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AF | PDBR | CY2012 | PD2012 00613
Original file (PD2012 00613.rtf) Auto-classification: Approved
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1200613
BRANCH OF SERVICE: Army  BOARD DATE: 20130402
SEPARATION DATE: 20030522


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (88M20/Truck Driver) medically separated for a heart condition. He began experiencing left sided chest pain with exertion in June 2002 and was diagnosed with aortic insufficiency. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The aortic insufficiency (AS) with chest pain syndrome was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501 and no other conditions were submitted by the MEB. The PEB adjudicated the heart condition as unfitting, rated 10%, with application of the VASRD. The CI made no appeals, and was medically separated with that disability rating.


CI CONTENTION: “I was separated at a rating of 10% for aortic valve.” He also lists all of his VA conditions.


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 cardiac condition is addressed below. The additional VA conditions, alluded to in the application, were not identified by the PEB and are therefore not within the DoDI 6040.44 defined purview of the Board. These, and any condition or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the respective Army Board for Correction of Military Records.


 RATING COMPARISON :

Service IPEB – Dated 20030312
 VA - (4 Mos. Pre -Separation)
Condition
 Code Rating Condition Code Rating Exam
Aortic Insufficiency w/ Chest Pain Syndrome 7000 10% Aortic Insufficiency w/ Chest Pain Syndrome 7000 10%* 20030114
No Additional MEB/PEB Entries
 Other x 0 20030114
Combined: 10%
 Combined: 10%
Derived from VA Rating Decision (VA RD ) dated 200 30623 ( most proximate to date of separation ) .
*VASRD, dated20040317, increased the rating to 100% due to an aortic valve replacement. Later, VARD, dated 20060614, reduced the rating to 10%, effective 20060901. The subsequent 30% and 60% rating increases were based on C&P exams performed in or after 2009.


ANALYSIS SUMMARY:

Aortic Insufficiency Condition. The CI developed chest pain while running and shortness of breath (SOB) in June 2002. A diagnosis of bicuspid aortic valve with AS was rendered. An electrocardiogram (e) performed on 30 July 2002 showed possible left ventricular hypertrophy (LVH). This was followed by other testing including a graduated treadmill stress test, aortogram, an echocardiogram (ECHO), and a trans-esophageal echocardiogram (TEE). On the TEE, 6 August 2002, 9 months prior to separation, there was no left ventricular hypertrophy (LVH); wall thickness of the left ventricle was normal and the ejection fraction (EF) was 69%. The stress test, 23 August 2002, demonstrated excellent exercise tolerance and the CI achieved 13 metabolic equivalents. Aortogram, 26 August 2002, 9 months prior to separation, demonstrated moderate AS without evidence of aortic stenosis. On 7 October 2002, another EKG was performed and demonstrated a possible LVH. An ECHO, 24 October 2002 recorded normal wall thickness and no ventricular hypertrophy with EF of 78%. On 20 November 2002, EKG showed LVH. The CI underwent a second ECHO, 21 November 2002, that recorded normal chambers, but slight increase in the wall thickness of the left ventricle of 1.2 (0.6-1.1) and EF of 65%. The CI continued with chest pain on exertion, which was treated with medication. The CI’s profile allowed him to walk and bike at his own pace. On 22 December 2003, approximately 7 months after separation, an ECHO recorded mild dilatation of the left ventricle, EF of 55-60%, and mild dilatation of the left atrium. On 13 February 2004, approximately 10 months after separation, the CI underwent surgical repair of the heart wall and aortic valve replacement. At the time of the MEB evaluation of 16 December 2002, approximately 5 months prior to separation, the CI had chest pain on exertion and was unable to perform any aerobic conditioning or fitness training without experiencing increasing symptoms. The examiner noted a regular rate and rhythm, and a quiet heart murmur. Lungs were clear to auscultation bilaterally. The VA Compensation and Pension (C&P) exam was performed on 14 January 2003, 5 months prior to separation. Symptoms documented were post-exertional chest pain, SOB after walking short distances and climbing stairs, and dizziness without fainting. The examiner noted a regular rate and rhythm; there was no evidence of congestive heart failure. The lungs were clear without signs of congestion, or airway compromise. The examiner believed the CI’s condition will eventually require aortic valve replacement.

The Board directs attention to its rating recommendation based on the above evidence. The PEB and VA both coded the AS with chronic pain syndrome condition as 7000 (valvular heart disease), rated 10% based on continuous need for medication. A higher rating under this code requires workload not greater than seven metabolic equivalent of tasks (METS), resulting in fatigue, dizziness, syncope, and dyspnea; or evidence of cardiac hypertrophy or dilatation on ECHO, EKG, or x-ray. Although the CI had documented METS of 13, the evidence presented above documented EKG and TEE changes of LVH and dilatation, suggesting mild, but present cardiac deterioration. The Board unanimously agreed at the time of separation the threshold for the higher rating of 30% was met. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was sufficient cause to recommend a change in the PEB adjudication for the AS with chest pain syndrome 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 AS with chest pain syndrome condition, the Board unanimously recommends a disability rating of 30%, coded 7000 IAW VASRD §4.100. There were no other conditions within the Board’s scope of review for consideration.



RECOMMENDATION: The Board recommends that the CI’s prior determination be modified as follows; and, that the discharge with severance pay be recharacterized to reflect permanent disability retirement, effective as of the date of his prior medical separation:

UNFITTING CONDITION
 VASRD CODE RATING
Aortic Insufficiency w/ Chest Pain Syndrome Condition 7000 30%
COMBINED
 30%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120605, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record




         Physical Disability Board of Review


SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD-ZB),


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for AR20130009533 (PD201200613)


1. Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) pertaining to the individual named in the subject line above to recharacterize the individual’s separation as a permanent disability retirement with the combined disability rating of 30% effective the date of the individual’s original medical separation for disability with severance pay.

2. I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum:

         a. Providing a correction to the individual’s separation document showing that the individual was separated by reason of permanent disability retirement effective the date of the original medical separation for disability with severance pay.

         b. Providing orders showing that the individual was retired with permanent disability effective the date of the original medical separation for disability with severance pay.

         c. Adjusting pay and allowances accordingly. Pay and allowance adjustment will account for recoupment of severance pay, and payment of permanent retired pay at 30% effective the date of the original medical separation for disability with severance pay.

         d. Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and medical TRICARE retiree options.

3. I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

BY ORDER OF THE SECRETARY OF THE ARMY:




Encl                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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