Citation Nr: A20016640 Decision Date: 11/09/20 Archive Date: 11/09/20 DOCKET NO. 191227-52341 DATE: November 9, 2020 ORDER A rating of 10 percent, but no greater, for vasovagal syncope is granted, subject to the laws and regulations governing payment of monetary benefits. FINDING OF FACT The Veteran has a confirmed diagnosis of vasovagal syncope with a history of syncopal episodes. CONCLUSION OF LAW The criteria for a rating of 10 percent, but no greater, for vasovagal syncope have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.3, 4.7, 4.121, 4.124a, Diagnostic Code (DC) 8199-8108, 8911. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Air Force from January 1999 to December 2000. The matter is on appeal before the Board from a December 11, 2019 rating decision. In the December 27, 2019 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal (December 2019). 38 C.F.R. § 20.301. Increased Rating Vasovagal Syncope The Veteran filed a claim for a compensable evaluation for her service-connected vasovagal syncope in March 2019. The Board notes that the Veteran’s vasovagal syncope is currently rated by analogy to supraventricular arrythmias under DC 7099-7020. It has previously been rated by analogy to narcolepsy under DC 8199-8108, and was initially rated under DC 8210 for paralysis of the tenth (pneumogastric, vagus) cranial nerve. After review of the record, the Board finds that the currently assigned DC is not the most appropriate diagnostic code for evaluating the Veteran’s disability. See Read v. Shinseki, 651 F.3d 1296 (Fed. Cir. 2011) (holding that a change in Diagnostic Code does not constitute severance of service connection where the situs of the disability was corrected to more accurately determine the Veteran's entitled benefits). Rather, the Board finds that rating by analogy under DC 8199-8108, most closely aligns with the Veteran’s disability. DC 8199-8108 rates narcolepsy, which is rated under epilepsy, petit mal. Epilepsy, petit mal is rated under DC 8911 under the general rating formula for minor seizures. A 10 percent evaluation is warranted with a confirmed diagnosis of epilepsy with a history of seizures. A 20 percent evaluation is warranted with at least 2 minor seizures in the last 6 months. A 40 percent evaluation is warranted with at least 5 to 8 minor seizures weekly. A 60 percent evaluation is warranted with 9 to 10 minor seizures per week. An 80 percent evaluation is warranted with more than 10 minor seizures weekly. When continuous medication is shown necessary for the control of epilepsy, the minimum evaluation will be 10 percent. This rating will not be combined with any other rating for epilepsy. 38 C.F.R. § 4.124a, DC 8911. As to the frequency of epilepsy, and by analogy vasovagal syncope, competent, consistent lay testimony emphasizing convulsive and immediate post-convulsive characteristics may be accepted. The frequency of seizures should be ascertained under the ordinary conditions of life (while not hospitalized). 38 C.F.R. § 4.121. The Veteran underwent VA examinations in June 2019 and in September 2019. At the June 2019 VA examination, the Veteran reported that she suffers from fainting spells and that she can feel them coming. She stated that the spells only last a few seconds. The last episode occurred in Target about a month prior, and she did not go to the ER when it happened. It was noted that she had not seen her primary care provider about her condition recently, however, she reported having an EEG in the past that was negative. She does not take continuous medication for her condition. She also underwent a psychological examination in June 2019, at which she reported that she frequently faints at her current hairstylist vocation. She noted that she does not know what physical activity may precipitate a fainting spell, or when they might occur. At the September 2019 VA examination, the Veteran reported that she has tunnel vision, and fainting with a loss of consciousness. Sometimes she will faint at work. She noted having been to acupuncture and her regular doctor, however, she was not undergoing any treatment currently. She explained that in relation to her condition she had not seen anyone for the issue since she got out of the military, because she did not know that she had medical coverage through VA. Therefore, she just dealt with it. She relayed that there were no triggers, and that the episodes would come on randomly. Before she faints, she reported seeing an aura. There was no history of seizures. The examiner found that the Veteran’s fainting spells impacted her ability to work, because she needs be careful when she is cutting hair. She will see an aura and need to rest before she faints. A review of the Veteran’s medical treatment records does not provide any further findings in relation to the Veteran’s vasovagal syncope. Based upon the foregoing, the Board finds that a rating of 10 percent is warranted for the Veteran’s vasovagal syncope over the entire period on appeal. The Veteran has credibly reported having fainting spells, and that before she faints, she will see an aura that notifies her that she needs to rest. She does not know when the fainting spells will occur, but she can feel them coming. By analogy a 10 percent rating is warranted with a confirmed diagnosis of vasovagal syncope and a history of syncopal episodes. The Veteran’s reports credibly establish a history of syncopal episodes, however, a rating in excess of 10 percent is not warranted as the evidence does not establish the frequency that her fainting spells occur and no seizures have been documented. Only one fainting spell has been specifically reported over the period on appeal, and the rest of the testimony only provides that she faints “frequently.” Thus, a history of fainting spells has been established, but a particular frequency in which they occur has not. Accordingly, a rating of 10 percent, but no greater, for vasovagal syncope is granted. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Lutgens-Staley, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.