RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:	CASE: PD-2017-05867
BRANCH OF SERVICE:  ARMY	SEPARATION DATE: 20061016

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, M1 Armor Crewman, medically separated for “bicuspid aortic valve…non-cardiac chest pain” with a disability rating of 0%.

CI CONTENTION: “Heart condition has remained the same or gotten worse. Previously condition of anxiety has been changed to PTSD.” 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 - 20060914	VARD - 20070123	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bicuspid Aortic Valve…Non-Cardiac Chest Pain	7000	0%	Bicuspid Aortic Valve with Aortic Regurgitation…	7000	10%	STR	
Anxiety Disorder	Not Unfitting	Anxiety Disorder, Not
Otherwise Specified	9413	10%	STR	
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Bicuspid Aortic Valve…Non-Cardiac Chest Pain. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s heart condition began in August 2004 when he experienced tachycardia, dehydration and hypertension after a fitness test run. While the tachycardia persisted with medications, his blood pressure improved. He deployed to Iraq in January 2005 and awoke one night with severe chest pains. An echocardiogram showed a bicuspid aortic valve (congenital condition), but normal heart size was normal and an unremarkable chest X-ray. He was medically evacuated and further tests revealed mild aortic regurgitation with the bicuspid aortic valve but no other pathology. Stress testing on 26 July 2005 showed 13.4 METS with normal exercise tolerance, but testing was stopped due to shortness of breath (SOB). Psychological evaluation showed anxiety, but the CI was determined to be fit for duty from August 2005-January 2006. After redeployment, a new echocardiogram showed hypertensive heart disease and a bicuspid aortic valve with recommendation for endocarditis

prophylaxis; there was also a round extra cardiac structure which appeared to be compressing the right atrium (considered mild).

The 4 August 2006 MEB NARSUM examination, 2 months prior to separation, noted complaints of intermittent chest pain, with palpitations and SOB with activity. Running caused symptoms, and if agitated, the CI had chest pain. He was limited in daily and strenuous activities due to continued tachycardia and dyspnea, and required medications for symptomatic control. Physical findings referenced from 28 June 2006, showed an early systolic click with grade 1/6 diastolic murmur over the aorta. An EKG was normal, and medications included Metoprolol (chest pain, hypertension). A stress test on 29 August 2006 showed 10.9 METS. There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the heart condition 0%, coded 7000 (valvular heart disease), citing workload of 13.4 METs as well as atypical, non-cardiac chest pain and dyspnea. The VA rated the heart condition 10%, coded 7000, based on the STR, citing workload greater than 7 METs but not greater than 10 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or required continuous medication. The NARSUM examiner noted the CI required medications for symptomatic control, and panel members thus agreed that criteria were met for a 10% disability rating. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the heart condition, coded 7000.

Contended PEB Condition: Anxiety Disorder. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. The contended condition was profiled with a designator of “2” indicated that some activity limitations; however the anxiety disorder was not implicated in the commander’s statement, and did not fail retention standards. There was no performance-based evidence from the record that the condition significantly interfered with satisfactory duty performance at separation. After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS: In the matter of the bicuspid aortic valve condition, the panel recommends a disability rating of 10%, coded 7000 IAW VASRD §4.100. In the matter of the contended anxiety disorder, the panel recommends no change from the PEB determinations as not unfitting. 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, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Bicuspid Aortic Valve	7100	10%	

The following documentary evidence was considered:

AR20200004366,

DEPARTMENT OF THE ARMY
ARMY REVIEW BOARDS AGENCY 251 18TH STREET SOUTH, SUITE 385
ARLINGTON, VA 22202-3531

Dear

The Department of Defense Physical Disability Board of Review (DoD PDBR)
reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability. I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation. This will not result in any change to your separation document or the amount of severance pay. A copy of this decision will be filed with your Physical Evaluation Board records. I regret that the facts of the case did not provide you with the outcome you may have desired.

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.

A copy of this decision has also been provided to the Department of Veterans Affairs.

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