RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03891
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090226

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Infantryman, medically separated for “arteriosclerotic heart disease” with a disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 - 20081113	VARD - 20090925	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Arteriosclerotic Heart Disease	7005	10%	CAD with Mild Septal Ischemia S/P AMI	7005	10%	20090828	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Arteriosclerotic Heart Disease.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI presented on 13 November 2007 with several days’ history of exertional chest pain and was found to have arteriosclerotic heart disease.  An echocardiogram was normal (without evidence of hypertrophy).  A cardiac catheterization showed mild but diffuse arteriosclerotic heart disease.  Over the 2-day hospitalization, he was found to have sustained an acute myocardial infarction (AMI, also known as a heart attack) and placed on medications (routine for this condition).  An electrocardiogram (ECG) on 15 November 2007 showed non-specific changes which were stable.  Again, hypertrophy was absent.  He was entered into cardiac rehabilitation and encouraged to quit smoking which he did not do.  He reported on-going exertional chest pain and underwent an exercise tolerance test with Thallium.  He achieved 17 METS (excellent exercise tolerance) and 90% maximal heart rate.  He was asymptomatic and without ECG or imaging evidence of ischemia other than the septal wall.  The ejection fraction was 62% (normal).  His cardiologist thought him fit for full duty on 19 June 2008.  However, he reported shortness of breath and chest discomfort with normal military activities and occasionally used nitroglycerin (for chest pain).  He was referred for an MEB, presumably for the finding of ischemia of the septal wall.  An ECG on 3 October 2008 showed sinus arrhythmia, a normal variant, and was considered normal.  

The 29 October 2008 MEB NARSUM examination, 4 months prior to separation, noted the above history.  Physical examination was unremarkable.  A repeat nuclear stress test on 23 April 2009 was also unremarkable.  An echocardiogram the next day was normal (no hypertrophy).  This testing was done as part of a chest pain evaluation; a repeat AMI was excluded.  

At the 28 August 2009 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported that he continued to smoke, but that his cardiac condition was stable.  Physical examination was unremarkable for cardiac pathology.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the arteriosclerotic heart disease 10%, coded 7005 (arteriosclerotic heart disease), citing maintenance with multiple medications.  The VA also rated the condition 10%, using the same code (7005), based on the C&P examination, citing continuous medications.  The criteria for a 10% examination are met by the use of medications.  The exercise tolerance was excellent and hypertrophy/dilation were absent on multiple studies.  After due deliberation, considering all 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 arteriosclerotic heart disease.  

BOARD FINDINGS:  In the matter of the arteriosclerotic heart disease 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.  

AR20180016606, 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.