RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04078
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20051217

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, UH-60 Helicopter Repairer, medically separated for “supraventricular tachycardia” with a disability rating of 0%.  

CI CONTENTION:  Review all conditions.  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 - 20051108	VARD - 20060531	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Supraventricular Tachycardia	7011	0%	Supraventricular Tachycardia	7010	10%	20060410	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Supraventricular Tachycardia (SVT).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s SVT (abnormally fast heartbeat) began in 2003 with symptoms of tachycardia and palpitations.  Paroxysmal SVT (PSVT, same abnormally fast heartbeat) was diagnosed by Holter monitor.  The NARSUM examiner detailed the SVT history (dates added from STR sources) paraphrased as:  The CI’s first SVT symptom episode occurred in 2003 followed up by a normal exercise stress test.  SVT re-occurred in Korea and a “medic-run LifePack stip” documented a heart rate over 200 bpm (28 Mar 2004).  Echocardiogram on 22 March 2005 was essentially normal with an ejection fraction of 60-70% (normal amount of blood leaving the heart).  A subsequent event monitor captured 3 episodes of PSVT in 3 weeks (3 June 2004).  He was evaluated by cardiology with a second event monitor capturing 2 more episodes of SVT (unknown date) and referred to electrophysiology, but he did not desire ablative therapy (12 May 2005 evaluation).  The CI had good exercise tolerance and achieved 12.9 METS on exercise testing on 13 June 2005.  His most recent event monitor captured two episodes of atrial flutter (16 Jun 2005).  Additional events captured in the STR were an EKG with tachycardia on 4 March 2005 and PSVT on a monitor dated 22 March 2005.  

The 29 June 2005 MEB NARSUM examination, 6 months prior to separation, noted complaints of palpitations and lightheadedness.  The CI reported having one to four episodes a month which lasted 1 to 20 minutes, and he was generally able to self-terminate the episodes [resolved with Valsalva (clearing your ears) or carotid massage (sinus) per STR].  The episodes were not associated with syncope, although the CI had some presyncope symptoms.  When they occurred he had to limit or stop all exertional activity.  He had never required cardioversion and was taking Atenolol for suppressive therapy.  Physical examination showed essentially normal cardiac findings with a normal heart rate.

At the 10 April 2006 VA Compensation and Pension (C&P) general evaluation, 4 months after separation, the CI reported SVT with dizziness and weakness, and indicated that Atenolol helped control the episodes.  He indicated he still had an occasional episode, but episodes were not as frequent as prior to going on medication.  The examiner found a normal heart rate and rhythm without murmur, rub or gallop.  

A cardiology examination with Holter monitoring on 31 October 2006, 10 months after separation, documented tachyarrhythmia 42% of the time with sustained periods (not numbered) of heart rates in the 170 to 200 range.  Repeated Holter monitoring on 1 November 2006 documented tachyarrhythmia with persistent long periods of predominately sinus tachycardia, and the cardiologist recommended considering possible diagnoses of inappropriate sinus tachycardia (IST) or chronic nonparoxysmal sinus tachycardia, but could not rule out SVT.  Sixteen months remote from separation, on 10 April 2007, Holter monitoring documented five episodes of SVT.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the SVT 0%, coded 7011 (ventricular arrhythmias [sustained]), citing Holter monitor captured SVT events one to four times per month, exercise testing with 12.9 METS without symptoms and medication for suppressive therapy.  The VA rated the SVT 10%, coded 7010 (supraventricular arrhythmias), based on the C&P general examination, citing one to four episodes per year of paroxysm atrial fibrillation or other SVT documented by ECG or Holter monitor.

Rating under code 7011 for ventricular arrhythmias is based on METs, symptoms and medications.  The CI was taking continuous medication and would warrant a 10% rating under this code.  However, the CI did not have ventricular arrhythmias and the panel agreed that the CI’s diagnosed condition was SVT (and/or PSVT) and should ideally be rated under code 7010, which uses different criteria.  Rating under code 7010 is based on the number of episodes per year documented by ECG or Holter; with one to four episodes per year for the 10% rating and more than four episodes per year for the highest 30% rating.  

The panel considered the source STR evidence and the MEB NARSUM summary of “episodes per year documented by ECG or Holter” focusing on the year prior to separation.  The source STR evidence of specific treatment notes or monitor reports clearly documented four episodes that were captured on ECG or monitor.  The panel deliberated if the MEB NARSUM-described, but undated, “second event monitor capturing 2 more episodes of SVT” leading to the electrophysiology referral (electrophysiology evaluation was conducted on 12 May 2005) was during the year prior to separation.  Given the timing of the electrophysiology referral the panel adjudged, as more likely than not, that the second event monitor capturing two more episodes of SVT were in addition to the four source STR events and was within the 12 months prior to separation.  The panel therefore concluded that the CI had more than four episodes documented by ECG or Holter monitor during the year prior to separation.  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 SVT, coded 7010.

BOARD FINDINGS:  In the matter of the supraventricular tachycardia, the panel recommends a disability rating of 30%, coded 7010 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	
Supraventricular Tachycardia	7010	30%	

XXXXXXXXXX 

XXXXXXXXXX
XXXXXXXXXX
XXXXXXXXXX

Dear XXXXXXXXXX:

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] [Reserve retirement].  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.  Inquiry concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, 
	A copy of this decision has also been provided to the Department of Veterans Affairs [and to the counsel you listed on your application; [name and address]].