:  PD-2017-02606
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090621

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Military Policeman, medically separated for “postural orthostatic tachycardia syndrome [POTS]” with a disability rating of 10%.  

CI CONTENTION:  “VA rated it higher.”  The CI also submitted a list of disabilities to be reviewed, many of which were not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  

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 - 20090311	VARD - 20091030	
Condition	Code	Rating	Condition	Code	Rating	Exam	
POTS	8999-8911	10%	POTS	8199-8108	10%	20090708/09	
Cognitive Disorder	Not Unfitting	Traumatic Brain Injury	8045	70%		
		Facial Asymmetry	8045-7800	30%		
		Right Facial Paralysis	8045-8207	10%		
PTSD	Not Unfitting	PTSD	8045-9411	50%		
Sleep Apnea	Not Unfitting	Sleep Apnea	6847	50%		
Headache Syndrome	Not Unfitting	Headaches Associated with TBI	8045-8100	30%		
Left Knee Tendinitis	Not Unfitting	Left Knee Strain	5257	0%		
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS: 100%	

ANALYSIS SUMMARY:  

Postural Orthostatic Tachycardia Syndrome.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s condition began in the summer of 2006 while running during physical training.  He underwent a series of diagnostic studies which included a normal EKG, and following a near syncopal episode while running in early 2007, he was referred for a cardiology consult.  An echocardiogram and Holter monitor test were unremarkable, but POTS was diagnosed after a positive tilt-table test in June 2007.

During the 10 June 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 12 months prior to separation, the CI reported dizziness upon standing or with physical exertion, and that he was in treatment for postural orthostatic tachycardia.  Physical examination showed blood pressure of 129/83 and a pulse of 66.  The 12 February 2009 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of light-headedness, nausea and palpitations which lasted a few minutes.  He had no syncopal episodes in the past year, however, he continued to experience 10-15 near syncopal episodes each month.  The CI was unable to run or walk for more than a mile, and while performing push-ups could elicit symptoms, he did well with sit-ups.  His condition had improved with medication, increased fluids and liberal use of salt.  Physical findings updated on the DD Form 2808 were unchanged from the previous examination.

At the 9 July 2009 VA Compensation and Pension (C&P) examination, 1 months after separation, the CI reported intermittent dyspnea, lightheadedness, chest pain, fatigue and syncope, precipitated by brisk walking, heat, running, lifting heavy objects, or standing quickly from a sitting position.  The last syncope episode by self-report occurred 4 months earlier.  Physical examination noted blood pressure of 120/80, pulse of 72, and normal heart sounds.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the POTS 10%, analogously coded 8999-8911 (epilepsy, petit mal), citing confirmed diagnosis with continuous medications.  The VA also rated the POTS 10%, but analogously coded 8199-8108 (narcolepsy), based on the C&P examination, citing a confirmed diagnosis of POTS with atypical chest pain.  Panel members agreed there was no evidence of at least two minor syncopal episodes in the last 6 months prior to separation that would justify a higher 20% rating under codes 8911 or 8108.  The NARSUM documented one syncopal episode in the past year, and the C&P examiner noted one self-reported episode that occurred the month prior to separation.  Although the CI had complaints of light-headedness, nausea and palpitations which lasted a few minutes, and near syncopal episodes, these did not meet the definition of syncope since there was no temporary loss of consciousness.  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 POTS.  

Contended PEB Conditions:  Cognitive Disorder; PTSD; Sleep Apnea; Headache Syndrome; Left Knee Tendinitis.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  None of the conditions were profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  The 15 October 2008 neuropsychological evaluation documented mild cognitive disorder and the examiner stated the cognitive deficits were not clinically significant enough to fall below retention standards.  The MEB psychiatric examination recorded mild to moderate PTSD, but noted the most significant complaint by the CI was cognitive in nature.  It was opined that neither the cognitive disorder nor the PTSD fell below retention standards.  The treatment record prior to separation showed that the CI completed four out of four PTSD sessions with mental health (MH) and was discharged with a global assessment of functioning score consistent with minimal symptoms.  There were no MH treatment entries in the 9 months prior to separation, and no evidence that any MH condition ever resulted in treatment in the emergency room or hospitalization.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the postural orthostatic tachycardia syndrome and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication.  In the matter of the contended cognitive disorder, PTSD, sleep apnea, headache and left knee conditions, the panel recommends no change from the PEB determinations as not unfitting.  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 20170316, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20190011719, 

Dear XXXXXXXXXXXXXXXX:

	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.

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