Search Decisions

Decision Text

AF | PDBR | CY2014 | PD-2014-01149
Original file (PD-2014-01149.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX        CASE: PD-2014 -01149
BRANCH OF SERVICE: AIR FORCE      BOARD DATE: 201 5 0513
Separation Date: 20090827


SUMMARY OF CASE : Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 ( Security Forces Craftsman ) medically separated for chest pain. The condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty. He was placed on light duty and referred for a Medical Evaluation Board (MEB). The chest pain condition, characterized as “atypical chest pain” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. The MEB also identified and forwarded two other conditions (first degree A-V block and right lower lobe lung nodule) for PEB adjudication. The Informal PEB adjudicated “exertional chest pain” as unfitting, rated 10% with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). Of the remaining conditions the right lower lobe lu ng nodule was determined to be C ategory II (c onditions that can be unfitting but are not currently compensable or ratable ) . The first degree A-V block was not specifically addressed by the PEB. The CI made no appeals and was medically separated.


CI CONTENTION : “The original diagnosis of coronary artery vasospasms by my primary care physician & cardiologist was changed to atypical chest pain by the medical treatment facility's Group Commander for medical board review. Once the package was submitted, I was advised by the medical board's legal counsel that there was no classification for atypical chest pain and I could not petition the 10% finding. Continued... All medical issues must be categorized (sic) within the Title 38 classifications; which the VA classified my coronary vasospasms as an atrioventricular (AV) block. According to Title 38, 4.104 (7015N) an AV block with a "left ventricular dysfunction with an ejection fraction (EF) of 30 to 50 percent" qualifies as a 60% disability. My left ventricular EF is 46% placing it as a 60% disability if Title 38, 4. 7 is applied, "Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned" or 4.3 "a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant." Regardless, the VA has initially (sic) awarded a 30% rating for my disability based on laws and regulations (while the 60% claim is still under review). The Air Force did not apply Title 38's guidelines and generalized my condition which restricted my ability to dispute any medical board findings (no classification, means no objective method for establishing severity of disability). If the Air Force classified my disability according to the law, I should have received a 60% disability rating based on my 46% EF and been medically retired instead of separated for my 15.5 years of dedicated service.”


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 :
invalid font number 31502
Service IPEB – Dated 20000501
 VA - (~2.5 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Exertional Chest Pain 5399-5321 10% First Degree Atrioventricular Block (Also Claimed as Coronary Artery Vasospasm) 7015 30% 20091106-7
Other x1 (Not In Scope)
 Other x15
Combined: 10%
 Combined: 50%
invalid font number 31502

ANALYSIS SUMMARY :

Exertional Chest Pain . The CI had a 5- year history of sharp left sided chest pain symptoms that usually presented about 3/4 of the way into a 1.5 mile run . The CIs’ primary care provider (PCP) evaluated the CI for a cardiovascular clearance prior to initiation of a medication for attention deficit hyperactivity disorder . The physical exam cardiac exam was normal. The examiner noted that a prior electrocardiogram (EKG) showed a first degree heart block and the patient was asymptomatic; therefore , the examiner concluded that this could occur in healthy young patients and no further workup or treatment was required at that time. A repeat EKG done on the same date confirmed the previous results. The CI was seen a week later by his PCP and reported the 5- year history of left sided che st pain which lasted minutes during intense runs with lightheadedness. A cardiac stress test was normal and the cardiologist opined that the chest pain was pleuritic in nature. The CI had a repeat episode of chest pain and as he drove himself to the emergency room , the symptoms resolved and he drove back home. He reported that he sometimes would experience tunnel vision and lightheadedness with the chest pain. The civilian cardiologist noted mild shortness of breath, sharp retrosternal chest pain , localized, non-radiating which was transient and subsided in a few minutes. The cardiac exam and EKG w ere normal . An echocardiogram demonstrated minimal left ventricular hypertrophy, evidence of left ventricular diastolic dysfunction, preserved left ventricular systolic function with a normal left ventricular ejection fraction (LVEF) , and mild valvular dysfunction. An exercise cardiolite spect test demonstrated a mildly reduced left ventricle systolic function with an ejection fraction of 46% and decreas ed perfusion which was possibly reversible although motion artifact was also noted on the exam. The exercise echocardiogram and EKG documented the CI achieved 17.2 METS and 100% predicted heart rate. The cardiologist wrote that the CI was “safe to exercise up to a workload of 17 METS. T he civilian cardiologist saw the CI in foll ow-up documented that based on the findings of the cardiac testing that the he most likely had vasospasm of the coronary arteries which could occur secondary to a combination of over-exertion or exposure to cold. The Duty Limiting Condition report noted that the CI could exercise up to 17 METS or until he began to experience chest pain. The MEB narrative summary exam performed 7 months prior to separation documented that the CI had undergone a Cardiolite stress test which was abnormal because of a possible motion artifact; however , there was no comment made on the mildly reduced left ventricle systolic function with an ejection fraction of 46% which was not attributable to the possible motion artifact. The cardiac exam was normal. The examiner opined that the CI was not currently world-wide qualified because of the angina he would experience with exertion. The VA Compensation and Pension exam wa s missing from the record.

The Board direct ed attenti on to its rating recommendation based on the above evidence . The PEB coded the exertional chest pain condition as 5399 analogous to 5321 ( Group XXI. Function: Respiration. Muscles of respiration: Thoracic muscle group ) . The VA coded the first degree atrioventricular block co ndition as 7015 ( Atrioventricular block ) and rated at 30% for evidence of cardiac hypertrophy echocardiogram . The Board reviewed the VA’s rating decision and recognized the note for VASRD code 7015 contained the following statement, “ Simple delayed P-R conduction time, in the absence of other evidence of cardiac disease, is not a disability. ” The Board noted that the CI did have a simple delayed P-R interval ( first degree AV block) and no other evidence of cardiac disease. The CI had excellent exercise tolerance of >17 METS (under code 7015 7-10 METS is rated at 10% ) and the “ minimal left ventricular hypertrophy ” with preserved systolic function and normal ejection fraction was not abnormal for an avid exerciser which the CI was. The results of the exercise cardiolite spect test were equivocal based on the noted motion artifact demonstrated on the exam along with the other cardiac data demonstrating otherwise normal cardiac function and the CI’s excellent exercise tolerance. After deliberation, Board members agreed that the evidence present for review did not support any underlying cardiovascular disease. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends no change in the PEB adjudication fo r the exertional chest pain 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 exertional chest pain condition and IAW VASRD §4.71a, 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 20 140301 , w/atchs
Exhib it B. Service Treatment Record
Exhibit C. Department of Veterans ’ Affairs Treatment Record





XXXXXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review
invalid font number 31502


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

Dear XXXXXXXXXXXXXXXXXXXX :

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2014-01149 .

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,







XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

cc:
SAF/MRBR


Similar Decisions

  • AF | PDBR | CY2011 | PD2011-00927

    Original file (PD2011-00927.docx) Auto-classification: Approved

    The PEB adjudicated the history of chest pain with EKG evidence of a septal infarct and sinus arrhythmia condition and the asthma condition as unfitting, rated 0% and 0% respectively, with likely application of DoDI 1332.39 and the Veterans Administration Schedule for Rating Disabilities (VASRD). The VA coded the CI’s combined respiratory conditions (asthma and OSA) as 6602-6847 at 50% IAW VASRD §4.96 (a) and stated “The law requires when certain respiratory conditions coexist, a single...

  • AF | PDBR | CY2012 | PD 2012 00427

    Original file (PD 2012 00427.txt) Auto-classification: Denied

    Pre -Separation) Condition Code Rating Condition Code Rating Exam AV Block, 2nd Degree Pacemaker 7015 10% Mobits Type II Heart Block S/P Pacemaker Placement 7015 60% 20050727 No Additional MEB/PEB Entries Other x 4 20050727 Combined: 10% Combined: 70% Derived from VA Rating Decision (VARD) dated 20061222 (most proximate to date of separation [DOS]). The Board concluded that the evaluation done by the cardiologist as part of the MEB exam, a month prior to separation, was the most probative...

  • 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 | CY2013 | PD2013 00191

    Original file (PD2013 00191.rtf) Auto-classification: Approved

    It, and any other 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.In accordance with DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed recommendation of the Department of Defense...

  • AF | PDBR | CY2011 | PD2011-00277

    Original file (PD2011-00277.docx) Auto-classification: Approved

    ConditionCodeRatingConditionCodeRatingExam Chronic Pericarditis with Exercise Limiting Chest Pain Secondary to Acute Viral Myopericarditis Chronic Serous Pericarditis70020%Post-viral Cardiomyopathy w/Recurring Atrial Fibrillation7099-702010%*20050802History of Paroxysmal Atrial Fibrillation Medically ControlledNot Unfitting↓No Additional MEB/PEB Entries↓PTSD941130%**STR0% x 0/Not Service Connected x 2 Combined: 0%Combined: 40%*** *Post-viral Cardiomyopathy w/Recurring Atrial Fibrillation...

  • AF | PDBR | CY2009 | PD2009-00042

    Original file (PD2009-00042.docx) Auto-classification: Denied

    The Air Force Informal Physical Evaluation Board (PEB) found her unfit for continued service and she was separated with a 10% disability rating for 7099-7020 Cardiac septal aneurysm and mild mitral valve regurgitation (Ejection fraction 60-65%) using the Veterans Affairs Schedule for Ratings Disabilities (VASRD) and applicable Air Force and Department of Defense regulations. Given the VA’s reasonable 30% rating rationale of diminished symptom free exertion (METs), interplay between CI’s...

  • AF | PDBR | CY2014 | PD-2014-01572

    Original file (PD-2014-01572.rtf) Auto-classification: Denied

    Post-Separation) ConditionCodeRatingConditionCodeRatingExam Pericarditis…70020%Myopericarditis7099-7002NSC20100119Other x 0 (in Scope)Other x 8 Rating: 0%Rating: 60%Derived from VA Rating Decision (VARD)dated 20100413. The echocardiogram showed normal chambers, normal left ventricular function, with an ejection fraction of 60-65% with no evidence of residual cardiac function. In the matter of the myopericarditis condition and IAW VASRD §4.104, the Board unanimously recommends no change in...

  • AF | PDBR | CY2012 | PD2012 00613

    Original file (PD2012 00613.rtf) Auto-classification: Approved

    SEPARATION DATE: 20030522 The aortic insufficiency (AS) with chest pain syndromewas forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501 and no other conditions were submitted by the MEB.The PEB adjudicated the heart condition as unfitting, rated 10%, with application of the VASRD.The CI made no appeals, and was medically separatedwith thatdisability rating. Providing orders showing that the individual was retired with permanent disability effective the date of the original...

  • AF | PDBR | CY2014 | PD 2014 00038

    Original file (PD 2014 00038.rtf) Auto-classification: Denied

    The Informal PEB adjudicated bradycardia and sick sinus syndrome, transient light headedness, chest pain, mild distal esophageal stricture currently asymptomatic, dyspnea on exertion, and gastroesophageal reflux (GERD) currently controlledas unfitting, rated at 0%.The remaining conditions, migraines, chronic lower back pain and obesity conditions were determined to be Category III and not unfitting.The CI made no appeals and was medically separated. The NARSUM examiner noted that the CI was...

  • AF | PDBR | CY2012 | PD2012 01663

    Original file (PD2012 01663.rtf) Auto-classification: Denied

    Her condition was determined to be stable and heart function was within normal limits. There was no cardiac hypertrophy by direct measurement on the last echocardiogram prior to separation and the ejection fraction was within normal limits. 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...