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AF | PDBR | CY2012 | PD2012 01905
Original file (PD2012 01905.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx         CASE: PD1201905
BRANCH OF SERVICE: navy  BOARD DATE: 20130618
SEPARATION DATE: 20030630


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PN1/E-6 (9310/Personnelman) medically separated for idiopathic atrial fibrillation (A Fib). The CI was placed on an 8 month limited duty (LIMDU) status in April 2002 after diagnosis with A Fib. Anti-coagulation therapy with Coumadin was begun. A second 8 month LIMDU period was initiated, but because of the continued requirement for anti-arrhythmic therapy and Coumadin, he was referred for a Medical Evaluation Board (MEB) after 4 months on the second LIMDU period. The idiopathic A Fib condition was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. The MEB also forwarded Hashimotos thyroiditis and left shoulder impingement syndrome conditions for PEB adjudication. The orthopedic MEB addendum added “suggestion of cervical nerve root compression” as a MEB condition. The PEB adjudicated “idiopathic atrial fibrillation” as unfitting, rated 10%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be Category III. The CI made no appeals, and was medically separated.


CI CONTENTION: “Even though, I was given disability only 10%. At the time of discharge I faced multiple problems including but not limited to irregular heartbeat, Thyroid and Sinusitis, Allergies and Leg injury.”


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. Ratings for unfitting conditions will be reviewed in all cases. The unfitting idiopathic A Fib, as requested for consideration, meets the criteria prescribed in DoDI 6040.44 for Board purview. The requested thyroid condition, which was determined to be not unfitting by the PEB, is likewise in Scope and addressed below. The allergies and leg injury conditions are outside the Board’s defined Scope of Review, but remain eligible for future consideration by the Board for Correction of Naval Records.


RATING COMPARISON:

Service IPEB – Dated 20030516
 VA - (Day of Separation)
Condition
 Code Rating Condition Code Rating Exam
Idiopathic A Fib
 7010 10% Idiopathic A Fib…Hyperthyroidism 7900-7010 10% 20030630
Left Shoulder…
 Cat III NR Residual Motor Vehicle Accident, Left Shoulder 5203 NSC* 20030630
Mild Shoulder…
 Cat III NR
Suggestion ...Compression
 Cat III NR Residual Motor Vehicle Accident Cervical Condition 5237 NSC* 20030630
Hashimoto’s Thyroiditis
 Cat III NR Hashimoto’s Thyroiditis** 7804-7903 10% 20030630
Combined: 10%
 Combined: 10%
D erived from VA Rating Decision (VARD) dated 20030630 ( most proximate to date of separation [DOS] ). *Initially deferred, then determined to be not service connected on 20040413 VARD. **Renamed Residuals Left Thyroid Lobectomy with Scar and rated 10% on 20040413 VARD.

ANALYSIS SUMMARY:

Idiopathic Atrial Fibrillation Condition. The service treatment record (STR) shows that the CI was found to be in A Fib during a separation physical in November 2001, and started on Coumadin anti-coagulation therapy. In March 2002, the CI underwent successful cardioversion but soon reverted to A Fib. He was diagnosed with hyperthyroidism in June 2002 during an evaluation for his A Fib; it was implicated as a possible cause of his A Fib. Ultrasound of his thyroid gland showed a left upper pole thyroid nodule and thyroid scan showed that it was a cold nodule (suspicious for cancer). A needle biopsy did not exclude cancer, and in September 2002, the CI underwent left thyroid lobectomy. Thyroid cancer was excluded, but Hashimoto’s disease was diagnosed and he was placed on LIMDU for an additional 8 months. Repeat cardioversion in March 2003 was successful. He was treated with Sotalol to stabilize the arrhythmia. Due to the requirement for ongoing treatment with Sotalol and Coumadin, he was referred to the informal PEB. At the MEB examination, 3 months pre-separation, no specific cardiac complaints were noted. The CI was taking Synthroid, Coumadin, and Sotalol. The CI was in normal sinus rhythm, with no signs of A Fib. He was about 2 weeks post cardioversion. The examiner stated “the patient will be maintained on Coumadin and anti-arrhythmic therapy for approximately the next six months at the discretion of his cardiologist. At the discretion of his cardiologist, the patient may remain on anti-arrhythmic therapy indefinitely as determined by the refractory nature of his atrial fibrillation.” At the time separation, the Coumadin had been discontinued, but he remained on Sotalol for arrhythmia control and Synthroid for hypothyroidism replacement. At the VA Compensation and Pension exam performed on the day of separation, the CI reported his dose of Synthroid had been recently increased. He denied symptoms of either cardiac or thyroid problems. The VA examiner documented “regular rate and rhythm, bradycardic at 50.” An echocardiogram on 17 February 2004, 8 months after separation, was normal. A Holter monitor test (a 24 hour electrocardiogram) had been essentially normal the week prior and specifically showed no runs of A Fib.

The Board directed attention to its rating recommendation based on the above evidence. The PEB found the idiopathic A Fib condition unfitting due to the use of Sotalol and Coumadin in treatment; his therapy (specifically, the anticoagulation) was contrary to further military service. There was no specific mention of hypothyroidism by diagnosis by the MEB or on the Joint Disability Evaluation Tracking System form. The PEB coded 7010 for supraventricular arrhythmias, and rated it at 10% for one to four episodes per year of idiopathic A Fib. The VA coded the idiopathic A Fib to include hyperthyroidism; 7900, analogously to 7900-7010, and rated by the metabolic equivalent of tasks (METS) workload scale for cardiac disability at 10% for workload greater than seven METs but not greater than ten METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or continuous medication is required. The VA did not address the hypothyroidism until following an appeal in April 2004. The VA then rated this condition separately for 10% under code 7804-7903 for scars and hypothyroidism retroactive to the date of separation. The Board reviewed the unfitting PEB diagnosis of idiopathic A Fib and found good alignment with the coding 7010 for supraventricular arrhythmias, and found the disability at the level of one to four episodes per year of idiopathic A Fib supported a disability rating of 10%. 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 idiopathic A Fib condition.

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting. The only condition within the Scope of Review is the contended Category III Hashimoto’s thyroiditis condition. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (Reasonable doubt) standard used for its rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. The hyperthyroidism was transient. While the CI had surgery for a cold nodule in the left upper pole of the thyroid, this was done to exclude cancer, not as curative procedure for hyperthyroidism. In addition, it was not causative of the hypothyroidism. The hypothyroidism was well treated with replacement thyroid hormone. There was no performance based evidence from the record that Hashimotos’s thryroiditis or hypothyroidism itself significantly interfered with satisfactory duty performance once treated. After due deliberation in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for Hashimoto’s thyroiditis and no additional disability rating is recommended.


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 idiopathic A Fib condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication. In the matter of the contended Hashimoto’s thyroiditis and secondary hypothyroidism conditions, the Board unanimously recommends no change from the PEB determination as not unfitting. 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
Idiopathic Atrial Fibrillation Condition
 7010 10%
COMBINED
 10%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20121111, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





xx
President
Physical Disability Board of Review


 MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 11 Sep 13

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandum, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:
- former USN
- former USN
- former USMC
- former USN
- former USN



         xx
         Assistant General Counsel
         (Manpower & Reserve Affairs)

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