RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-04840 BRANCH OF SERVICE:  NAVY	SEPARATION DATE: 20080530

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Equipment Operator, medically separated for “recurrent…dizziness and syncope (loss of consciousness)…” with a disability rating of 10%.

CI CONTENTION: In addition to his heart condition, diabetes and associated complications (including leg neuropathy, gastroparesis, and kidney disease) the CI requested review of conditions not identified by either the MEB or the PEB. 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 - 20080407	VARD - 20081009	
Condition	Code	Rating	Condition	Code	Rating	Exam	
…Dizziness & Syncope…	6299-6204	10%	No VA Placement	
…Diabetes Mellitus	Cat III	Diabetes	7913	20%	20080717	
Coronary Artery Disease…		Coronary Artery Disease…	7005	60%		
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 70%	

ANALYSIS SUMMARY:

Recurrent…Dizziness & Syncope. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s dizziness and syncope began as early as Spring 2007 with no causal factors identified. There were no treatment notes addressing the dizziness/syncope in record. In June 2007 an episode of dizziness led to syncope while driving and the CI was hospitalized for 24 hours for testing. He reported episodes of dizziness which occurred frequently and seemed related to changing positions, but could occur after prolonged standing with several episodes of syncope. Extensive evaluations to include cardiology and neurology did not identify an etiology of the syncope. The CI had a history of coronary artery disease with stents placed twice and the cardiac tests were negative for ongoing ischemia as well. He also had a history of diabetes mellitus Type 2 diagnosed in 2006, treated with oral hypoglycemic medication and diet, with non- fasting blood sugars ranging from 140 to 160 mg/dl.

The 25 February 2008 non-medical assessment (NMA) did not mention any specific medical condition, only that the CI was not deployable/worldwide assignable. During the 18 March 2008 MEB examination (recorded on DD Forms 2807-1 and 2808), 2 months prior to separation, the CI reported episodes of dizziness, vertigo and fainting. Physical examination showed blood pressure of 156/85 mmHg (millimeters of mercury) and a pulse of 65. All physical examination boxes were checked normal.

The 15 May 2008 MEB NARSUM examination, 2 weeks prior to separation, noted complaints of continued problems with dizziness and episodes of syncope, which occurred unpredictably. Physical examination of the heart and lungs were normal. There were no carotid bruits. The abdomen was non-tender without enlarged organs or masses. Neurological examination was normal, including a normal gait. Blood work showed a blood sugar of 124mg/dl (slightly elevated) and a hemoglobin AIC of 5.6% (normal). Thyroid and liver function tests were normal. The NARSUM noted that the CI had been on limited duty (LIMDU) restriction with a self-paced exercise program due to shortness of breath with exercise that had been unchanged for the last several months, and for at least the prior 6 months on LIMDU since the June 2007 episode of syncope occurred. The 17 July 2008 VA C&P examination did not address the dizziness and syncope because the CI did not submit a claim for the condition.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the dizziness and syncope at 10%, coded 6299-6204 (analogous to peripheral vestibular disorders). The panel agreed a 10% rating was supported for occasional dizziness, coded 6204. There was no evidence of dizziness or occasional staggering to support a higher rating under 6204. Since the cause of the CI’s dizziness and syncope had not been determined, the panel also considered alternatively rating the syncope as syncope, NOS (not otherwise specified) rated analogous to narcolepsy, 8108, which is rated according to the same criteria as petit mal seizures (8911). However, there were no episodes of syncope in the last 6 months documented in the record to support higher than a 10% rating with this approach.

The panel majority concluded no higher than a 10% rating was supported under any applicable VASRD code. The dissenting voter thought the CI’s dizziness with syncope was more appropriately analogized to grand mal seizures (8910), supporting a 20% rating for one seizure in the past 2 years. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel majority concluded there was insufficient cause to recommend a change in the PEB adjudication for the dizziness and syncope condition.

Contended PEB Conditions: Diabetes Mellitus and Coronary Artery Disease. 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 LIMDU forms or implicated in the NMA and did not fail retention standards. There was no performance-based evidence from the record that either of 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 either of the contended conditions, so no additional disability ratings are recommended.

BOARD FINDINGS: In the matter of the recurrent and frequent episodes of dizziness and syncope and IAW VASRD §4.124a, the panel majority recommends no change in the PEB adjudication. The single voter for dissent recommends modification to 20%, coded 8999-8910 and did not elect to submit a minority opinion. In the matter of the contended diabetes mellitus and coronary artery disease conditions, the panel recommends no change from the PEB determinations as not unfitting. 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
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.