RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05268
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20070815

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Pavements and Construction Equipment Operator, medically separated for “supraventricular tachycardia” and “obstructive sleep apnea [OSA],” rated 10% and 0%, respectively, with a combined disability rating of 10%.  

CI CONTENTION:  No specific contention was made.  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 - 20070626	VARD - 20080618	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Supraventricular Tachycardia	7010	10%	Supraventricular Tachycardia	7010	0%	20071113	
OSA Requiring Use of CPAP	6847	0%	Sleep Apnea	6847	50%	20071113	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Supraventricular Tachycardia (SVT).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s heart condition began in February 2006 with atypical chest pain.  Holter monitor documented SVT and cardiac work-up revealed atypical chest pain on stress testing.  The CI had continued palpitations and pre-syncopal episodes, without further documentation of SVT, and cardiac ablation was not recommended.  The 30 April 2007 MEB NARSUM examination, 4 months prior to separation, noted a history of SVT, with continued intermittent symptoms (palpitations and pre-syncopal episodes) and no cardiac medication use.  Physical examination showed normal cardiac findings.  At the 13 November 2007 VA Compensation and Pension (C&P) examination, 3 months after separation, the CI reported episodes of SVT symptoms brought on by startle response or exertion and lasting 4-5 hours.  The examiner found a normal cardiac examination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the heart condition 10%, coded 7010 (supraventricular arrhythmias), citing:  “Although you have persistent episodes of palpitations, the Board notes only one episode of SVT documented by ECG or Holter monitor.  The VA rated the heart condition 0%, coded 7010, based on the C&P examination, citing an absence of evidence that showed frequency of symptoms and permanent atrial fibrillation or one to four episodes per year of SVT documented by ECG or Holter monitor.  The panel agreed that the evidence supported only one Holter monitor-documented episode, which supported the 10% rating under code 7010.  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 heart condition.  

OSA.  According to the STR and MEB NARSUM, the CI’s sleep apnea was first diagnosed in March 2006 and he was prescribed and used a continuous airway pressure (CPAP) machine.  The MEB NARSUM examination noted improved sleep and decreased daytime fatigue or sleepiness with use of CPAP.  Physical examination was non-contributory.  At the VA C&P examination the CI reported use of CPAP with good control of OSA symptoms such as excessive daytime sleepiness, snoring, nighttime apneic episodes, and poor sleep.  The examiner found a normal pulmonary examination.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the OSA 0%, coded 6847 (sleep apnea syndromes), citing “mild industrial impairment” with likely application of DoDI 1332.39 rating guidance (in effect at the time), which differed from VASRD rating criteria.  The VA rated the OSA 50%, coded 6847, based on the STR and C&P examination, citing “the requirement for a breathing device.”  The provisions of VASRD §4.97 provides for a minimum rating of 50% for OSA requiring a breathing assistance device, and the evidence establishes that this criterion was met in this case.  There was no evidence of chronic respiratory failure with carbon dioxide retention, cor pulmonale or the requirement for a tracheostomy to support the next higher 100% rating.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 50% for the OSA, coded 6847.  

BOARD FINDINGS:  In the matter of the heart condition and IAW VASRD §4.104, the panel recommends no change in the PEB adjudication.  In the matter of the OSA, the panel recommends a disability rating of 50%, coded 6847, IAW VASRD §4.97.  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	
Supraventricular Tachycardia	7010	10%	
Obstructive Sleep Apnea	6847	50%	
COMBINED	60%	

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05268.

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 not in accordance with the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay.

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept the recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 90 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married, in such a case, failure to render an election will result in automatic enrollment by law.