RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXXXXXXXXXXXXX	CASE: PD-2020-00199
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20061221

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Culinary Specialist, medically separated for “presyncope,” with a disability rating of 0%.

CI CONTENTION: Review requested of her heart condition and migraines issues. She also requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and/or 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 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 - 20060922	VARD - 20070926	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Presyncope	8299-8210	0%	Paroxysmal Supra Ventricular Tachycardia	7099-7010	10%	
20070522	
Premature Ventricular Contractions	Cat II					
Migraines	Cat III	Migraine Headaches with
Syncope	8100	10%		
COMBINED RATING: 0%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Presyncope. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s fainting condition began in March 2005 with an unknown etiology. Her evaluations were all normal and included echocardiograms (regular and stress), an electrophysiology study, tilt table test, and brain MRI and electroencephalogram.

At the 6 August 2006 MEB NARSUM examination, 4 months prior to separation, the CI complained of recurrent episodes of syncope and presyncope as well as pounding palpitations that were irregular with groups of four strong beats. She did not have shortness of breath on exertion. After taking medication, she had no further syncope episodes, but continued to experience presyncope symptoms, which she was able to abort by changing position. The CI reportedly had two episodes of syncope in the previous 8 months--one in December 2005 and

Controlled by: SAF/MRB
CUI Categories: SP-MIL/SP-PRVCY Limited Dissemination Control: N/A POC: SAF.MRB.Workflow@us.af.mil

CUI//SP-PRVCY

the second in May 2006. The examiner noted the previous normal electrophysiology study with no inducible supraventricular or ventricular tachycardia. The study concluded that the CI’s palpitations were secondary to premature ventricular contractions (PVCs). The EKG was also normal. The examiner referenced physical examination findings from 28 June 2006, 6 months prior to separation, which showed lungs clear to auscultation, regular heart rhythm and rate, and with no murmurs or abnormal sounds. Vascularity was normal. During the 30 August 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), the CI responded “yes” to complaints of heart trouble, palpitations, and changes in blood pressure. She also reported migraine headaches. Physical examination was unremarkable.

At the 22 May 2007 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported palpitations twice a day, which occurred while in the lying position and lasted less than a minute. She denied chest pain, shortness of breath, fatigue or dizziness, and unexpected syncope episodes. She occasionally experienced fainting episodes, but only with severe headaches and not cardiac arrhythmia; she also had continued taking anti-arrhythmic medication. Physical findings showed normal blood pressure and heart rate, no murmurs, and normal sinus rhythm.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the presyncope 0%, analogously coded 8299-8210 (vagus cranial nerve), and listed the PVCs as a related Category II condition that contributed to the disability in this case. The panel agreed that the PVC was a diagnosis related to the presyncope, and was not a separate condition which could be separately rated IAW §4.14 (avoidance of pyramiding; more than one rating based on the same impairment is prohibited). The VA rated the paroxysmal supraventricular tachycardia 0%, coded 7010 (supraventricular arrhythmias), based on the C&P examination, citing absence of permanent atrial fibrillation; or “one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor.”

A compensable rating of 10% under code 8210 is warranted when “sensory and motor loss to organs of voice, respiration, pharynx, stomach and heart causes a moderate degree of impairment.” In this case, the CI had presyncope events which were diagnosed as likely vasovagal in origin and successfully treated with medication. Additionally, she was able to abort presyncope episodes by changing position. At the time of the NARSUM, the CI was doing fairly well with only two episodes of syncope in the previous 8 months. The C&P examination documented the absence of syncope or presyncope events related to any heart condition. Panel members agreed the presyncope episodes did not reach the moderate impairment threshold for a 10% rating. The panel also considered code 7010, but was unable to justify a 10% rating due to a normal ECG. There were no additional codes applicable to the rating of this condition. 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 presyncope.

Contended PEB Condition: Migraine. The panel’s main charge is to assess the fairness of the PEB determination that the contended migraine was not unfitting. The contended condition was not noted on limited duty forms or the non-medical assessment, 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 presyncope and IAW VASRD §4.124a, the panel recommends no change in the PEB adjudication. In the matter of the migraine condition, the

panel recommends no change from the PEB determination as not unfitting. 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:

Exhibit A. DD Form 294, dated 20201207, w/atchs Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Record

4/11/2

THE ASSISTANT SECRETARY OF THE NAVY
(MANPOWER AND RESERVE AFFAIRS) 1000 NAVY PENTAGON
WASHINGTON, D. C. 203S0-1000

6040
Memo 00/01

MEMORANDUM FOR COMMANDER, NAVY PERSONNEL COMMAND
Subj:	 PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS Ref:	(a) DODI 6040.44
(b)	PDBR ltr dtd 9 Jun 21 ICO 
(c)	PDBR ltr dtd 11 Apr 22 ICO
1.	Pursuant to references (b) and (c), the recommendation of the Physical Disability Board of Review set forth in references (b) and (c) are approved. The official record of the following individuals are to be corrected as follows:
a.	XXXXXXXXXXXXXXX former USN: No Change.

2.	Please take action to implement these decisions and provide notification to the above individuals once those actions are complete.