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AF | PDBR | CY2012 | PD2012 00757
Original file (PD2012 00757.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD1200757
BRANCH OF SERVICE: Army  BOARD DATE: 20140225
SEPARATION DATE: 20011030


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a mobilized National Guard SSG/E-6 (52D/Generator Operator) medically separated for coronary artery disease (CAD). The CI underwent triple bypass surgery in May 2000, and was mobilized in December 2000. During a physical therapy (PT) test he developed chest pain and was admitted to Winn Army and then Eisenhower Medical Center for further testing and evaluation. The heart condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The heart condition, characterized as “coronary artery disease, EPTS”, was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB adjudicated “coronary artery disease” as unfitting, rated 10%, with application of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: The CI writes: “Failed the PT test because of chest pain while doing sit-up repetitions for a physical training test.”


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 CAD 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 20010802
 VA - (5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Coronary Artery Disease 7005 10% Coronary Artery Disease, s/p Coronary Artery Bypass Graft 7005 NSC 20020322
No Additional MEB/PEB Entries
 Other x 4 20020322
Combined: 10%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 200 20722 ( most proximate to date of separation [ DOS ] ) .


ANALYSIS SUMMARY:

Coronary artery disease (CAD). The CI had a long history of angina pectoris. In May 2000, he underwent a 3 vessel coronary artery bypass graft. Following surgery, he did reasonably well for several months. On 23 January 2001, the CI was having chest pain and went to the Emergency Room (ER) at Fort Stewart. Creatine kinase and Troponin I were both normal, indicating no infarction of the cardiac muscle. Chest X-ray showed mild cardiomegaly (heart enlargement), but no other active disease. He was given Naprosyn and told to follow-up with primary care the next day.

On 6 April 2001, he had onset of non-exertional pressure-type chest pain, associated with diaphoresis (sweating) and shortness of breath. He went to the ER and was admitted to the hospital. Tests showed no evidence of myocardial infarction. He was then referred to cardiology at Eisenhower Army Medical Center, Fort Gordon. Cardiac catheterization revealed that all three coronary artery bypass grafts were patent. Left ventricular wall motion was normal, and the ejection fraction was estimated at 55-65%. A treadmill stress test (TST) on 10 April 2001 showed maximum workload of 9 metabolic equivalents of tasks (METS). The test was stopped due to chest pain and the electrocardiogram tracing was positive for ischemic changes. Because of his significant CAD an MEB was initiated. The MEB physical exam (PE) was performed in June 2001. At that exam, PE of the heart and lungs was normal. The CI was separated from service on 30 October 2001. Five months later, he had a VA Compensation and Pension exam. At that exam, PE of the heart and lungs was normal. Chest X-ray once again showed mild cardiomegaly. On 24 April 2002, TST revealed maximum workload of 7 METS. The test was stopped due to chest pain.

The Army PEB and the VA both used diagnostic code 7005 for the CAD condition. The PEB assigned a disability rating of 10%, while the VA denied service-connection for CAD. For the reader’s convenience, the VASRD §4.104 language for diagnostic code 7005 (CAD) is excerpted below:

Workload of greater than 5 METs but not greater than 7 METs results in
dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac
 hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray ....... . . 3 0

Workload of greater than 7 METs but not greater than 10 METs results in
dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication
 required…………….. ………………………………………………………………................................ . . 1 0

The Board carefully reviewed all evidentiary information available and directs attention to its rating recommendation. The Board deliberated at length with regard to the appropriate disposition of this case. After considerable discussion, the Board determined that the condition appeared to have been EPTS and that the record did not show sufficient evidence of permanent service-aggravation. However, IAW DoDI 6040.44, the Board may not lower the disability rating assigned by the PEB. Therefore, after due deliberation, consideration of all of the evidence, and mindful of VASRD §4.3 (reasonable doubt), the Board recommends by majority decision (2:1 vote) a disability rating of 10%.


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 CAD condition, the Board recommends by majority decision (2:1 vote) a disability rating of 10%, coded 7005 IAW VASRD §4.104. The single voter for dissent did not elect to submit a minority opinion. 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
Coronary Artery Disease (CAD) 7005 10%
COMBINED 10%


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








                                   
XXXXXXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review


 SFMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXX , AR20140012283 (PD201200757)

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                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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