RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04845
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20090727

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Aircraft Metals Technology Journeyman, medically separated for “neurocardiogenic syncope” with a disability rating of 10%.

CI CONTENTION:  Review requested of additional conditions (left knee and right shoulder) not identified by the Medical Evaluation Board (MEB) and/or Physical Evaluation Board (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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20090310	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neurocardiogenic Syncope	8199-8108	10%	No VA Examination Proximate to Separation	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:

Neurocardiogenic Syncope.  According to the service treatment record and MEB narrative summary (NARSUM), the CI experienced two syncope episodes (a sudden loss of consciousness caused by a drop in blood pressure) on 28 February 2007, more than 2 years before separation.  Neurology and cardiology work-ups to include lab studies and neuroimaging were negative.  The CI was seen by neurology on 14 July 2007 for two reported syncope episodes at work the day prior.  He was symptom-free from October 2007 to August 2008 until he presented with syncope symptoms in September 2008 when a repeat tilt table test confirmed a diagnosis of neurocardiogenic syncope.  The CI was witnessed to have a blacked out/syncope episode at his work parking lot in February 2009.

The 29 October 2008 MEB NARSUM examination, 9 months prior to separation, noted complaints of dizziness and fainting spells.  He reported dizzy spells on average twice a week but denied syncopal episodes since his last tilt table test. Medications included Toprol XL and Micardis.  He was slowly advancing his physical activity, but was currently performing a desk job and was restricted from driving.  Physical examination, including neurology and cardiology, showed blood pressure of 135/80 and normal physical findings.  The 31 March 2009 cardiology examination noted the CI had episodes of dizziness and light-headedness but no frank syncope.  He complained of some atypical chest pain that occurred before or after his dizzy episodes.  A cardiac recorder test showed some abnormal sinus rhythm and sinus tachycardia (fast heartbeat.)  Physical examination was unremarkable.  Blood pressure was 130/78.  The examiner noted the syncope was unchanged from the previous week and the dizziness had worsened since the last visit.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the syncope condition 10%, analogously coded 8199-8108 (narcolepsy), which according to the VASRD is rated as a minor seizure (8911) under the general rating formula for major or minor epileptic seizure.  A 40% rating requires, “At least 1 major seizure in the last 6 months or 2 in the last year; or averaging at least 5 to 8 minor seizures weekly.”  The 20% rating requires, “At least 1 major seizure in the last 2 years; or at least 2 minor seizures in the last 6 months.”  A 10% rating requires, “A confirmed diagnosis of epilepsy with a history of seizures.”

The panel noted the CI reported recurrent light headedness and dizziness symptoms.  A cardiology examination on 31 March 2009 documented no further drops in blood pressure resulting in unconsciousness that resulted in a syncopal episode.  The panel agreed that only actual syncope, not light-headedness and dizziness symptoms, are credited as minor seizures under the general rating formula for major or minor epileptic seizure.  The panel majority concedes that the CI had one blackout/syncope episode (analogous to minor seizures) in February 2009, witnessed by a co-worker, within 6 months of separation which supports a 10% rating under analogous code 8199-8108.  The panel also considered VASRD codes 8210, 6204 and 8914 but they did not warrant a higher 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 syncope condition.

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

Dear XXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-04845.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no rating modification or re-characterization of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that modification of your disability rating or characterization of your separation is not warranted.  Accordingly, I accept the recommendation that your application be denied.

						Sincerely,