RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04086
BRANCH OF SERVICE:  Army	SEPARATION DATE:  20070725

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E2, Petroleum Supply Specialist, medically separated for “vaccinia associated myopericarditis” with a disability rating of 0%.

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 - 20070612	VARD - 20080917	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Vaccinia associated with Myopericarditis	7002	0%	Idiopathic Myocarditis	7001	10%	20080818	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:

Vaccinia associated with Myopericarditis.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s vaccinia, associated with myopericarditis (inflammation of both the pericardium [tissue surrounding the heart] and the actual heart muscle), began in October 2006 when the CI developed chest pain, light headedness, increased sweating and bilateral arm numbness approximately nine days after receiving a small pox vaccine.  Despite multiple short-term hospitalizations as well as intensive diagnostic procedures and multiple medications, the CI continued to experience moderate activity-limiting chest pain.  

The 4 May 2007 MEB NARSUM examination, 2 months prior to separation, noted complaints of continued mild chest pain which worsened with increased activity.  The CI’s general physical examination (PE) was completely normal and prior abnormal blood chemistries had normalized.  The CI achieved 10.9 METS on the 27 April 2007 stress test.  The examiner noted the CI’s past and current cardiac symptoms were “probably” associated or caused by the small-pox vaccine.  Specifically, the provider recommended “continued restrictions to not perform any strenuous exertional activity due to recurrent limiting chest pain.”  Prescription medications remained as continued therapy.    
    
The VA Compensation and Pension Examination (C&P) examination, 13 months after separation, noted complaints of chest pain lasting only minutes at least three times a day.  Physical examination revealed no abnormalities.  Stress test showed 9 METS.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the vaccinia associated with myopericarditis 0%, coded 7002 (pericarditis), citing 10.9 METS (metabolic equivalents).  The VA rated the condition as idiopathic myocarditis at 10% coded 7001 (endocarditis) based on the C&P examination, citing METS 7-10.

Panel members first considered and agreed that in this case, either code utilized by the PEB or VA (7001 or 7002) were not diagnostically supported by the VASRD criteria of having “documented pericarditis” resulting in a MET deficiency, congestive heart failure or continuous medication.  Although the required continuous use of medication near the time of Service separation would appear to support a 10% rating under code 7002, the normal PE and normal blood chemistries would not support the VASRD’s requirement of a diagnosis of “documented pericarditis.”  

Panel members additionally agreed that the sole and lingering symptom of chest pain was atypical and clinically relevant in this case and therefore, was supported to be analogized to VASRD code 5321 (Group XXI; muscles of respiration) IAW VASRD §4.20 (analogous ratings).  The corresponding impairment ratings included 0% (slight), 10% (moderate) and 20% for (severe or moderately severe).  Although the NARSUM clearly described the CI’s chest pain as “mild,” panel members placed a high degree of probative value on the increase of pain with activities.  Therefore, after due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for cardiac (chest pain), coded 5399-5321.  

BOARD FINDINGS:  In the matter of the vaccinia associated with myopericarditis, the panel recommends a disability rating of 10%, analogously coded 5399-5321 IAW VASRD §4.73.  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, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Vaccinia Associated with Myopericarditis 	5399-5321	10%	

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Dear XXXXXXXXXX:

The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified to 10% but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	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. 

	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].