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AF | PDBR | CY2014 | PD-2014-02198
Original file (PD-2014-02198.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX    CASE: PD-2014-02198
BRANCH OF SERVICE: Army  BOARD DATE: 20150129
SEPARATION DATE: 20060823


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-6 (Army Recruiter) medically separated for cardiomyopathy. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty or satisfy physical fitness standards. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The “cardiomyopathy, non-ischemic” condition was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated “cardiomyopathy, non-ischemic” as unfitting, rated 10%, with likely application of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “Please consider all conditions.”


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 :

IPEB – Dated 20060515
 VA* - (~2 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Cardiomyopathy, Non-Ischemic 7020 10% Idiopathic Cardiomyopathy 7005 60% 20061028
Other x 0 (Not In Scope)
 Other x 2
RATING: 10%
 RATING: 60%
* Derived from VA Rating Decision (VA RD ) dated 20 061222 (most proximate to date of separation ( DOS ) ) .


ANALYSIS SUMMARY:

Cardiomyopathy, Non-Ischemic Condition. The CI was hospitalized for evaluation in March 2005 of abnormal right sided sensations. No cause for the neurological symptoms was found. However, an echocardiogram on 8 March 2005 showed that he had reduced left ventricular function with an ejection fraction of 35-40% (normal is 60-65%). The next day he underwent a coronary angiogram which showed a low function of the entire heart and an ejection fraction of 40-45%. The coronary vessels showed no significant disease other than a 50% stenosis of the ostial diagonal branch of the left anterior descending artery. At a follow-up cardiology appointment on 28 March 2005, he reported that his exercise tolerance had declined over the past year from running 3-6 miles a day to walking one mile a day. He was begun on medications and noted improvement in his symptoms. On 23 May 2005, he was able to walk 4-5 miles a day without a problem and climb one flight of stairs. An exercise tolerance test on 18 July 2005 was near normal achieving Stage Four at 9 minutes 59 seconds. He also had an echocardiogram that day which showed an ejection fraction of 50%. The narrative summary was dated 21 October 2005 and noted the above. Based on this information, he was determined not to meet retention standards. Repeat studies on 12 December 2005 showed a normal exercise workload on stress testing achieving 12.9 METS (metabolic equivalents) and 12 minutes and 15 seconds (normal). A nuclear medicine study showed normal wall motion and ejection fraction. However, his cardiologist recommended significant work restrictions not compatible with military duties.

At the VA Compensation and Pension (C&P) examination performed by an urologist on 28 October 2006, 2 months after separation, the CI reported no occupational impairment from his heart condition. The initial cardiac studies were recorded, but not the normal studies from December 2005 which were those most proximate to separation. The cardiac examination was normal. No additional studies were recorded as being performed for the C&P examination. There are no further records for review regarding the cardiac condition until a C&P dated 21 February 2008, 22 months after separation and outside the normal 12-month window for higher probative value. It did note that there was an additional test with 7-10 METS exercise tolerance, but no date was recorded. He was able to walk two miles in 45-50 minutes which is consistent with the testing done in December 2005.

The Board directed attention to its rating recommendation based on the above evidence. Looking at the record, it is evident that the CI had a significant cardiomyopathy (injury to the heart muscle) in March 2005. Over time and with treatment, his cardiac function returned to normal. The PEB used the code 7020 (cardiomyopathy) while the VA utilized 7005 (arteriosclerotic heart disease) for the heart condition. The PEB noted the normal work load and ejection fraction above 50% when assigning the 10% rating. The VA rated the heart condition at 60% citing the 35% ejection fraction noted at the initial evaluation which was over 16 months prior to separation. The Board observed that neither code offers a rating advantage over the other and that the 10% rating is supported solely by the daily use of medications. 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 the cardiomyopathy 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 cardiomyopathy 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 re-characterization of the CI’s disability and separation determination.
The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140423, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record







XXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review
SAMR-RB                                                                         


MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557


SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20150010561 (PD201402198)


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              XXXXXXXXXXXXXXX
                           Deputy Assistant Secretary of the Army
                           (Review Boards)
                                                     
CF:
( ) DoD PDBR
( ) DVA

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