RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

 

NAME: XXXXXXXXXXXXXXXX CASE: PD1200427 

BRANCH OF SERVICE: ARMY BOARD DATE: 20130418 

SEPARATION DATE: 20060126 

 

 

SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this 
covered individual (CI) was an activated National Guard SSG/E-6 (31B30/Military Police [MP]) 
medically separated for a heart condition. He has a history of symptomatic bradycardia and in 
October 2004 underwent an uncomplicated placement of a permanent pacemaker. The 
condition could not be adequately rehabilitated to meet the deployable requirements of his 
Military Occupational Specialty (MOS). He was issued a permanent P2 profile and referred for a 
Medical Evaluation Board (MEB). The heart condition, characterized as “AV Block 2nd degree, 
stable with pacemaker” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501 
and no other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated the 
heart condition as unfitting, rated 10% with application of the Veteran’s Administration 
Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated 
with a 10% disability rating. 

 

 

CI CONTENTION: The CI makes no contentions. 

 

 

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 rating for the unfitting heart condition is 
addressed below; and, 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 Board for 
Correction of Military Records. 

 

 

RATING COMPARISON: 

 

Service IPEB – Dated 20051209 

VA - (6 Mos. Pre -Separation) 

Condition 

Code 

Rating 

Condition 

Code 

Rating 

Exam 

AV Block, 2nd Degree 
Pacemaker 

7015 

10% 

Mobits Type II Heart Block S/P 
Pacemaker Placement 

7015 

60% 

20050727 

No Additional MEB/PEB Entries 

Other x 4 

20050727 

Combined: 10% 

Combined: 70% 



Derived from VA Rating Decision (VARD) dated 20061222 (most proximate to date of separation [DOS]). 

 

 

ANALYSIS SUMMARY: 

 

Heart Condition. The narrative summary (NARSUM) notes that following placement of the 
pacemaker in October 2004, the CI did well both postoperatively and for the remainder of the 
year leading up to the MEB. He was without complaints or problems during that period and 


was considered to have been doing well at routine follow up exams. His condition was 
considered stable and it was not expected to interfere with his ability to function in general and 
specifically with his ability to run, perform push-ups or sit-ups. It was recommended that he 
not be deployed to OCONUS because of the potential need for timely maintenance of the 
pacemaker. The commander’s statement citing the stresses of his job as a squad leader in an 
MP platoon, felt that he was not medically fit to perform the duties required of his MOS. At the 
MEB cardiology exam about a month prior to separation, the CI reported no cardiac complaints. 
Treadmill stress test revealed a maximum workload of 12.8 metabolic equivalent of tasks 
(METS) and was discontinued because of fatigue. Electrocardiogram (ECG) was non-diagnostic. 
X-ray study done as part of the MEB physical demonstrated optimal appearance and positioning 
of the pacemaker leads and tips. 

 

At the VA Compensation and Pension (C&P) exam performed 6 months prior to separation, the 
CI reported that pacemaker placement had improved his symptoms and that he could perform 
functions that would not make him very tired. His METS level was determined to be “about 
four to five” as reported on 27 July 2005. However, it is noted that a treadmill test dated 
28 July 2005 by a civilian consultant revealed a measured maximum workload of 10 METS. 
Although left ventricular hypertrophy (LVH) was noted in stress testing in this exam, that finding 
was not replicated in the cardiology addendum to the MEB or in subsequent exams. 
Echocardiogram (ECHO) performed 3 months after separation showed no LVH and an ejection 
fraction of 55-60. 

 

The CI was seen for chest pain 12 months after separation and underwent cardiac 
catheterization (normal coronary arteries). Additionally, a myocardial perfusion scan 
performed 12 months after separation demonstrated a large, mildly severe, septal wall defect 
and ejection fraction was calculated at 47% with normal left ventricle size. The CI was 
diagnosed with “atypical chest pain and cardiomyopathy now symptom free ...” An ECHO 
performed 14 months after separation documented no LVH, normal wall motion and a normal 
ejection fraction of 60%. Subsequent VA exams were noted and subsequent VA ratings of 60% 
were based on decreased ejection fraction “of 30 to 50 percent.” 

 

The Board directs attention to its rating recommendation based on the above evidence. The 
only applicable code is VASRD 7015 (atrioventricular block) assigned by both the PEB and VA. 
The Board first considered the PEB’s rating of the disability at 10%. In doing so, the PEB cited 
the cardiologist’s note, a month prior to separation, wherein it was stated that the CI was 
asymptomatic and that he was able to achieve 12.8 METS on exercise testing. The PEB 
determined that the condition merited a 10% rating because of the requirement of the 
pacemaker. The VA, however, based its initial rating on a C&P exam done in July 2005, about 5 
months prior to separation, in which the CI’s METS level was stated as “about four to five.” It 
awarded a 60% rating under 7015 for which the condition would qualify with a METS score of 
between 3 and 5. It is obvious that there is a clear disparity between these examinations, with 
very significant implications regarding the Board's rating recommendation. The Board thus 
carefully deliberated its probative value assignment to these conflicting evaluations, and 
carefully reviewed the service file for corroborating evidence in the 12-month period prior to 
separation. Subsequent VA ratings of 60% were based on decreased ejection fraction, which 
was not present at the time of separation. The decline in ejection fraction noted at a year post-
separation was adjudged post-separation worsening. The Board concluded that the evaluation 
done by the cardiologist as part of the MEB exam, a month prior to separation, was the most 
probative both because it was a specialist examination using measurements obtained through 
treadmill stress testing and also because it was the exam most proximate to the date of 
separation. In addition, further support is given to the PEB rating by the results of the civilian 


consultant mentioned above whose METS determination of 10 was more closely aligned with 
that of the cardiologist done a few months later. There did not appear to be any objective data 
in evidence proximate to the date of separation which indicated functioning at a lower level or 
evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray 
that would justify a higher 30% rating; or an ejection fraction of 30 to 50 percent for a higher 
60% rating under 7015. 

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 second degree atrioventricular block condition/pacemaker condition. 
The Board concluded therefore that this condition could not be recommended for additional 
disability rating. 

 

 

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 second degree AV Block 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 

AV Block, 2nd Degree Pacemaker 

7015 

10% 

COMBINED 

10% 



 

 

The following documentary evidence was considered: 

 

Exhibit A. DD Form 294, dated 20120530, w/atchs 

Exhibit B. Service Treatment Record 

Exhibit C. Department of Veterans’ Affairs Treatment Record 

 

 

 

 

 xxxxxxxxxxxxxxxxxxxxxxx, DAF 

 Director of Operations 

 Physical Disability Board of Review 

 


SFMR-RB 


 

 

MEMORANDUM FOR Commander, US Army Physical Disability Agency 

(TAPD-ZB / xxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 

 

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for 
xxxxxxxxxxxxxxxxxxxxxxxxxx, AR20130009624 (PD201200427) 

 

 

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD 
PDBR) recommendation and record of proceedings pertaining to the subject individual. Under 
the authority of Title 10, United States Code, section 1554a, I accept the Board’s 
recommendation and hereby deny the individual’s application. 

This decision is final. The individual concerned, counsel (if any), and any Members of Congress 
who have shown interest in this application have been notified of this decision by mail. 

 

 BY ORDER OF THE SECRETARY OF THE ARMY: 

 

 

 

 

Encl xxxxxxxxxxxxxxxxxxx 

 Deputy Assistant Secretary 

 (Army Review Boards)