RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04014
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20091125

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Unit Supply Specialist, medically separated for “supraventricular tachycardia” with a disability rating of 10%. 

CI CONTENTION:  The CI contends her condition has continued to worsen and negatively impacts her daily activities.  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 – 20090817	VARD – 20100429	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Supraventricular Tachycardia	7010	10%	Supraventricular Tachycardia	7010	10%	20100106	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Supraventricular Tachycardia.  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced chest pain associated with shortness of breath and the sensation of a rapid heartbeat in December 2007.  She also experienced two syncopal (fainting) episodes as well as recurrent episodes of dizziness, lightheadedness and feeling as if she were exercising when she was resting.  An EKG was abnormal and she was seen by a cardiologist who diagnosed episodic supraventricular tachycardia.  She underwent an ablation of the cardiac focus in May 2008 and again in December 2008.  It was a partial ablation because her atrial focus was close to her atrioventricular node and therefore difficult to treat.  Treatment notes indicated mitral valve prolapse in 1997.
During the 10 June 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the examiner noted the CI had continued episodes of supraventricular tachycardia despite several ablation attempts.  The 25 June 2009 MEB NARSUM examination, 5 months prior to separation, noted complaints of continued chest pain and shortness of breath (SOB) despite attempted ablations.  She had no further episodes of syncope.  She had 1-3 symptomatic episodes per week in a random time frame.  Her cardiologist continued to try to control her symptoms with medication.  The examiner referenced the cardiology note of April 2009 which noted frequent chest pain, SOB and palpitation without clear etiology.  There was no paroxysmal nighttime SOB, no lower extremity edema, and no exertional angina complaints.  She gained more than 35 pounds in the past 9 months due to inability to exercise.  She was taking Metoprololol XL daily to control her heart rate.  There were no reports of missed duty and she was able to perform most of the duties of her MOS.  Her last EKG was normal and an echocardiogram dated November 2008 noted mild to moderate mitral regurgitation with normal chamber size and normal left ventricular ejection fraction with a mildly dilated aortic root.  The exercise stress test in November 2008 showed a normal response to exercise with maximal METS of 11.30 without symptoms or EKG changes, no ischemia (lack of blood flow) and multiple supraventricular tachycardia (SVT) episodes.  The Treadmill test induced repeated runs of junctional tachycardia, at a rate of 140-155.  CXR was read as normal.  She did 2 hours per week of cardiovascular exercise and 2 hours per week of light weight training.  Her condition was stable after her last ablation 6 months previously.  Physical examination showed essentially normal vital signs.  The examiner noted multiple episodes of SVT unrelated to any specific activity.  The 19 May 2009 Cardiology note indicated the CI was hooked up to the event monitor on 28 April 2009.  Results included frequent junctional tachycardia, normal left ventricular ejection fraction, mild-moderate mitral regurgitation and normal sinus rate of 73.  

At the 6 January 2010 VA Compensation and Pension (C&P) evaluation, 1 month after separation, the CI reported chest pain, SOB and a sensation of a rapid heartbeat, which occurred with moderate activity and sometimes at rest.  She reported a lack of stamina, weakness/fatigue and pain.  Chest X-rays showed a mildly dilated aortic root.  She continued to take Metaprololol XL and was looking for a job.  Physical examination showed normal pulse and blood pressure, moderate obesity, with no cardiac or other abnormalities.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the supraventricular tachycardia 10%, coded 7010 (supraventricular arrhythmias), citing a rating for one to four supraventricular arrhythmia episodes as documented by event monitor.  The VA also rated the supraventricular tachycardia 10% coded 7010, based on the C&P examination 1 month after separation, citing tachycardia documented by Holter monitor.  The panel noted there was no evidence of supraventricular arrhythmias with more than four episodes per year documented by ECG or Holter monitor to meet criteria for a 30% 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 supraventricular tachycardia.  

BOARD FINDINGS:  In the matter of the supraventricular tachycardia 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.   	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170327, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record  

AR20180006249  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.

Sincerely,					      
Enclosure