RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-02691
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20050414

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E7, Animal Care Specialist, medically separated for “chronic obstructive sleep apnea [OSA]” with a disability rating of 0%.  

CI CONTENTION:  The CI stated that he received a “70% rating since time of rating, heart attack, open heart surgery.”  The CI also requested review of conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 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 - 20050321	VARD - 20060501	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic OSA 	6847	0%	OSA	6847	50%	20050817	
Coronary Artery Disease	Not Unfitting	Coronary Artery Disease with Hypertension	7005	10%	20050817	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Chronic OSA.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), a sleep study performed in December 2004 confirmed the diagnosis of mild OSA, and prescribed nightly CPAP [continuous positive airway pressure].  The NARSUM examiner reported that the CI required access to an electrical outlet on a nightly basis for use of the CPAP machine.  

The 28 January 2005 MEB NARSUM sleep addendum, 3 months prior to separation, noted that the CI’s OSA symptoms were significantly helped by the use of the CPAP machine.  The permanent profile dated 26 February 2005 specified that the CI had OSA and that he would stop breathing greater than 11 times each hour during sleep leading to chronic sleep deprivation.  Although the profile stated that the CI could drive personal and government vehicles as long as he was using the CPAP machine at night, he could only operate in field environments for 72 hours without a CPAP before becoming a risk to himself and others. 

The 17 August 2005 VA Compensation and Pension (C&P) examination, 4 months after separation, did not list OSA as a diagnosis and the condition was not evaluated or examined.  However, according to the VARD dated 1 May 2005, the VA used evidence from the STR and PEB to rate the OSA condition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the OSA 0%, coded 6847 (sleep apnea syndromes), citing application of DoDI 1332.39 rating guidance, which differed from VASRD rating criteria.  The VA rated the OSA 50%, coded 6847, citing required use of a CPAP machine.  

Panel members noted the CPAP machine was identified by the NARSUM examiner as a required treatment for OSA and VASRD §4.97 provides for a minimum rating of 50% for OSA requiring a breathing assistance device.  There was no evidence of chronic respiratory failure with carbon dioxide retention, cor pulmonale or requirement for a tracheostomy to support the next higher 100% rating.  In consideration of these facts, the panel recommends a disability rating of 50% for the OSA condition, coded 6847.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 50% for the OSA condition, coded 6847.  

Contended PEB Condition:  Coronary Artery Disease.  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was profiled, generally implicated in the commander’s statement (who noted profile restrictions) and did not meet retention standards.  

In July 2004 the CI was medically evacuated from theater for syncope/pre-syncope and chest pain with an abnormal EKG.  There were abnormal cardiac studies and the CI had a cardiac catheterization which led to a diagnosis of non-obstructive atherosclerotic heart disease.  The 14 February 2005 cardiology NARSUM, 2 months prior to separation, noted complaints of chest pain with coronary artery disease.  Follow-up on cardiac studies indicated left ventricular function was normal based on flow ventriculography, and treadmill stress test with perfusion imaging documented a peak workload of 12 METS (excellent exercise tolerance) with no symptoms, appropriate hemodynamic response and no ischemic EKG changes.  There was near normal perfusion with only mildly decreased perfusion at the apex which was possibly a shadow effect.  The CI was on chronic medications which were changed during his evaluation.  The cardiologist stated:  “The most prominent restriction is based on the recommendation from Pulmonary Sleep Medicine that he requires CPAP therapy.”  He also stated that “there [were] no cardiac restrictions, however [the CI] could be expected to have recurrent chest pain and ha[d] been given the definitive diagnosis of coronary artery disease that could interfere with his duty performance.  However, he [had] completed a 120-day trial of duty without recurrent event.”  

The 6 July 2005 cardiology evaluation, 3 months after separation, included an exercise stress test to 13.4 METS.  Functional Capacity was excellent and the impression was “normal maximal GXT without symptoms, albeit some (chronic) exertional ectopy, no arrhythmias.  FIT FOR DUTY as DOD Security Guard from cardiac standpoint.”  

The panel considered that the MEB was initiated for atypical chest pain, and the cardiac evaluation found no surgical lesions, indications of a myocardial infarction, or other significant cardiac pathology.  The CI was on chronic medications with well controlled blood pressure, METS over 10 and no cardiac symptoms.  The cardiologist indicated the CI may have recurrence of chest pain, but that he had been symptom free for several months, and specified satisfactory completion of a 120-day trial of duty without recurrence.  

There was insufficient performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the OSA, the panel recommends a disability rating of 50%, coded 6847 IAW VASRD §4.97.  In the matter of the contended coronary artery disease, the panel recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Chronic Obstructive Sleep Apnea 	6847	50%	

The following documentary evidence was considered:  

Exhibit A.  DD Form 294, dated 20170321, w/atchs  
Exhibit B.  Service Treatment Record  
Exhibit C.  Department of Veterans Affairs Record  

AR20190008406, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 50% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiries concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

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