RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:  ARMY 
SEPARATION DATE:  20020429 

 
NAME:  XXXXXXXXXXXXXXX 
CASE NUMBER:  PD1200422 
BOARD DATE:  20130205 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  CPT/O-3  (56A/Chaplain),  medically  separated  for 
status  post  (s/p)  mitral  valve  ring  repair  with  post-operative  atrial  fibrillation  on  chronic 
anticoagulation  and  antiarrhythmic  therapy.    The  CI  was  diagnosed  with  mitral  regurgitation 
(MR) in 1995 and he underwent a repair of the mitral valve annular ring in November 1998.  In 
March  1999,  atrial  fibrillation  was  discovered  and  after  anticoagulation,  he  underwent 
cardioversion  with  return  to normal  sinus  rhythm  in  September  1999.   A  Physical  Evaluation 
Board  (PEB)  previously  found  the  CI  fit  for  duty  on  two  occasions,  once  in  June  1998  after 
experiencing recurrent rhabdomyolysis and again in February 2001 for the s/p mitral valve ring 
repair  on  chronic  anticoagulation  and  anti-arrhythmic  therapy  condition.    This  second  duty 
determination of “fit” was preceded by the CI non-concurring a PEB’s initial adjudication of a 
10% disability rating and then an Informal Reconsideration by the PEB determined the CI to be 
fit for duty.  The CI was to be involuntarily separated 31 December 2001 when he was referred 
for a third Medical Evaluation Board (MEB) that convened in January 2002.  He was issued a P3 
profile  for  these  conditions  in  November  2000.    The  MEB  identified  chronic  anticoagulation, 
history  of  MR  s/p  mitral  valve  annular  ring  repair  and  exertional  rhabdomyolysis,  and 
forwarded them as medically unacceptable for PEB adjudication.  The PEB adjudicated the s/p 
mitral  ring  repair  with  post-operative  atrial  fibrillation  on  chronic  anticoagulation  and  anti-
arrhythmic  therapy  as  unfitting  and  rated  it  0%,  with  application  of  the  Veterans  Affairs 
Schedule for Rating Disabilities (VASRD).  The remaining condition, exertional rhabdomyolysis 
was determined to be not unfitting.  The CI made no appeals, and was medically separated with 
a 0% disability rating. 
 
 
CI CONTENTION:  “The Army rated me for only one condition which the VA does not rate but I 
did not receive a rating from the Army for status post-operative pericarditis and residuals of 
mitral valve repair or hypertension for which I received a VA rating.” 
 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in 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 ratings 
for  the  unfitting  chronic  anticoagulation  and  history  of  MR  s/p  mitral  annular  ring  repair 
conditions will be reviewed.  The other requested conditions, hypertension and pericarditis are 
not within the Board’s purview.  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 service Board for Correction of Military Records. 
 
 
 
 

Code 

Rating 

Exam 

7099-7000 

 
 
 
RATING COMPARISON: 
 

Rating 

0% 

20010221 

20010221 
20010221 

30% 

0% 
10% 

5099-5025 
7101 

Code 
7099-
7016- 
7010 
Not Unfitting 

VA (14 Mos. Pre-Separation) – All Effective Date 20020102* 
Condition 
s/p  pericarditis  and  residuals  of 
mitral valve repair 
Exertional Rhabdomyolysis 
Hypertension 
0% x3 / Not Service-Connected x4 
Combined:  40% 

Service IPEB – Dated 20020124 
Condition 
S/P  mitral  ring  repair  w/ 
post op atrial fibrillation on 
chronic anticoagulation 
Exertional Rhabdomyolysis 
↓No Additional MEB/PEB Entries↓ 
Combined:  0% 
*The VARD dated 20030127 made no changes to rated conditions and added four NSC conditions based on C&P exam dated 
20021022; The VARD effective date remained 2 January 2002 despite the fact the separation date was 29 April 2002. 
 
 
ANALYSIS  SUMMARY:    The  Board  notes  the  current  VA  ratings  listed  by  the  CI  for  all  of  his 
conditions, but must emphasize that its recommendations are premised on severity at the time 
of  separation.    The  VA  ratings  that  it  considers  in  that  regard  are  those  rendered  most 
proximate to separation.  The Disability Evaluation System (DES) has neither the role nor the 
authority to compensate members for anticipated future severity or potential complications of 
conditions resulting in medical separation.  That role and authority is granted by Congress to 
the  Department  of  Veterans  Affairs  (DVA).    The  Board  further  notes  that  the  presence  of  a 
diagnosis, in and of itself, is not sufficient to render a condition unfitting and ratable.  While the 
DES considers all of the member's medical conditions, compensation can only be offered for 
those  medical  conditions  that  cut  short  a  member's  career,  and  then  only  to  the  degree  of 
severity present at the time of final disposition.  However, the DVA, operating under a different 
set of laws (Title 38, United States Code), is empowered to periodically re-evaluate Veterans for 
the purpose of adjusting the disability rating should the degree of impairment vary over time. 
 
The PEB applied an analogous code of 7099-7016-7010 for the s/p mitral ring repair with post-
operative atrial fibrillation (AFib) and rated it 0%.  This coding scheme reflected a bundling of 
MEB  conditions  into  a  single  unfitting  condition.    The  Board  must  apply  separate  codes  and 
ratings  in  its  recommendations  if  compensable  ratings  for  each  condition  are  achieved  IAW 
VASRD §4.104.  If the Board judges that two or more separate ratings are warranted in such 
cases,  however,  it  must  satisfy  the  requirement  that  each  “unbundled”  condition  was 
reasonably justified as unfitting in and of it.  Not uncommonly, this approach by the PEB reflects 
its judgment that the constellation of conditions was unfitting, and that there was no need for 
separate fitness adjudications, not a judgment that each condition was independently unfitting.  
Thus,  the  Board  must  exercise  the  prerogative  of  separate  fitness  recommendations  in  this 
circumstance, with the caveat that its recommendations may not produce a lower combined 
rating than that of the PEB. 
 
The  first  task  of  the  Board  is  to  “unbundle”  the  two  conditions  and  determine  if  each  was 
separately unfitting.  The first condition to be considered will be the MEB diagnosis of “mitral 
regurgitation with mitral valve prolapse, status post mitral annular ring repair” (MR w/ mitral 
valve  prolapsed  (MVP)s/p  repair),  then  the  MEB  diagnosis  of  “chronic  anticoagulation  for  a 
history  of  AFib”  condition  will  be  considered  for  fitness  determinations.    The  CI  had  a 
permanent  profile  in  place  when  his  MR  w/  MVP  was  surgically  corrected.    Because  of  the 
limitations on that permanent profile, a new profile was not required.  In November 2000, the 
CI underwent a PEB for the MR w/ MVP s/p repair condition and was adjudicated as fit for duty 

after an Informal Reconsideration PEB.  That PEB document cited the following:  “Officer has 
continued to carry out his assigned duties despite his medical problems.  His physical profile is 
not unduly restrictive, permitting functional activities.  He can take and pass an alternate Army 
Physical Fitness Test.”  His MR w/ MVP s/p repair condition had been stable for over 2 years 
prior to separation.  After due deliberation, the Board agreed that evidence does not support a 
conclusion that the MR with MVP, s/p mitral annular ring repair, as an isolated condition, would 
have rendered the CI incapable of continued service within his Military Occupational Specialty, 
and accordingly cannot recommend a separate rating for it. 
 
The  chronic  anticoagulation  for  a  history  of  atrial  fibrillation  (AFib)  will  be  considered  as  an 
entity  for  fitness  determination  and  if  found  to  be  unfitting  will  be  rated  accordingly.    In 
November 2000, the CI underwent a PEB for the chronic anticoagulation for a history of AFib 
and he was determined to be fit for duty after an Informal Reconsideration PEB.  The CI had no 
documented episodes of AFib within the 2 year period prior to separation, as his AFib was well 
controlled  on  medication.    If  the  CI  had  not  required  chronic  anticoagulation  therapy  for  his 
AFib,  this  condition  would  have  been  found  not  unfitting.    However,  chronic  anticoagulation 
therapy  alone  is  medically  unacceptable  for  continued  military  service  IAW  AR  40-501.    The 
Board’s deliberations concluded that the chronic anticoagulation for a history of AFib condition 
was  reasonably  justified  as  separately  unfitting  and  therefore  was  considered  for  a  separate 
disability rating. 
 
Chronic Anticoagulation For A History Of Atrial Fibrillation (AFib).  At the MEB exam prepared 3 
months  prior  to  separation,  the  CI  reported  taking  Coumadin  and  that  he  sometimes  felt 
pressure  in  his  chest  under  stress.    He  had  a  mitral  valve  repair  in  November  1998  and  an 
abnormal heartbeat corrected in 1999.  He took Lopressor, Coumadin and an anti-arrhythmic 
medication.  The MEB physical exam noted normal lungs, heart and lower extremities with an 
electrocardiogram (EKG) result of normal sinus rhythm with a first degree heart block. 
 
The  MEB  narrative  summary  prepared  3  months  prior  to  separation,  noting  the  CI  was  on 
chronic  anticoagulation  for  a  history  of  AFib.    He  was  diagnosed  with  MR  in  1995  and  he 
underwent  an  uncomplicated  repair  of  the  mitral  valve  annular  ring  in  November  1998.  
Anticoagulation  therapy  was 
  His 
anticoagulation therapy was discontinued 3 months after the CI’s surgical procedure.  Between 
March  and  September  1999,  the  CI  had  2  incidental  findings  of  AFib  with  each  episode 
terminated by successful elective cardioversion.  The CI’s anticoagulation was continued and he 
was  started  on  Anti-Arrhythmic  medications.    Throughout  the  next  year,  the  CI  did  well, 
remained  asymptomatic  without dyspnea  on  exertion,  orthopnea,  edema  or  palpitation,  and 
remained in normal sinus rhythm.  In June 2000, the patient had a 24-hour Holter that showed 
normal sinus rhythm without any evidence of AFib.  In February 2000, the CI had a PEB and was 
found  fit  for  duty  under  his  current  profile.    The  patient  continued  to  do  well,  denying  any 
palpitations, chest pain and exertional symptoms.  Prior to his final PEB, the CI had a cardiology 
evaluation on 15 January 2002 that revealed he was still taking anti-arrhythmics and Coumadin.  
He  denied  chest  pain,  shortness  of  breath,  edema  or  dyspnea  on  exertion  and  was  doing 
sporadic exercise.  Physical examination showed his lungs were clear to auscultation bilaterally, 
he had no jugular venous distension or carotid bruits.  Cardiac exam showed a regular rate and 
rhythm with normal heart sounds and no murmurs.  His lower extremities showed no edema.  
EKG revealed a normal sinus rhythm with a first degree AV block consistent with prior EKGs.  
The CI underwent a full Bruce graded exercise test for assessment of functional capacity.  He 
exercised for 9 minutes on a full Bruce protocol obtaining 10 METS of effort and was essentially 
normal.  His present condition was stated as stable, with normal rhythm and current functional 
capacity  of  10  METS.    Conclusion  made  by  the  cardiologist  was  that  the  CI  was  in  stable 

initiated  and  the  patient  was  returned  to  duty. 

condition but currently failed to meet retention criteria, IAW AR 40-501, para 3-21m, as he was 
on  chronic  Coumadin  therapy,  which  would  interfere  with  his  duty  requirements  and 
assignments. 
 
At the VA Compensation and Pension (C&P) exam performed 6 months after separation, the CI 
reported  that  in  1996,  he  developed  symptoms  of  shortness  of  breath  and  chest  pain.    In 
addition to the history noted above, the C&P examination included the following details:  He 
stated  that  he  had  episodes  of  congestive  heart  failure  and  underwent  management  of 
pericarditis  in  1998.    He  denied  any  history  of  rheumatic  heart  disease  and  that  his  current 
treatment  for  his  cardiac  problems  is  Coumadin.    He  was  under  constant  and  continuous 
treatment for his heart condition by a VA physician.  Physical examination revealed a normal 
neck, lung and heart exam.  There was no evidence of congestive heart failure, cardiomegaly, or 
cor  pulmonale  and  no  lower  extremity  edema  was  noted.    Several  diagnostic  tests  were 
performed  in  October  2002:    chest  X-ray:    No  active  cardiopulmonary  disease  noted;  EKG: 
normal sinus rhythm, first degree A-V block; exercise treadmill test was essentially normal.  The 
CI had cardiac disease resulting in slight limitation of physical activity, was comfortable at rest 
and in the performance of ordinary, light, daily activities; greater than ordinary physical activity, 
such  as  heavy  physical  exertion,  results  in  fatigue,  palpitation,  dyspnea,  or  anginal  pain.  
Recommendations:  The CI could perform at his usual daily activities without any limitation or 
restrictions.  In regards to his occupation, he could perform at his usual occupation.  He should 
have  avoided  those  activities  that  required  strenuous  activity,  heavy  lifting,  and  pushing, 
shoving or prolonged mobilization. 
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB applied an analogous code of 7099-7016-7010 for the bundled s/p mitral ring repair with 
post-operative  atrial  fibrillation,  last  episode  in  September  1999  prior  to  cardioversion  on 
chronic anticoagulation and anti-arrhythmic therapy conditions and rated it 0%.  The VA did not 
rate the chronic anticoagulation for a history of atrial fibrillation condition.  The AFib condition 
is  rated  using  the  VASRD  code  7010,  Supraventricular  arrhythmias,  as  AFib  is  a  type  of 
supraventricular  arrhythmia.    The  criteria  utilized  for  rating  this  condition  are  based  on  the 
frequency of the episodes per year with more than 4 episodes equating with a 30% evaluation 
and  1  to  4  episodes  per  year  equating  with  a  10%  evaluation.    The  CI  had  no  documented 
episodes of AFib within the 2-year period prior to separation, as his AFib was well controlled on 
medication.    Citing  VASRD  §4.31  (Zero  percent  evaluation),  “In  every  instance  where  the 
schedule  does  not  provide  a  0%  evaluation  for  a  diagnostic  code,  a  0%  evaluation  shall  be 
assigned  when  the  requirements  for  a  compensable  evaluation  are  not met.”    The  CI’s  well-
controlled AFib was unfitting, due to the chronic anticoagulation requirement.  However, it did 
not meet the requirements for a compensable rating IAW VASRD §4.104 Schedule of ratings-
cardiovascular system.  After due deliberation, considering all of the evidence and mindful of 
VASRD §4.3 (Resolution of reasonable doubt), the Board recommends a disability rating of 0% 
for the chronic anticoagulation for a history of atrial fibrillation condition.  Application of VASRD 
code 7010, Supraventricular arrhythmias, as the only unfitting condition present conferred no 
rating advantage to the CI, therefore no change from the PEB designation 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  s/p  mitral  valve  ring  repair  with  post-operative  atrial 

fibrillation  on  chronic  anticoagulation  and  anti-arrhythmic  therapy  condition,  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 
Status  Post  Mitral  Ring  Repair  with  Post-operative  Atrial 
Fibrillation on Chronic Anticoagulation 

VASRD CODE 
7099-7016-7010 

RATING 
0% 

COMBINED 

0% 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20120424, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

           XXXXXXXXXXXXXXXXX, DAF 
           Director 
           Physical Disability Board of Review 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXX, AR20130002821 (PD201200422) 
 
 
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 
 
 
 

     XXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)