Search Decisions

Decision Text

AF | PDBR | CY2013 | PD-2013-02514
Original file (PD-2013-02514.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2013-02514
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20150114
SEPARATION DATE: 20050906


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Munitions Systems Technician) medically separated for cardiogenic syncope. The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards. She was issued a permanent P4 profile and referred for a Medical Evaluation Board (MEB). The recurrent syncope condition, characterized as “medically unacceptable” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB adjudicated “cardiogenic syncope” as unfitting, rated 10% with likely application of the VA Schedule for Rating Disabilities (VASRD). The remaining condition , irritable bowel syndrome w as determined to be C ategory II ( can be unfitting but are not currently compensable or ratable ) . The CI made no appeals and was medically separated.


CI CONTENTION: “Vinus tach, cyst on breast.”


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 when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting. Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military/Naval Records. Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.


RATING COMPARISON :

Service IPEB – Dated 20050720
 VA* - (3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Cardiogenic Syncope 8210-8299 10% Sinus Tachycardia and Atrial Tachycardia, Status Post Ablation 7010 10% 20051118
Other x 1 (Not in Scope)
 Other x 3
Combined: 10%
 Combined: 30%
* Derived from VA Rating Decision (VA RD ) dated 200 60606 (most proximate to date of separation ( DOS ) )



ANALYSIS SUMMARY:
Cardiogenic Syncope. The CI’s history of syncopal (fainting) episodes began in 2003. Medical records indicated no prior history of heart disease or epilepsy. On 11 December 2003, cardiologist diagnosed neurocardiogenic syncope which in general is the increased activity of the vagus nerve that controls the heartbeat and muscle movement for breathing, typically in response to emotional situations. Diagnosis came after initial cardiac studies were negative. The CI had normal electrocardiogram (EKG), Doppler studies and echocardiogram. Holter recorder documented only sinus tachycardia (fast heartbeat) with no other arrhythmias (irregular heartbeats). Although she had normal studies, the CI continued to report syncopal episodes and was referred to the heart clinic for possible electrophysiology studies. In February 2004 she was placed on a beta-blocker, anti-hypertensive medication and was free of the episodes for approximately 3 months. Dynamic heart studies performed on 10 March 2004, recorded diagnostic impression of “reported paroxysm supraventricular tachycardia/atrial tachycardia/ possible inappropriate sinus tachycardia,” and syncope “probably” related to the arrhythmia in combination with a “vasovagal scenario.” On 11 June 2004, the CI presented to the emergency room (ER) with the report that she had passed out while outside in the heat. Physical examination recorded no abnormalities; she was alert and appropriately oriented, and all laboratory studies were normal. EKG was normal. The physician diagnosed possible heat exhaustion. In October 2004, the CI underwent right atrial tachycardia ablation procedure to correct the heartbeat/rhythm; however, the abnormal rhythm was not resolved and beta blocker medication was still required to control the occasional arrhythmia.

The MEB narrative summary dated 28 June 2005 noted the CI’s initial syncopal episode occurred after exercising. She reported episodes consisting of dizziness or complete fainting on an almost weekly basis. The physician noted ablation surgery had not completely resolved the issue. Physical examination was unremarkable. The physician diagnosed recurrent syncope-suspect cardiogenic, and stated, “Since her limitations are related to heat and exertion….she is not capable of performing her work requirements....” A cardiology clinic entry dated 6 July 2005, 2 months prior to separation, recorded the CI reported that she had some episodes of palpitations lasting from a few seconds to a few minutes when she was excited or stressed. However, she had not experienced any syncopal, did not have any near-syncopal symptoms, and continued to work as a military police at the gate. The EKG recorded normal sinus rhythm and no signs of atrial tachycardia or an accessory pathway (successful ablation).

The VA Compensation and Pension exam dated 18 November 2005, 3 months after separation, recorded the CI’s syncopal history, diagnoses, and treatment, and indicated the condition was well controlled with medication.

The Board directed attention to its rating recommendation based on the above evidence. The PEB rated the cardiogenic syncope at 10%, coded analogously 8210-8299 (incomplete paralysis, moderate of cranial nerve X [10th]-vagus). The VA rated the condition, diagnosed as sinus tachycardia and atrial tachycardia, at 10% coded 7010 (supraventricular arrhythmia). The higher rating of 30% under the 8210 code required documented evidence that the condition was severe. Based upon the evidence, all Board members agreed that the 30% rating was not approached. The CI presented once to the ER after a syncopal episode, underwent successful ablation surgery with no additional syncope episodes, and although she continued to report palpitations, she noted these occurred only during times of stress or when excited. She continued to work as a military police at the gate. The Board next considered rating the condition under the 7010 code. Board members agreed a rating under this code was of no additional benefit since the higher rating of 30% was not supported by the evidence. Therefore, 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 cardiogenic syncope 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 cardiogenic syncope condition and IAW VASRD §4.124a, 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131127, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record






XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2013-02514.

         After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation.

         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.

Sincerely,




XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

Similar Decisions

  • AF | PDBR | CY2009 | PD2009-00383

    Original file (PD2009-00383.docx) Auto-classification: Denied

    Despite normal tests, the CI continued to have symptoms and the Cardiologist opined his chest pain and palpitations were not cardiac conditions. The CI’s symptoms of chest pain and palpitations did not result from a cardiac condition. No VASRD code for non-cardiac chest pain and palpitations exists and the CI’s disability must be rated analogously.

  • AF | PDBR | CY2012 | PD2012-00422

    Original file (PD2012-00422.pdf) Auto-classification: Denied

    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). (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.”...

  • AF | PDBR | CY2009 | PD2009-00624

    Original file (PD2009-00624.docx) Auto-classification: Denied

    It was the opinion of the MEB that the CI, because of his physical limitations, would be unable to fulfill his duties as an active duty Marine and his case was referred to the PEB for final disposition. The VA C&P examination on 8 April 2009, one month after separation, noted that he was taking medication with no episodes of atrial fibrillation since separation; however, he had not performed any heavy exertional activities due to the order from his Cardiologists to not exercise due to the...

  • AF | PDBR | CY2009 | PD2009-00057

    Original file (PD2009-00057.docx) Auto-classification: Denied

    CI CONTENTIONS : The CI contends that neither the PEB nor the VA rating is fair. All Holter rhythm recordings and multiple EKG’s in evidence were reviewed, and it was concluded that no additional undocumented arrhythmias are demonstrable. Specifically investigated was an ER encounter during the MEB period which resulted from exertional symptoms that may have been caused by an additional episode of SVT.

  • AF | PDBR | CY2013 | PD2013 01389

    Original file (PD2013 01389.rtf) Auto-classification: Denied

    Pre-Separation) ConditionCodeRatingConditionCodeRatingExam Vasovagal Syncope8299-821010%Tachycardia/Vasovagal Syncope7099-701110%20040401Other X 0 (Not in Scope)Other x 520040401 Rating: 10%Combined: 30%Derived from VA Rating Decision (VARD)dated 20040612 ( most proximate to date of separation [DOS]). The Board directs attention to its rating recommendationbased on the above evidence.The PEB coded the syncopal condition analogously to 8210 for vasovagal nerve impairment. RECOMMENDATION :...

  • AF | PDBR | CY2013 | PD2013 01346

    Original file (PD2013 01346.rtf) Auto-classification: Denied

    The A-fib condition, characterized as “atrial fibrillation refractory to radiofrequency catheter oblation…possibly exercise induced” wasforwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123; no other conditions were submitted by the MEB.The informal PEBadjudicated the A-fib conditionas unfitting, rated 10%, referencing the Department of Defense Instruction (DoDI) 1332.39and Veteran’s Affairs Schedule for Rating Disabilities (VASRD).The CI made no appeals, and was medically...

  • AF | PDBR | CY2012 | PD2012 00861

    Original file (PD2012 00861.rtf) Auto-classification: Denied

    RATING COMPARISON : Army PEB – dated 20020123VA* – (4 yearsPost-Separation)ConditionCodeRatingConditionCodeRatingExam Symptomatic Palpitations7099-70100%W-P-W Syndrome70100%20060915HypertensionNot UnfittingHypertension710110%20060915DeconditioningNot UnfittingNo VA Entry20060915No Additional MEB/PEB EntriesOther x 620060915 Combined: 0%Combined: 10% * Derived from VA Rating Decision (VARD)dated 20060929(the original VARD was not in evidence) ANALYSIS SUMMARY :IAW DoDI 6040.44, the Board’s...

  • AF | PDBR | CY2012 | PD2012-00896

    Original file (PD2012-00896.pdf) Auto-classification: Denied

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW BRANCH OF SERVICE: ARMY SEPARATION DATE: 20030512 NAME: XXXXXXXXXXXXXXXXXX CASE NUMBER: PD1200896 BOARD DATE: 20130123 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty, SPC/E-4, (92A/Automated Logistical Specialist), medically separated for paroxysmal atrial fibrillation (PAF) with chest pain syndrome. The MEB forwarded no other conditions for Physical...

  • AF | PDBR | CY2012 | PD2012 01905

    Original file (PD2012 01905.rtf) Auto-classification: Denied

    Ratings for unfitting conditions will be reviewed in all cases. The VA then rated this condition separately for 10% under code 7804-7903 for scars and hypothyroidism retroactive to the date of separation. 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.

  • AF | PDBR | CY2014 | PD 2014 00605

    Original file (PD 2014 00605.rtf) Auto-classification: Denied

    RECORD OF PROCEEDINGSPHYSICAL DISABILITY BOARD OF REVIEWNAME: XXXXXXXXXXXXXX CASE: PD-2014-00605BRANCH OF SERVICE: AIR FORCEBOARD DATE: 20140827 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.IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. Neurocardiogenic...