Search Decisions

Decision Text

AF | PDBR | CY2013 | PD2013 01346
Original file (PD2013 01346.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX         CASE: PD 13-01346      
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20140115
Date of Permanent SEPARATION: 20040909  


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSGT/E-5 (8R000/Recruiter) medically separated for atrial fibrillation (A-fib). He began having intermittent A-fib with exercise in 2001 and underwent radiofrequency oblation in 2004, which was unsuccessful in eliminating the atrial fibrillation. The heart condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards. He was issued a permanent P4U2L2 profile and referred for a Medical Evaluation Board (MEB). The A-fib condition, characterized as “atrial fibrillation refractory to radiofrequency catheter oblation…possibly exercise induced” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123; no other conditions were submitted by the MEB. The informal PEB adjudicated the A-fib condition as unfitting, rated 10%, referencing the Department of Defense Instruction (DoDI) 1332.39 and Veteran’s Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated.


CI CONTENTION: “I was discharged out of the United States Air Force because of Paroxysmal atrial fibrillation in which I underwent a catheter ablation. I am on medication for the remainder of my live to continue a normal sinus rhythm. I have been in atrial fibrillation several times since the catheter ablation and a recommendation has been made for a second surgery. This is a problem that I will continue to have for the duration of my life. At the time of the separation from the United States Air Force I was at a location with no military installation for me to find out what rights I had. When researching my condition of Paroxysmal atrial fibrillation other service members have received a 30% rating for the same condition and a medical retirement. I was discharged with a 0% rating for Paroxysmal atrial fibrillation with no retirement benefits. Please see fit to increase this rating and grant me a medical retirement as opposed to a discharge.”


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 Service rating for the unfitting atrial fibrillation condition is addressed below; 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 USAF Board for Correction of Military Records (BCMR).


 RATING COMPARISON :

Service IPEB – Dated 20040723
 VA - (2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Atrial Fibrillation 7010 10% Paroxysmal Atrial Fibrillation 7010 0% 20041030
No Additional MEB/PEB Entries
 Other x 4 20041030
Combined: 10%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 200 50203 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Atrial Fibrillation Condition. The CI was first diagnosed with A-fib after an electrocardiogram (ECG) on 12 July 2001. He reported prior episodes of chest pain, but the A-fib had not previously been documented. He was admitted overnight for observation and then released for an evaluation as an outpatient. An echocardiogram (ECHO) was normal as was a thyroid (TSH) test. On 20 February 2002, another ECG revealed A-fib. A stress ECHO on 23 February 2004 was also normal. He was evaluated in electrophysiology on 11 March 2004. The CI reported that he had paroxysms of A-fib 2-3 times a month for the past four years lasting up to six hours, but had never required cardioversion. He denied chest pain or shortness of breath with these episodes and no precipitating factors were identified. Two weeks prior to this evaluation, he reported a syncopal episode in association with the A-fib. An ECG that day was normal other than early repolarization. He was diagnosed with lone atrial fibrillation. Two weeks later, he was again seen by the electrophysiologist and reported increased episodes. Ablation was then scheduled. On 29 April 2004, he underwent electrophysiology studies and an attempted ablation. He was in normal sinus rhythm at baseline. Multiple attempts to induce either an atrial or ventricular dysrhythmia were unsuccessful. The ablation was thought to be successful at the time of the procedure. He was begun on an anti-arrhythmic that day. Shortly thereafter, he had recurrent A-fib, but it was not clear at the 13 May 2004 follow up if this represented treatment failure or not. He reported exertional shortness of breath which had increased since the surgery and also reported working 14-16 hours a day in the military. Subsequently, it was recommended that he not participate in physical training. His work week was limited to 25 hours a week and caffeine was eliminated from his diet. A repeat ECHO on 24 May 2004 was essentially normal. He was then referred to MEB for refractory A-fib. The narrative summary (NARSUM) was dictated on 10 June 2004. The CI reported that he had had A-fib 4-5 times since the attempted ablation. On examination, his cardiac examination was normal. He was thought to not be deployable due to the possibility of recurrent A-fib in a heavy exertion deployed environment. At the VA Compensation and Pension (C&P) examination performed two months after separation, the CI reported that he was symptomatic 1-2 times a week for five minutes or less on medications as opposed to 2-3 times a week with palpitations lasting for hours. His cardiac examination was again normal including rate and rhythm. The CI declined an ECG. The Board directed attention to its rating recommendation based on the above evidence. The PEB and VA both coded the condition as 7010, supraventricular dysrhythmia, but rated it 10% and 0%, respectively. The Board considered the evidence. While the CI reported frequent episodes of symptoms, only a few episodes of A-fib are actually documented in the records in evidence. The VA determined that the condition was non-compensable due to the lack of monitored A-fib. The cardiac evaluations by both the MEB and VA examiners were normal and no abnormal rhythm was noted. The Board considered if a higher, 30% rating was supported. The difference between a 10% and 30% record is that the latter requires documentation by ECG or Holter monitor (a continuous ECG) of A-fib of five or more times a year. The record does not show over four documented episodes in evidence over the final two years of active duty although several are referenced in clinical notes. The Board also noted that the CI was diagnosed by the electro-physiologist with lone A-fib which corresponds to a 10% rating. 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 A-fib 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 A-fib 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
Atrial Fibrillation 7010 10%
COMBINED 10%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130910, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record



                          
                                                    XXXXXXXXXX , DAF
President
P hysical Disability Board of Review
 invalid font number 31502

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

          Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2013-01346.
         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,





 XXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

Similar Decisions

  • 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 | 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 | PD-2012-01216

    Original file (PD-2012-01216.txt) Auto-classification: Denied

    The CI was then medically separated with a 20% disability rating. The PEB placed the CI on TDRL with medically unfitting conditions of right knee instability and atrial fibrillation as charted above. The Atrial Fibrillation Condition.

  • 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.

  • ARMY | BCMR | CY2012 | 20120004069

    Original file (20120004069.txt) Auto-classification: Denied

    The applicant requests correction of his military records to show that he was retired due to a physical disability instead of discharged due to permanent physical disability. He adds that the Department of Veterans Affairs (VA) Schedule for Rating Disabilities (VASRD) Code 7010 states that paroxysmal atrial fibrillation or other supraventricular tachycardia with more than four episodes per year as documented by electrocardiography (ECG) or holter monitor is rated at 30%. He was only rated...

  • AF | PDBR | CY2013 | PD-2013-02514

    Original file (PD-2013-02514.rtf) Auto-classification: Denied

    Although she had normal studies, the CI continued to report syncopal episodes and was referred to the heart clinic for possible electrophysiology studies. The EKG recorded normal sinus rhythm and no signs of atrial tachycardia or an accessory pathway (successful ablation).The VA Compensation and Pensionexamdated 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...

  • 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 | CY2012 | PD2012 00378

    Original file (PD2012 00378.rtf) Auto-classification: Denied

    The CI was then medically separated the CI with a 10% disability rating. By precedent, the Board threshold for a “moderate” peripheral nerve rating requires some functionally significant motor and/or sensory impairment.After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that the chronic low back pain w/ radicular pain left leg condition should be rated for two separate conditions; an unfitting low back pain condition...

  • AF | PDBR | CY2012 | PD 2012 00400

    Original file (PD 2012 00400.txt) Auto-classification: Denied

    The contended conditions adjudicated as not unfitting by the PEB were hyperlipidemia, hypertension, sleep apnea and anxiety NOS (PTSD). The Board noted that the anxiety NOS (PTSD) condition continued to improve by evidence of better sleep with treatment from May 2008 until separation according to the record. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD...

  • AF | PDBR | CY2014 | PD-2014-02202

    Original file (PD-2014-02202.rtf) Auto-classification: Denied

    The CI appealed this decision to the Secretary of Air Force Personnel Council (SAFPC) which changed the DVT condition to“ pulmonary thromboembolism” with a 0% rating and determined that the PAFdid not contribute to the CI’s unfitness and therefore, did not warrant a disability rating. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD)...