Author: JOHN J. D'ORAZIO
Last saved by: ADA, ROBERT P CIV USAF SAF/MRBD
Company: Pre-installed Company

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	 CASE:  PD 13-01346	
BRANCH OF SERVICE:  AIR FORCE	 BOARD DATE:  20140115
Date of Permanent SEPARATION:  20040909	

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-5 (8R000/Recruiter) medically separated for atrial fibrillation (A-fib).  He began having intermittent A-fib with exercise in 2001 and underwent radiofrequency oblation in 2004, which was unsuccessful in eliminating the atrial fibrillation.  The heart condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards.  He was issued a permanent P4U2L2 profile and referred for a Medical Evaluation Board (MEB).  The A-fib condition, characterized as “atrial fibrillation refractory to radiofrequency catheter oblation…possibly exercise induced” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123; no other conditions were submitted by the MEB.  The informal PEB adjudicated the A-fib condition as unfitting, rated 10%, referencing the Department of Defense Instruction (DoDI) 1332.39 and Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated. 

CI CONTENTION:  “I was discharged out of the United States Air Force because of Paroxysmal atrial fibrillation in which I underwent a catheter ablation.  I am on medication for the remainder of my live to continue a normal sinus rhythm.  I have been in atrial fibrillation several times since the catheter ablation and a recommendation has been made for a second surgery.  This is a problem that I will continue to have for the duration of my life.  At the time of the separation from the United States Air Force I was at a location with no military installation for me to find out what rights I had.  When researching my condition of Paroxysmal atrial fibrillation other service members have received a 30% rating for the same condition and a medical retirement.  I was discharged with a 0% rating for Paroxysmal atrial fibrillation with no retirement benefits. Please see fit to increase this rating and grant me a medical retirement as opposed to a discharge.”

SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The Service rating for the unfitting atrial fibrillation condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the USAF Board for Correction of Military Records (BCMR).

RATING COMPARISON:  
   
Service IPEB – Dated 20040723 | VA - (2 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Atrial Fibrillation | 7010 | 10% | Paroxysmal Atrial Fibrillation | 7010 | 0% | 20041030
No Additional MEB/PEB Entries | Other x 4 | 20041030
Combined:  10% | Combined:  40%
Derived from VA Rating Decision (VARD) dated 20050203 (most proximate to date of separation [DOS]).   

ANALYSIS SUMMARY:  

Atrial Fibrillation Condition. The CI was first diagnosed with A-fib after an electrocardiogram (ECG) on 12 July 2001.  He reported prior episodes of chest pain, but the A-fib had not previously been documented.  He was admitted overnight for observation and then released for an evaluation as an outpatient.  An echocardiogram (ECHO) was normal as was a thyroid (TSH) test.  On 20 February 2002, another ECG revealed A-fib.  A stress ECHO on 23 February 2004 was also normal.  He was evaluated in electrophysiology on 11 March 2004.  The CI reported that he had paroxysms of A-fib 2-3 times a month for the past four years lasting up to six hours, but had never required cardioversion.  He denied chest pain or shortness of breath with these episodes and no precipitating factors were identified.  Two weeks prior to this evaluation, he reported a syncopal episode in association with the A-fib.  An ECG that day was normal other than early repolarization.  He was diagnosed with lone atrial fibrillation.  Two weeks later, he was again seen by the electrophysiologist and reported increased episodes.  Ablation was then scheduled.  On 29 April 2004, he underwent electrophysiology studies and an attempted ablation.  He was in normal sinus rhythm at baseline.  Multiple attempts to induce either an atrial or ventricular dysrhythmia were unsuccessful.  The ablation was thought to be successful at the time of the procedure.  He was begun on an anti-arrhythmic that day.  Shortly thereafter, he had recurrent A-fib, but it was not clear at the 13 May 2004 follow up if this represented treatment failure or not.  He reported exertional shortness of breath which had increased since the surgery and also reported working 14-16 hours a day in the military.  Subsequently, it was recommended that he not participate in physical training.  His work week was limited to 25 hours a week and caffeine was eliminated from his diet.  A repeat ECHO on 24 May 2004 was essentially normal.  He was then referred to MEB for refractory A-fib.  The narrative summary (NARSUM) was dictated on 10 June 2004.  The CI reported that he had had A-fib 4-5 times since the attempted ablation.  On examination, his cardiac examination was normal.  He was thought to not be deployable due to the possibility of recurrent A-fib in a heavy exertion deployed environment.  At the VA Compensation and Pension (C&P) examination performed two months after separation, the CI reported that he was symptomatic 1-2 times a week for five minutes or less on medications as opposed to 2-3 times a week with palpitations lasting for hours.  His cardiac examination was again normal including rate and rhythm.  The CI declined an ECG.  The Board directed attention to its rating recommendation based on the above evidence.  The PEB and VA both coded the condition as 7010, supraventricular dysrhythmia, but rated it 10% and 0%, respectively.  The Board considered the evidence.  While the CI reported frequent episodes of symptoms, only a few episodes of A-fib are actually documented in the records in evidence.  The VA determined that the condition was non-compensable due to the lack of monitored A-fib.  The cardiac evaluations by both the MEB and VA examiners were normal and no abnormal rhythm was noted.  The Board considered if a higher, 30% rating was supported.  The difference between a 10% and 30% record is that the latter requires documentation by ECG or Holter monitor (a continuous ECG) of A-fib of five or more times a year. The record does not show over four documented episodes in evidence over the final two years of active duty although several are referenced in clinical notes.  The Board also noted that the CI was diagnosed by the electro-physiologist with lone A-fib which corresponds to a 10% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the A-fib condition.  

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised.  In the matter of the A-fib condition and IAW VASRD §4.104, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration. 

RECOMMENDATION:  The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:  

UNFITTING CONDITION | VASRD CODE | RATING
Atrial Fibrillation | 7010 | 10%
COMBINED | 10%

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130910, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			
	           				 	XXXXXXXXXX, DAF
President 
Physical Disability Board of Review

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 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2013-01346.

	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.

							Sincerely,

XXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

PD 13-01346