RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05845
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090427

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Automated Logistical Specialist, medically separated for “coronary artery disease” with a disability rating of 10%.  

CI CONTENTION:  Review requested of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 - 20090306	VARD - 20090713	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Coronary Artery Disease	7005	10%	Coronary Artery Disease	7005	10%	20090516	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Coronary Artery Disease.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s coronary artery condition began in August 2008 while deployed, and he underwent a stent placement for coronary artery stenosis in September 2008.  The 10 October 2008 echocardiogram demonstrated mild left atrial dilatation but normal left ventricular functioning without evidence of hypertrophy.  A stress test on 17 October 2008 showed a 13.7 METS workload and a clinically and electrically negative exercise stress electrocardiogram study at fair workload.  There was no evidence of myocardial ischemia or infarction. 

The 4 December 2008 MEB NARSUM examination, 5 months prior to separation, showed regular rate and rhythm and normal heart sounds without murmurs.   The examiner listed continued heart medications (nitroglycerin and Plavix).  At the 10 March 2009 cardiology evaluation, 1 month before separation, the CI denied angina pectoris, shortness of breath at rest, dyspnea on exertion, orthopnea, peripheral edema, claudication, palpitations, lightheadedness, dizziness, pre-syncope, coughing, wheezing, or sputum production. He had stopped smoking cigarettes, followed a low salt/low fat/low cholesterol diet, and continued his prescribed medications.  He performed physical training at his own pace and had completed a cardiac rehabilitation program.  Cardiac examination was normal.  

At the 16 May 2009 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported continued cardiac medication and the examiner noted normal cardiac findings.  The 16 June 2009 stress test demonstrated 10.2 METS workload and a left ventricular ejection fraction of greater than 65% with no evidence of cardiac hypertrophy or dilatation.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the coronary artery condition 10%, coded 7005 (arteriosclerotic (coronary) heart disease), citing the requirement for continuous medication.  The VA also rated the coronary artery condition 10%, coded 7005, based on the C&P examination citing, a workload greater than 7 METs but not greater than 10 METs, resulting in dyspnea, fatigue, angina, dizziness or syncope, or continuous medication being required.  There was no evidence of workload not greater than 7 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray for a 30% rating.  After due deliberation, considering all of 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 coronary artery condition.  

BOARD FINDINGS  In the matter of the coronary artery condition and IAW VASRD §4.104, 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.  

ARXXXXXXXXXXX, XXXXXXXXXXXXXXX

Dear XXXXXXXXXXX:

              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.

Sincerely,					      

Enclosure