RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-04880
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040310

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O3, All Source Intelligence Officer, medically separated for “aortic insufficiency” with a disability rating of 10%.   

CI CONTENTION:  “Condition requires a lifetime of medication and additional heart surgery in the medium term (8-10 years).”  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 - 20031126	VARD - 20040514	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Aortic Insufficiency	7000	10%	Congenital Aortic Stenosis with Status Post Aortic Valvuloplasty, Aortic Valve Repair with Insufficiency, Mild Mitral Insufficiency and Hypertension	7000	10%	20040121	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Aortic Insufficiency.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s aortic insufficiency condition began in April 2000 and worsened in early 2003 when he began having dyspnea on exertion with one flight of stairs, occasional lower extremity edema, intermittent chest pain, and lightheadedness.  Prior to surgery, transesophageal echocardiography (TEE) on 12 May 2003 showed severe aortic regurgitation and trivial mitral, tricuspid, and pulmonic valve regurgitation.  The CI underwent surgery for aortic valvuloplasty of a congenital bicuspid aortic valve on 14 May 2003.  Following surgery, a chest X-ray on 15 May 2003 showed an enlarged heart silhouette and an electrocardiogram (ECG) on 18 May 2003 showed left ventricular hypertrophy.  Echocardiogram performed on the same day showed the left ventricle was mildly dilated and there was mild left ventricular hypertrophy.  A TEE performed on 23 July 2003 showed the left ventricle was mildly dilated and the left ventricular wall thickness was above the upper limit of normal.  There was mild to moderate aortic regurgitation and moderate mitral regurgitation.  An ECG on 29 July 2003 showed non-specific T-wave changes.  A graded exercise test (treadmill) was performed on 9 September 2003 and the CI reached his target heart rate and attained 12 METS (one MET equals the energy equivalent of standing quietly at rest) without any abnormal heart rhythms or ECG changes.  The CI had significant dyspnea at peak exercise.  

The 6 October 2003 MEB NARSUM examination, 5 months prior to separation, noted complaints of moderate exercise intolerance that the CI attributed to his medication (B-blocker).  Physical examination showed mildly elevated blood pressure at 170/60 mmHg with a normal heart rate.  His chest was clear to auscultation and the heart showed regular rate and rhythm, with a grade 2/6 systolic murmur at the apex of the heart (mitral valve location).  There was no evidence of heart failure.  The MEB NARSUM examiner noted that the worsening aortic and mitral valve regurgitation since the immediate post-operative period was concerning and the CI would need to be followed closely.  There was the possibility of his condition worsening and requiring open heart surgery and implantation of a prosthetic heart valve.  

At the 21 January 2004 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported he walked 2 to 3 miles per day.  He denied palpitations, syncope, or chest pain.  Physical examination showed normal blood pressure of 136/77 and regular heart rate.  There was no evidence of congestive heart failure.  The lungs were clear to auscultation.  Heart rate and rhythm were regular.  There was a soft murmur heard at the sternal border.  There were no extra heart sounds.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the aortic insufficiency condition 10%, coded 7000 (valvular heart disease). The PEB cited achievement of 12 METS on exercise testing and the requirement for continuous medication.  The VA based the rating on the C&P examination and also cited the requirement for continuous medication.

The panel noted that following the CI’s aortic valve repair surgery there was evidence of cardiac hypertrophy (heart enlargement) on chest X-ray, TEE, and on the 18 May 2003 ECG.  A repeat TEE on 23 July 2003 showed mild left ventricular enlargement.  A repeat ECG on 29 July 2003 was read as showing non-specific T-wave changes.  However, the MEB NARSUM examiner noted the CI’s heart valve conditions had worsened since the immediate post-operative period.  At the VA examination prior to separation, the examiner cited the same service examinations noted above and new ECG, echocardiogram, or graded exercise tests were not performed.  Members agreed the threshold for a 30% rating was reasonably satisfied on the basis of cardiac hypertrophy noted on echocardiogram and X-ray.  There was no evidence of more than one episode of acute congestive heart failure, chronic congestive heart failure, or active valve infection to support a higher rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the aortic insufficiency condition, coded 7000.  

BOARD FINDINGS:  In the matter of the aortic insufficiency condition, the panel recommends a disability rating of 30%, coded 7000 IAW VASRD §4.104.  There are no other conditions within the panel’s scope of review for consideration.  
The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Aortic Insufficiency	7000	30%	

XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

I accept the recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) to re-characterize your separation as a disability retirement with the combined disability rating of 30% effective the date of your medical separation for disability with severance pay.  Enclosed is a copy of the Board’s recommendation and record of proceedings for your information.

	The re-characterization of your separation as a disability retirement will result in an adjustment to your pay providing retirement pay from the date of your original medical separation minus the amount of severance pay you were previously paid at separation.
 
	The accepted DoD PDBR recommendation has been forwarded to the Army Physical Disability Agency for required correction of records and then to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to your pay and allowances.  These agencies will provide you with official notification by mail as soon as the directed corrections have been made and will provide information on your retirement benefits.  Due to the large number of cases in process, please be advised that it may be several months before you receive notification that the corrections are completed and pay adjusted.  Inquiries concerning your correction of records should be addressed to the U.S. Army Physical Disability Agency, (AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557.

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,		      

Enclosure