RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03320
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20060606

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Pharmacy Specialist, medically separated for “congestive failure from diastolic dysfunction” with a disability rating of 10%.  

CI CONTENTION:  “Left ventricular hypertrophy.”  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 - 20060418	VARD - 20061023	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Congestive Failure from Diastolic Dysfunction	7099-7020	10%	Congestive Heart Failure Status Post Myocardial Infarction	7006-7005	30%	20060713	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Congestive Failure from Diastolic Dysfunction.  According to the service treatment record and MEB narrative summary (NARSUM), the CI first experienced chest pain during an Army fitness test in 2003.  He continued to have chest pain with activity, and on 29 May 2005, an abnormal electrocardiogram (EKG) was consistent with left ventricular hypertrophy (LVH) and strain pattern.  In June 2005, chest pain required hospitalization for evaluation, and an echocardiogram on 18 August 2005 showed moderate concentric LVH with an ejection fraction of 65%.  Cardiac catheterization was negative for coronary artery disease.  
The 8 February 2006 MEB NARSUM examination, 4 months prior to separation, noted CI complaints of chest pain with activities and elevated ambient temperatures.  The provider referred to a 19 December 2005 finding of elevated blood pressure and a focused cardiopulmonary examination with normal lung and heart sounds without abnormalities.  The diagnosis was “congestive heart failure from diastolic dysfunction manifested by chest pain during exercise and moderately reduced exercise tolerance.”  

At the 13 July 2006 VA Compensation and Pension (C&P) examination, 1 month after separation, the CI reported a history of a myocardial infarction with chest pain treated by medication and use of nitroglycerin 2-3 times a week.  Physical examination noted an EKG with LVH and a repolarization abnormality.  The physician indicated an unknown ejection fraction and estimated a metabolic equivalent of task (MET) level of 6 that was “difficult to assess because of inactivity” due to a left leg condition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the heart condition 10%, analogously coded 7099-7020 (cardiomyopathy), citing a concentrically enlarged left ventricle with an ejection fraction of 65% requiring medication.  The VA rated the heart condition 30%, dual coded 7006-7005 (myocardial infarction-arteriosclerotic heart disease), based on the C&P examination and STR, citing a current MET of 6 and citing 30% rating criteria.  While members found no myocardial infarction or arteriosclerotic heart disease diagnoses in the STR, LVH was indicated by EKG and echocardiogram and warranted a 30% rating for “evidence of cardiac hypertrophy” under VASRD diagnostic code 7020.  There was no record of more than one episode of acute congestive heart failure in the previous year, workload greater than 5 METs, and ejection fraction over 50 percent for a higher rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the heart condition, coded 7099-7020.  

BOARD FINDINGS:  In the matter of the congestive failure from diastolic dysfunction, the panel recommends a disability rating of 30%, coded 7099-7020 IAW VASRD §4.104.  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	
Congestive Failure from Diastolic Dysfunction	7099-7020	30%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170509, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

AR20180009598, 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 30% 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.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), XXXXXXXXXXXXXXXXXX.

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

Sincerely,					      
Enclosure