RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04601
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080409

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Calvary Scout, medically separated for “cardiogenic 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’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 - 20080503	VARD - 20080801	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cardiogenic Syncope	8299-8210 	10%	Cardiogenic Syncope Secondary to Bradycardiac Arrhythmia to Include Operative Atrial Pacemaker Placement 	7010-7018 	10%	20080701	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Cardiogenic Syncope:  According to the service treatment record and MEB narrative summary (NARSUM), the CI spontaneously experienced his first syncopal episode (fainting) in August 2007 while operating a motor vehicle.  A complete cardiac work-up revealed significant abnormal findings of irregular pulse rhythm with extended pauses in heartbeats.  On 23 September 2007, the CI underwent surgical insertion of a cardiac pacemaker.  On follow-up clinical encounters, he was doing well without the continuation of previous symptoms.  
At the 29 October 2007 MEB NARSUM examination, 5 months prior to separation, the CI endorsed no new or additional complaints.  His physical examination (PE) was “unremarkable.”  At the 1 July 2008 VA Compensation and Pension (C&P) examination, 3 months after separation, he reported “…doing very well and denie[d] any other problems.”  His cardiac-focused PE revealed no abnormalities.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the syncope condition 10%, analogously coded 8299-8210 (vagus nerve paralysis), citing incomplete and moderate paralysis.  The VA also rated the syncope condition 10%, dual coded 7010-7018 (implantable cardiac pacemakers), based on the C&P examination, citing minimum evaluation following an implantable cardiac pacemaker.  Members first considered and deliberated over the appropriateness of the coding schemes used by the PEB and VA for rating purposes.  Code 7018 is specific for the placement of an implantable cardiac pacemaker with two rating levels of either 10% or 100%.  For the 10% rating, the condition is to be evaluated according to the type of cardiac rhythm tracing.  Absent any sort of atrioventricular block and or ventricular arrhythmias, the panel then adjudged that code 7010 (pacemaker for supraventricular arrhythmias) best described the CI’s condition for no greater than a 10% impairment; however, this rating provided no additional benefit to the CI.  Therefore, after due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the cardiogenic syncope condition. 

BOARD FINDINGS:  In the matter of the cardiogenic syncope and IAW VASRD §4.104, 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:

AR20180014224, XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	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.