RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03805
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20050108

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Microwave Systems Operator, medically separated for “bicuspid aortic valve syndrome” with a disability rating of 10%.  

CI CONTENTION:  The VA rated higher for the heart condition.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in Do DI 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 - 20041110	VARD - 20050523	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bicuspid Aortic Valve Syndrome	7000	10%	Bicuspid Aortic Syndrome, (Claimed As Heart Condition)	7099-7000	30%	20050414	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Bicuspid Aortic Valve Syndrome.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s heart condition was discovered in 2002 during a routine physical examination. A heart murmur was noted and an echocardiogram showed aortic insufficiency and mitral valve prolapse with normal function and size of the left ventricle and left atrium.   During an exercise stress test in May 2004, he achieved 13.5 METS and had moderate fatigue and shortness of breath (SOB).  His heart rate went from 71 to 172 beats per minute and blood pressure from 128/70 to 200/80.  An echocardiogram on 6 July 2004 identified significant mitral insufficiency, a dilated aortic root and mild left ventricle enlargement.  No heart murmur or cardiac problems were noted on the 1994 entry physical.  

During the 28 September 2004 MEB examination (recorded on DD Form 2808), 4 months prior to separation, physical examination showed a 3/6 diastolic murmur.  At the 13 October 2004 MEB NARSUM examination, the CI reported that he could walk at a moderate pace and had no difficulties with activities of daily living.  He took medication to control his blood pressure, but he could not run or do pushups because of his condition.  Upon examination, he had no SOB on exertion.  Aerobic activity was limited so the heart rate would not exceed 110 beats per minute, but there was no evidence of heart failure.  The examiner noted he was being followed intermittently by cardiology and his condition was stable.  

At the 14 April 2005 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported he was doing well on no medication, and denied chest pain, SOB or swelling of the feet.  Physical examination showed a soft, early diastolic murmur best heard at the left parasternal area.  There was an ejection systolic murmur 2/6 in intensity.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the heart condition 10%, coded 7000 (valvular heart disease (including rheumatic heart disease), citing normal cardiac function, limits on all strenuous physical activity, unfitting profile restrictions, and rating in accordance with 10USC 1207a (8-year rule).  The VA rated the heart condition 30%, analogously coded 7099-7000, based on the C&P examination, citing documentation of cardiac hypertrophy on echocardiogram.  Panel members agreed that the July 2004 echocardiogram, which showed a bi-cuspid aortic valve with moderate to severe aortic insufficiency, mildly dilated aortic root and mildly enlarged left ventricle, met the 30% rating criteria under code 7000 for “evidence of cardiac hypertrophy or dilatation on electro-cardiogram, echocardiogram or X-ray.”  Although the NARSUM noted the CI was not taking any medication and the condition did not affect activities of daily living, his aerobic activities had to be limited.  Additionally, the panel noted the CI entry to exit date exceeded the 8-year period cited by the PEB.   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 7000.  

BOARD FINDINGS:  In the matter of the heart condition, the panel recommends a disability rating of 30%, coded 7000 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	
Bicuspid Aortic Valve Syndrome	7000	30%	

The following documentary evidence was considered:

AR20190010856, 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.  Inquiries concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 
	A copy of this decision has also been provided to the Department of Veterans Affairs.