RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX		CASE: PD-2017-03776 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20061214

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Motor Transport Operator, medically separated for “unexplained cardiac arrest” with a disability rating of 0%.

CI CONTENTION: “Disability code 7011: Sustained ventricular arrhythmias. The condition receives 100% rating the entire time it is treated in the hospital or the entire time an implantable defibrillator is in place.”  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 - 20060622	VARD/DRO - 20070522	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Unexplained Cardiac Arrest	7099-7020	0%	Status Post ICD [Implantable Cardioverter-Defibrillator] After Cardiac Arrest	7011	100%	STR	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 100%	

ANALYSIS SUMMARY:

Unexplained Cardiac Arrest. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s cardiac condition began in January 2006 when he collapsed while playing basketball during a deployment. Upon evaluation in the emergency room, he developed ventricular tachycardia (fast, abnormal heartbeat) and fibrillation (rapid, erratic heartbeat) which

required defibrillation. Despite an extensive cardiac workup, a specific cause of the fibrillation was not identified, and he underwent an automatic ICD (AICD) implantation on 10 February 2006.

The 20 March 2006 MEB NARSUM cardiology addendum, 9 months prior to separation, noted the complaint of a history of ventricular fibrillation after ICD implant. Physical examination showed a blood pressure of 114/60 and heart rate of 54 beats/minute. The CI was well- developed, well-nourished, in no distress, and oriented times three. At the neck, jugular venous distension was less than 5 cm, pulses were normal, and there were no bruits. The heart rate was regular with a normal S1 and a physiologically split S2 with no murmurs, rubs, or gallops. The lungs were clear and there was no edema of the extremities. A signal- averaged EKG showed a late potential was absent but was otherwise normal before implantation of the ICD, while an EKG revealed sinus bradycardia (slow heartbeat) with normal early repolarization. The cardiologist noted the CI’s condition was stable with normal ventricle function and no symptoms, and that he did not have clinical heart failure. The short-term prognosis was very good, particularly with the ICD as protection in the event of another cardiac arrest. With appropriate medical care, his long term prognosis depended upon whether he had an underlying heart condition that was not detectable by current testing.  Regular follow-up in an ICD clinic was recommended.

On 6 July 2006, a single chambered ICD interrogation was done with no programing changes made and the ICD function was assessed to be stable. The CI was seen on 13 July 2006 to discuss an electrophysiology study to evaluate supraventricular tachycardia that was noted during an AICD interrogation on 16 May 2006. Two episodes were terminated with ICD shocks. The CI was offered a possible atrioventricular (AV) nodal modification since he had dual AV node physiology, but he refused. He was treated with beta blocker (metoprolol) therapy, but still had episodes of tachy (rapid) palpitations (supraventricular tachycardia), diaphoresis (sweating), lightheadedness, and occasional ICD shocks. He was scheduled for electrophysiologic studies with a possible AV node modification on 17 July 2006, but the STR did not have any details on whether or not a procedure was performed.

At the 5 June 2007 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported a history of passing out and subsequent placement of a defibrillator. Physical examination showed blood pressure readings of 108/74, 110/75, and 108/74, and 20 respirations/minute. There was a scar over the left upper anterior chest wall below the left clavicle, and a subcutaneous defibrillator was noted over the left upper anterior chest wall. The lungs were clear to auscultation, and the heart had a regular sinus rhythm.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the cardiac condition 0%, analogously coded 7020 (cardiomyopathy), citing “normal exercise tolerance and currently without any cardiac signs or symptoms. The ICD was placed as a protection for a possible future event. Rated in accordance with PDA guidance email of 4/13/06.” The VA initially rated the cardiac condition 10%, coded 7011 (ventricular arrhythmias [sustained]) based on the STR, citing an evaluation of 10% if there is a workload greater than 7 METs [metabolic equivalent of task] but not greater than 10 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or the requirement for continuous medication. Upon review, the VA rated the condition 100%, citing evidence of AICD implantation. Panel members agreed that the cardiac condition met the criteria for a 100% rating under code 7011, “For indefinite period from date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia, or; for indefinite period from date of hospital admission for ventricular aneurysmectomy, or; with an automatic implantable Cardioverter-Defibrillator (AICD) in place.” After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 100% for the cardiac condition, coded 7011.

BOARD FINDINGS: In the matter of the cardiac condition, the panel recommends a disability rating of 100%, coded 7011 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	
Unexplained Cardiac Arrest S/P AICD Placement	7011	100%	

The following documentary evidence was considered:

PD-2017-03776 

AR20190011827, XXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXXX

	I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to recharacterize your separation as a permanent disability retirement with the combined disability rating of 100% 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 recharacterization of your separation as a permanent 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), XXXXXXXXXXXXXXXXXXXX.

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

PD-2017-03776