RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03576
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20070527

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Infantryman, medically separated for “coronary artery disease (CAD)” with a disability rating of 10%.

CI CONTENTION:  Review heart condition and 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 - 20070316	VARD - 20070718	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Coronary Artery Disease	7005	10%	Coronary Artery Disease	7005	10%	20070718	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Coronary Artery Disease.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s CAD began in the summer of 2006 when he experienced chest pain while performing a physical training run.  An emergency room evaluation determined no heart damage.  A cardiac stress test 2 weeks later was electrically negative but symptomatically positive for maximal cardia output (chest pain that developed during the stress test).  The CI underwent a cardiac catheterization which the CI reported showed some artery blockage but surgery was not advised.  Chest pain episodes continued at least 3 to 4 times per month with some relief with nitroglycerin; however, his duties remained limited.  A myocardial perfusion imaging study (shows how well blood flows through the heart) performed on 26 January 2007 revealed normal sinus rhythm (heart beat) and nonspecific ST-T wave changes (electrical activity).  Blood pressure response was normal.  The ejection fraction (EF or amount of blood pumped out of the heart) was 56% (normal range) and metabolic equivalents (METs or generally the amount of energy a person uses) were 10.2 (similar to jumping rope).  At the 8 February 2007 MEB NARSUM examination, 3 months prior to separation, the CI stated:  “I’ve got heart disease.”  His medications included:  Isordil (relax blood vessels), Toprol (present high blood pressure) and Plavix (prevent blood clots).  Physical examination (PE) showed the heart was not enlarged.  There was a normal sinus rhythm, no murmurs, no parasternal lifts and no rubs.  He had good peripheral (such as hands and feet) pulses and no peripheral edema.  His stress test showed 10.2 METs.  

At the 17 July 2007 VA Compensation and Pension (C&P) Cardiac examination, 2 months after separation, the CI reported chest discomfort.  Examination showed blood pressure of 114 mm Hg / 72 mmd Hg.  There was no jugular venous distention or peripheral edema findings.  Heart rate was regular with S1 and S2 sounds.  Murmurs, clicks and pericardial rubs were absent.  The examiner noted the CI’s stress test performed on 23 June 2006 was essentially normal.  Electrocardiography was normal.  Left heart catheterization performed on 29 January 2007 showed diffuse CAD with preserved ventricular function (EF 56%).  His condition required continuous medication with a resultant favorable response without any side effects.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the heart condition 10%, coded 7005 (arteriosclerotic (atherosclerotic) [artery wall thickens] heart disease (CAD)), citing the CI achieved 10.2 METS on exercise testing and continuous medication was required.  The VA also rated the heart condition 10%, also coded 7005, based on the C&P Cardiac examination, citing continuous medication is required.  The panel agreed that the CI’s achieved 10.2 METs and required continuous medication supports a 10% rating under code 7005.  Although the CI reported exertional chest pain (angina), cardiac testing showed METs greater than 5 to 7, and no evidence of ventricular hypertrophy (heart ventricle wall thickening) or dilatation (enlarged heart) to support a higher rating.  After due deliberation, considering all of 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 CAD condition.

BOARD FINDINGS:  In the matter of the CAD condition and IAW VASRD §4.104, 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.

AR20180015279, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	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.