RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-05667
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060523

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Dental Assistant Journeyman, medically separated for “syncope/presyncope” with disability rating of 0%.  

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’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 - 20060410	VARD - 20070412	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Syncope/Pre-syncope associated with Hypoglycemia, not Cardiogenic	8299-8210	0%	Pre-syncope (Episodic dizzy Spells) (Claimed Hypoglycemia)	6299-6204	10%	20070319	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  20% 	

ANALYSIS SUMMARY:  

Syncope/Pre-syncope associated with Hypoglycemia, not Cardiogenic.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s syncope/pre-syncope (fainting) symptoms began in May 2005 without an inciting incident.  Symptoms occurred at rest or with activity.  Originally thought to be due to hypoglycemia (low blood sugar), a recommendation to increase the frequency of meals did lesson her symptoms but without complete resolution.  An extensive neurologic and cardiac work-up to include a table-tilt (vascular response) test was normal.  
The 13 March 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of light-headedness with near-syncope but only one episode of actual loss of consciousness in last 9 months.  She endorsed having two episodes of dizziness per day with a duration of 30 seconds.  Additionally, she has the onset of dizziness with deep breathing.  Her general physical examination was normal.  Her diagnosis remained as pre-syncope.  At the 19 March 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported symptomatic dizziness episodes occurring once or twice a week.  Her physical examination was detailed and normal.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the syncope/pre-syncope condition 0%, analogously coded 8299-8210 (tenth [vagus] cranial nerve; paralysis), citing no specific reasoning.  The VA rated the syncope/pre-syncope condition 10%, analogously coded 6299-6204 (peripheral vestibular disorders), based on the C&P examination, citing occasional dizziness.  

VASRD Guidelines state that for the condition of syncope (when it is not differentiated between NOS [not otherwise specified] or Vasovagal), it should be analogized to code 8108 (narcolepsy) and rated as for “petit mal epilepsy” which further refers rating under the general formula for rating minor seizure.  This case met such differential criteria.  The minimal positive rating under this category is for a “confirmed diagnosis of epilepsy with a history of seizures.”  Such criteria was not supported in this case.  Therefore, 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/pre-syncope condition.  

BOARD FINDINGS:  In the matter of the syncope/pre-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.

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05667.

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 re-characterization or modification 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 re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.