RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:XXXXXXXXXXXXXXXXXXX	CASE:  PD-2017	-0432	2
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20051201
SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Aircraft Navigation Systems Technician, medically separated for “neurocardiogenic syncope (vasovagal syncope)” with a disability rating of 10%.
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 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 - 20050913	VARD - 20060306	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neurocardiogenic Syncope	8299-8210	10%	Neurocardiogenic Syncope	8199-8108	20%	20050922	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Neurocardiogenic Syncope. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s syncope condition began approximately 2 years prior to entering the Disability Evaluation System. She reported intermittent chest pains and tachycardia palpitations preceding syncopal events which were followed by a limited period of unconsciousness. There were also multiple syncopal episodes with preceding visual changes as well. An echocardiogram in September 2004 was normal, but a tilt table test in October 2004 was positive and induced syncopal events and blood pressure and heart rate changes consistent with neurocardiogenic syncope. A neurologist agreed with the diagnosis and recommended lower extremity compression stockings. Syncopal episodes persisted and impacted daily duties, physical exercise and performance. The CI initially had intermittent and near-syncopal events every 2-6 months, but by an internal medicine evaluation on 7 July 2005, she was having episodes every 2-3 months. She did not tolerate a trial of atenolol (beta blocker) and declined other treatment recommendations, citing personal values against pharmaceutical interventions and non-natural means. She did accept a high salt and fluid hydration effort with mild symptom improvement but recurrent syncope. At a follow-up visit on 15 August 2005, the provider noted the CI could not return to duty without a willingness to try other therapies. On the same day, the

MEB NARSUM examination, 4 months prior to separation, documented improvement but no symptom resolution with conservative measures. The examiner opined that the condition was not “recoverable to a full active duty status” without further attempts at intervention medications. Physical examination showed normal vital signs and unremarkable neurological and cardiac findings.

At the 22 September 2005 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported syncope attacks about 7 times per month, preceded and proceeded by dizziness, with loss of consciousness for about 5 minutes and attacks lasting about 40 minutes. She stated that according to her cardiologist and neurologist, the symptoms were due to low blood pressure. While there was functional impairment during the attacks, she had not lost time from work and was able to perform activities of daily living and remained in the same job in the Marines. Physical examination showed normal vital signs with unremarkable findings.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the syncope condition 10%, analogously coded 8299-8210 (incomplete, moderate paralysis of the tenth [pneumogastric, vagus] cranial nerve). The VA rated the syncope condition 20%, analogously coded 8199-8108 (narcolepsy), based on the C&P examination, citing objective evidence of two minor episodes of syncope every 3 months. Panel members noted that vasovagal syncope analogizes to code 8210, and is dependent upon the extent of sensory and motor loss to organs of voice, respiration, pharynx, stomach and heart. The NARSUM examination reported two attacks about every 3 months, and physical findings, including vital signs, were essentially normal. The CI accepted non-pharmaceutical treatment with some improvement and reported no loss of work or change in duties. The VASRD endorses the assignment of code 8108e in the presence of non-differentiated vasovagal syncope or syncope not otherwise specified, and so the panel agreed the CI’s condition was correctly coded 8299- 8210 and assigned a 10% disability. 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 syncope condition.

BOARD FINDINGS: In the matter of the syncope condition and IAW VASRD §4.124, 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:

2	PD-2017-04322

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

HI REPLY REFER TO ,
1850
CORB: 003
10 Sep 20

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

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 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.