RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-04289
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20060215

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

CI CONTENTION: The application included a letter dated 10 November 2005, which mentioned hypertension and obesity.  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 - 20051215	VARD - 20060530	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Atrial Fibrillation	7010	10%	Paroxysmal Atrial Fibrillation…	7010	10%	20060111	
Essential Hypertension	Cat III	Hypertension	7101	10%	20060111	
Obesity	Cat IV	No VA Placement	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	
	
ANALYSIS SUMMARY:

Atrial Fibrillation. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s heart condition began in May 2004 when he developed heart palpitations. The first episode occurred while he was deployed to Iraq and lasted 45 minutes. After the second episode the following day, the CI was medically evacuated to Germany where he was diagnosed with paroxysmal atrial fibrillation. He was treated with a dose of oral atenolol and converted to normal rhythm. An echocardiogram was normal. He was found fit for duty and returned to Iraq.

With the palpitations he also had chest pain and shortness of breath (SOB). The CI later reported he had a similar episode of palpitations in June 2003 that resolved with rest.

During his June 2005 exercise stress test he developed atrial fibrillation with a rapid ventricular response. He felt palpitations without chest pain or SOB. Within minutes he returned to a normal rhythm. Echocardiogram showed normal left ventricular function with a moderately dilated left ventricular chamber size but no left ventricular hypertrophy and normal valve function. An electrocardiogram (EKG) several days later showed atrial fibrillation and he was started on medication to control his heart rate. He also received an anti-coagulant, a lifetime therapy, to prevent cerebrovascular accident since he also had hypertension. The 21 July 2005 physical examination showed a blood pressure of 152/108, heart rate of 86 at rest and 128 with walking. The heart rate and rhythm were “irregularly irregular” with normal heart sounds and no murmurs, rubs or gallops, or evidence of other maladies. The CI was obese. Thyroid tests were normal.  EKG at that time also showed atrial fibrillation.

The 8 August 2005 MEB NARSUM examination, 6 months prior to separation, noted he was unable to perform his military duties due to his medical condition. At the 11 January 2006 VA Compensation and Pension (C&P) examination, one month before separation, the CI reported atrial fibrillation occurred about three times per week and lasted about 15 minutes. He had to take a deep breath and sweated a lot when he had symptoms. At times he had difficulty with running but had not lost any time from work. He was able to perform activities of daily living and was followed by cardiology. EKG was normal and the estimated MET level was 8.0. Physical examination showed a morbidly obese man with normal heart rate, rhythm, and heart sounds, and no murmur.  There was no other evidence of cardiac dysfunction.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and VA rated atrial fibrillation at 10%, coded 7010 (supraventricular arrhythmias). The PEB cited permanent atrial fibrillation. The VA based the rating on the C&P examination, citing three documented episodes of paroxysmal atrial fibrillation in the past year. The STR showed one possible but undocumented episode of atrial fibrillation in 2003, EKG documentation of three episodes of atrial fibrillation in Iraq in 2004, and two documented episodes of atrial fibrillation in 2005 with no syncope and minimal symptoms. The C&P examination one month prior to separation showed a normal EKG. The panel agreed there was no EKG or Holter monitor evidence of more than four episodes per year to meet criteria for a higher 30% rating. 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 atrial fibrillation condition.

Contended PEB Condition: Essential Hypertension and Obesity. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. The contended conditions were not noted on limited duty forms, implicated in the non-medical assessment, and did not fail retention standards. Obesity is not a physical disability and is not compensable. There was no performance-based evidence from the record that the conditions significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the atrial fibrillation condition and IAW VASRD §4.104, the panel recommends no change in the PEB adjudication. In the matter of the contended hypertension and obesity conditions, the panel agrees it cannot recommend them for additional disability  rating.     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:

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

IN   REPLY   REFER TO,
1850
CORB: 003 20May20

From: Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBRltr

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR ofno change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.