RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04213
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20031001

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Initial Organizational Maintenance Technician, medically separated for “syncope of unknown etiology” 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 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 – 200307101	VARD -  20060209	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Syncope of Unknown Etiology	8299-8210	10%	Syncopal Episodes	8999-8910	NSC	STR	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Syncope of Unknown Etiology. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI initially experienced loss of consciousness in March 2002 which reportedly occurred 2-3 times of day and lasted approximately 10 seconds each time. He had no prodromal symptoms and no dizziness, but did note a consistent pattern of white vision prior to episodes of lightheadedness and loss of consciousness. He denied tinnitus, nausea or vomiting, but occasionally had chest discomfort prior to an episode. Extensive cardiac evaluation including a chest X-ray, electrocardiogram, transthoracic echocardiogram, event monitor, in- hospital telemetry, carotid (Doppler) ultrasound, and stress test found no evidence of disease. Neurological and otolaryngology examination including tilt table testing, audiological evaluation, and a brain MRI, revealed no significant etiology for the syncope. Laboratory studies were within normal limits except for a slightly low red blood count.

The 1 March 2003 MEB NARSUM examination, 7 months prior to separation, noted CI complaints of episodic syncopal episodes. Physical examination showed a well-developed, well-nourished male in no apparent distress, who was alert and oriented times four. Blood pressure was 137/63, pulse 61 beats/minute, and respirations 14/minute, and he was 71 inches tall and weighed 178

pounds. The examination was unremarkable with no pulmonary, cardiovascular, or peripheral vascular abnormalities. There was no lower extremity clubbing, cyanosis, or edema, and the neurologic findings were grossly intact. An electrocardiogram showed all heart axes as well sinus rhythm, PR intervals, QRS duration, and QT corrected intervals to be normal.

The 28 April 2003 NARSUM neurology addendum, 5 months before separation, noted the CI had a history of syncope, pre-syncope and had a carotid bruit. There were witnessed events without seizures and no post-ictal state, and the frequency of episodes had decreased to several a week as compared to several a day. Physical examination revealed a blood pressure of 136/53 and pulse 60 beats/minute. Neurologic examination was normal except for a soft bruit heard in the right carotid artery and over what appeared to be the right vertebral artery. A carotid ultrasound was normal and flow in the vertebral arteries was also within limits. A cervical spine MRA showed normal flow in both the carotid and vertebral arteries and was normal at the level of the aortic arch. The assessment was syncope with a right-sided carotid and vertebral bruit, but without evidence of hemodynamic flow abnormalities in either the right carotid artery or the right vertebral artery. There was no VA examination in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the syncope condition 10%, analogously coded 8299-8210 (tenth (pneumogastric, vagus) cranial nerve). The VA utilized the STR and determined there was no evidence of a chronic condition and denied service connection. Panel members noted that the PEB used code 8299- 8210 to represent a vasovagal syncope where the body responds to certain triggers and there is an alteration in the heart rate and blood pressure resulting in loss of consciousness. Because the evidence documented several episodes a week, the panel majority agreed that a 30% rating for a severe, incomplete paralysis of the vagus nerve was more appropriate than a moderate 10% rating. The panel considered other VASRD codes and noted that syncope is a component of rating conditions IAW VASRD §4.104 (cardiovascular system), but that no cardiovascular etiology was identified. Alternatively, analogous code 8999-8911 (epilepsy, petit mal) offered a rating option for the CI’s symptoms which included “a brief interruption in consciousness or conscious control associated with staring or rhythmic blinking of the eyes or nodding of the head (“pure” petit mal), or sudden jerking movements of the arms, trunk, or head (myoclonic type) or sudden loss of postural control (akinetic type).” However, in the absence of EEG findings to support the presence of petit mal (absence) seizures, a rating under this code could not be justified. 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 syncope condition, coded 8299-8210.

BOARD FINDINGS: In the matter of the syncope condition, the panel majority recommends a disability rating of 30%, coded 8299-8210 IAW VASRD §4.124a. The single voter for dissent recommends no change and no re-characterization and did not elect to submit a minority opinion. 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	
Syncope of Unknown Etiology	8299-8210	30%	

DEPARTMENT OF THE NAVY
SECRETARY OF TIIE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN REPLY REFER TO:
1850
CORB:003
12 Oct 20

From:	Director, Secretary of the Navy Council of Review Boards To:	Ryan G. Marcou

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW (PDBR)
Ref:	(a) DoDI 6040.44
(b) PDBR ltr of 29 Nov 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy for appropriate action.

2.	On 5 October 2020, the Assistant Secretary of the Navy took action in your case by accepting the correct recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Physical Evaluation Board from 10 to 30 percent with assignment to the Permanent Disability Retired List.

3.	

The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the Navy Personnel Command, for correction of your records as stated above.	You will be notified once those changes are complete.