RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-05209 BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20050419

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Submarine Nuclear Propulsion Plant Operator-Specialist, medically separated for “postural orthostatic tachycardia syndrome [POTS]” with a disability rating of 10%.

CI CONTENTION: Review requested of lingering effects from a memory impairment and POTS. 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 - 20050107	VARD - 20050818	
Condition	Code	Rating	Condition	Code	Rating	Exam	
POTS	7099-8211	10%	Vasomotor Syncope with Postural Hypertension and Tachycardia	7099-7010	10%	20050405	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

POTS. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s POTS began in 2002 initially manifesting as syncope. Electrocardiogram (EKG) and echocardiogram results were normal, but a heart event monitor recorded mild sinus tachycardia. A tilt-table test showed an increase in heart rate from 64 to a high of 128, but blood pressure remained stable and he did not experience syncope. He was diagnosed with POTS and treatment included increased hydration and salt intake as well as Midodrine (alpha-adrenergic agonist) use, which he ultimately could not tolerate due to side effects. He had no further episodes of syncope on medications, but despite maximum doses of Florinef (steroid), he continued to have pre- syncopal orthostatic symptoms.

The 12 November 2004 MEB NARSUM examination, 5 months prior to separation, noted no syncopal events in the previous year, but the CI reported daily or near daily orthostatic symptoms with 3-4 significant pre-syncopal events. Physical examination showed supine blood pressure of

138/84 and pulse of 72, with no decrease in blood pressure or increase in heart rate after sitting or standing. Heart rate and rhythm were normal.

During the 5 April 2005 VA Compensation and Pension (C&P) examination, 2 weeks before separation, the CI reported lightheadedness, dizziness and near syncope with an increased heart rate on rising from a sitting to a standing position. Physical examination showed blood pressure of 130/80 in the recumbent condition with no significant change on standing. Heart rate and rhythm were normal. At the C&P neurology examination on the same day, the CI stated that he had no more fainting since taking Florinef, but still continue to get dizzy when he stood up.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the POTS 10%, analogously coded 7099-8211 (paralysis of eleventh (spinal accessory, external branch) cranial nerve). The panel determined this code included a typographical error, since 8210 (paralysis of the vagus nerve) is a common analogous code for syncope (not otherwise specified or vasovagal). The original VA Rating Decision also rated the POTS 10%, but analogously coded 7099-7010 (supraventricular arrhythmias), based on the C&P general examination, citing continuing tachycardia episodes confirmed by EKG and evidence of hypotension. Panel members agreed that a 10% rating, but no higher, was supported under analogous code 7099-7010 IAW VASRD §4.104 (schedule of ratings-cardiovascular system), for 1-4 episodes per year of a supraventricular tachycardia, documented by electrocardiogram or Holter monitor (over a day or a month) which was proximate to separation. A 10% rating was alternatively supported by analogous code 8299-8210 for syncope, as the CI’s condition showed moderate, incomplete paralysis IAW VASRD §4.124a. 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 POTS.

BOARD FINDINGS: In the matter of the postural orthostatic tachycardia syndrome 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.

The following documentary evidence was considered:

2	PD-2017-05209

DEPARTMENT OF THE NAVY
SECRETARY OF TIIE 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 Sep20

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.