RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX		CASE: PD-2017-06078 BRANCH OF SERVICE: ARMY	SEPARATION DATE: 20091227

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Unit Supply Specialist, medically separated for “recurrent syncope from heat and exertional intolerance” with a disability rating of 10%.

CI CONTENTION:  “My condition has not improved.”  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 - 20090910	VARD - 20100204	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Recurrent Syncope From Heat and Exertional Intolerance	8999-8911	10%	Vasovagal Syncope	7199-7112	0%	20091102	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Recurrent Syncope from Heat and Exertional Intolerance. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s recurrent syncope condition began in March 2008 after fainting while standing in formation during basic training. She also had two fainting episodes during weapons training and one during the run portion of the physical fitness test. She had three more fainting spells while standing in formation during advanced training. These episodes began with a rapid heartbeat, lightheadedness and dyspnea (shortness of breath) with heat sensation over the top part of the chest and loss of consciousness for about one minute. All fainting spells occurred in 2008 during the heat of the day. Pulmonary, ear nose and

throat, neurology and endocrinology examinations were unremarkable. There was no evidence of seizure activity or post-ictal confusion. Cardiology evaluation showed mild pulmonary pressure elevation on her echo and poor exercise tolerance. A brain MRI, pulmonary and orthopedic imaging were normal. During the 22 July 2009 MEB NARSUM examination, 5 months prior to separation, the CI reported recurrent syncope with heat intolerance. The CI believed the fainting episodes were associated with wearing Army clothing during high temperatures. Physical examination was normal. At the 2 November 2009 VA Compensation and Pension (C&P) examination, 2 months before separation, the CI reported the last syncope episode occurred in 2008.  Physical examination was within normal limits.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the syncope condition 10%, analogously coded 8999-8911 (petit mal, epilepsy), citing a confirmed diagnosis of recurrent syncope. The VA rated the syncope condition 0%, analogously coded 7199-7112 (asymptomatic aneurysm), based on the C&P examination, citing a noncompensable examination without evidence of a symptomatic aneurysm of a small artery. The panel determined the CI’s recurrent syncope (fainting spells) most closely clinically matched the epilepsy petit mal rating criterion (8911). The CI reportedly had brief and sudden lapses in attention, although she did report losing consciousness for 1 minute, she did not experience violent muscle contractions indicative of grand mal seizures (8910).

Under the General Rating Formula for Major and Minor Epileptic Seizures, a 20% rating requires, “At least 1 major seizure in the last 2 years; or at least 2 minor seizures in the last 6 months.” A 10% rating entails, “A confirmed diagnosis of epilepsy with a history of seizures.” Panel members agreed the MEB NARSUM reported the CI experiencing seven heat-related fainting spells (recurrent syncope) in 2008. The C&P examination documented the CI’s last episode occurring in 2008. Consequently, there were no recent fainting spells to support a 20% rating; however, the recurrent scope diagnosis does support an analogous 10% rating as described above. The panel also noted that the CI’s brain and pulmonary imaging were negative, and ear nose and throat, neurology and endocrinology examinations were unremarkable. This imagining and testing does not support ratings under codes: 6204 (peripheral vestibular disorder), 8210 (paralysis of the tenth (pneumogastric, valgus) cranial nerve), or analogously 7112 (asymptomatic aneurysm). 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 condition.

BOARD FINDINGS: In the matter of the syncope condition and IAW VASRD §4.20, 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:

PD-2017-06078 

AR20190009727, XXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXX

	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.

Enclosure

PD-2017-06078