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AF | PDBR | CY2012 | PD2012 01663
Original file (PD2012 01663.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:    CASE: PD1201663
BRANCH OF SERVICE: Army  BOARD DATE: 20130425
SEPARATION DATE: 20040206


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated Reserve (temporary tour of active duty) SGT/E-5 (71L/Administrative Specialist) medically separated for dilated cardiomyopathy (DCM). The CI had a history of peripartum cardiomyopathy (PPCM)/congestive heart failure (CHF) that began in November of 2001 between periods of active service. The CI continued with treatment which had begun prior to activation, but her condition did not improve adequately enough for her to meet the physical requirements of her Military Occupational Specialty (MOS) or to satisfy physical fitness standards. She was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The DCM condition was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-501. No other conditions were submitted by the MEB. The MEB characterized her condition as “existed prior to service” (EPTS). The PEB adjudicated the DCM condition as unfitting, rated at 10% with likely application of Veterans Affairs Schedule for Rating Disabilities (VASRD). Although the MEB characterized the condition as EPTS and the PEB determined the condition was not aggravated by service, the PEB nonetheless determined the condition to be ratable and compensable IAW 10 USC 1207a citing the CI had served at least 8 years on active duty. The CI made no appeals and was medically separated.


CI CONTENTION: The CI elaborated no specific contention in her application.


SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in Department of Defense Instruction (DoDI) 6040.44 (Enclosure 3, paragraph 5.e.2) is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The rating for the unfitting DCM 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.


 R ATING COMPARISON :

Service IPEB – Dated 20031914
 VA - (~5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Dilated Cardiomyopathy 7020 10% Cardiomyopathy with H/O CHF 7020 60%* 20040730
No Additional MEB/PEB Entries
 Other x 2 20040730
Combined: 10%
 Combined: 60%
VARD 20041109 (most proximate to date of separation [DOS] ) ; * Subsequent VARD dated 20060718 severed the 7020 rating citing a clear and unmistakable error . The VA determined the CI not eligible for rating/compensation due as the condition existed prior to service (EPTS).



ANALYSIS SUMMARY:

Dilated Cardiomyopathy Condition: The CI was diagnosed with PPCM and CHF in November 2001, while in an inactive status. She was placed on Lotensin, Aldactone, Lasix, and Coreg and did well, functioning at normal levels of daily activity, but unable to meet the rigors of military duty including running, exerting herself, wearing a mask, or performing physical fitness testing. She was activated on 7 February 2003. Six days later, she was referred from the soldier readiness program to internal medicine for evaluation of her PPCM and for profile consideration. She was seen on that same day and determined to be non-deployable. She was issued a permanent P-3 profile and referred to a MOS Medical Retention Board (MMRB). On 24 June 2003, an MEB was recommended by the same internist. At the time of diagnosis, she had an ejection fraction (EF) of 40%; a repeat echocardiogram on April 2002 showed and EF of 45-50% and a mildly enlarged right ventricle. The Board noted that this was prior to activation. An electrocardiogram obtained on 13 February 2003 showed left ventricular hypertrophy by voltage criteria. This was most likely a normal variant since an echocardiogram, a more definitive study, on 24 June 2003 showed normal right and left heart chamber sizes, normal left ventricular thickness and wall motion. The tricuspid valve, aortic valve, and mitral valve were grossly within normal limits. Normal color Doppler flow studies with an estimated ejection fraction of 55-60% (normal is 55-70%). On 24 September 2003, a thallium graded exercise stress testing showed EF at 52%, and achievement of 10.4 metabolic equivalents of task (METs) units of workload without chest pain or shortness of breath. The commander’s statement dated 12 May 2003 remarked that the CI was incapable of performing her duties and that the cardiomyopathy with left ventricular dysfunction condition created a burden for others and impacted unit readiness. Her profiled limitations were no running, bicycling, swimming, and no 40 pound back pack. The narrative summary was dictated on 18 October 2003, 6 months prior to separation. It noted that the CI could walk at limited levels. Her condition was determined to be stable and heart function was within normal limits. However, it was noted that should the patient be required to function at a level above routine activity such as running, overexertion, working for prolonged periods of time with little sleep in deployment in a combat area, her condition may deteriorate and require specialty medical care. The MEB physical exam on 4 June 2004 noted a grade 2/6 systolic murmur on the left sternal border; otherwise, it was a normal exam. At the VA Compensation and Pension exam performed on 30 July 2004, 5 months after separation, the CI reported that she was diagnosed with cardiomyopathy in 2001, 6 weeks after childbirth. She was much improved, with occasional palpitations, tightness of chest, and shortness of breath on moderate exertion. She could walk one mile at a time, had no ankle swelling, no falls, no dizziness, no cough, and no paroxysmal nocturnal dyspnea. Physical examination revealed normal carotids, no bruit, no jugular venous pressure elevation, and apical heart beat difficult to palpate, no murmur, clear lungs. The VA examiner estimated METS of 4-5. The Board noted that the CI was subjectively improved from previous examinations and that she had achieved 10.4 METS on testing the prior September.

The Board directs attention to its rating recommendation based on the above evidence. The Board considered VASRD diagnostic code 7020 used both by the PEB for a 10% rating and the VA for a 60% rating (later revoked due to condition existing prior to active duty, and not exacerbated by active duty). The Board considered the evidence, and found the CI had a 10.40 METS measured by treadmill testing without any symptoms, with a measured ejection fraction of 52% by thallium images, without evidence of abnormal distribution throughout the myocardium in all axes. There was no cardiac hypertrophy by direct measurement on the last echocardiogram prior to separation and the ejection fraction was within normal limits. The Board considered the estimated METS of 4-5 by the VA examiner to be speculative and contrary to the evidence in the medical treatment record with direct measurements by testing. There was no evidence in the clinical record of an episode of CHF in the past year or evidence of an ejection fraction of 30% to 50%, and METS were measured at 10.40 without symptoms thus providing no support for a possible rating of 60%. The METS were greater than seven, without evidence of cardiac hypertrophy by echocardiogram and thus did not meet the 30% rating criteria in the CI’s favor. The CI met the 10% rating criteria by continuous use of required medications. 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 DCM 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 DCM 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
Dilated Cardiomyopathy Condition 7020 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120918, 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 AR20130010959 (PD201201663)

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                                                 
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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