RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  xxxxxxxxxxxxxxxxxx	CASE:  PD-2017-05153
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20050715

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Heavy Wheeled Vehicle Operator, medically separated for “neurogenic cardiovascular syncope” with a disability rating of 10%.  

CI CONTENTION:  “This was a misunderstanding having to do with a divorce.  I would like to speak with someone about this.”  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 - 20050616	VARD - 20060614	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Neurogenic Cardiovascular Syncope…	8299-8210	10%	Neurogenic Cardiovascular Syncope…	7099-7011	10%	20060216	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Neurogenic Cardiovascular Syncope.  According to the service treatment record and Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neurogenic cardiovascular syncope (passing out/fainting) condition occurred multiple times without any known inciting event or activity.  An extensive neurologic and cardiac work-up was essentially normal, except for a positive table-tilt (vascular response) test.  The 2 June 2005 MEB NARSUM examination, one month prior to separation, documented that the CI had “episodes” at least monthly, sometimes weekly.  His physical examination (PE) was complete and normal.  
At the 16 February 2006 VA Compensation and Pension (C&P) examination, 7 months after separation, the CI reported symptoms of dizziness as often as three times per week.  The PE revealed no significant abnormalities. 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the neurogenic cardiovascular syncope condition 10%, analogously coded 8299-8210 (paralysis of tenth [pneumogastric, vagus] cranial nerve:  incomplete moderate), citing a resultant physical profile that prohibits fitness testing and common soldier tasks.  The VA rated the same condition 10%, analogously coded 7099-7011 (ventricular arrhythmias (sustained), based on the C&P examination, citing the use of continuous medication.  

Panel members first considered and agreed that the finding of a positive table-tilt test was indicative of, and intimately related to, a neuro-vascular response that is directly mediated via the 10th cranial nerve.  Therefore, the condition was best correlated to the PEB’s chosen primary VASRD code of 8210:  incomplete paralysis of either moderate (10%) or severe (30%) impairment.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel members agreed that the frequency, duration, and severity of the CI’s original symptoms were not significantly repetitious, or of worsening pathology, to support a “severe” level of intensity.  Therefore, the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the neurogenic cardiovascular syncope condition.  

BOARD FINDINGS:  In the matter of the neurogenic cardiovascular 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.  

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Dear XXXXXXXXXXXX:

	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.