RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXX CASE: PD1200890 BRANCH OF SERVICE: ARMY BOARD DATE: 20130425 SEPARATION DATE: 20030926 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Private First Class /E-3 (93P10/Aviation Operations Specialist) medically separated for vocal cord dysfunction (VCD). The CI was referred to a Medical Evaluation Board (MEB) for asthma and seasonal allergic rhinitis (SAR) in August 2002. That PEB was terminated because the CI’s asthma did not warrant a P3 Profile. The CI continued to have problems, returned to the allergy clinic and was referred to the ear, nose, and throat (ENT) clinic when his pulmonary function tests (PFTs) were suggestive of VCD. The CI was then evaluated at Walter Reed Army Medical Center (WRAMC) where the diagnosis of VCD was made. The CI then began speech pathology treatment, but despite this the condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) or satisfy physical fitness standards. He was issued a permanent P3 profile and referred for a new MEB. The VCD or paradoxical vocal cord motion (PVCM), and severe seasonal allergic rhinitis on allergy immunotherapy conditions were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated VCD as unfitting, rated 0%. The remaining condition was determined to be not unfitting. The CI made no appeals, and was medically separated with a 0% disability rating. CI CONTENTION: “The Wounded Warrior Act – request review of DoD disability rating to ensure accuracy + fairness.” 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 rating for the unfitting VCD 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 Board for Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20030801 VA - (14 Mos. Pre -Separation) Condition Code Rating Condition Code Rating Exam Vocal Cord Dysfunction 6599-6520 0% Vocal Cord Dysfunction 6699-6602 30% 20020723 Seasonal Allergic Rhinitis Not Unfitting Perennial Allergic Rhinitis 6522 0% 20020723 No Additional MEB/PEB Entries Other x 1 20020723 Combined: 0% Combined: 50% Derived from VA Rating Decision (VARD) dated 20031105 (most proximate to date of separation [DOS]). ANALYSIS SUMMARY: Vocal Cord Dysfunction (VCD) Condition. The narrative summary (NARSUM), 4 months prior to separation, noted the history summarized above. The chief complaint was “difficulty breathing with exercise outdoors and difficulty maintaining gas mask on face.” Specialty evaluation for asthma and VCD demonstrated PFTs (flow loop flattening; negative Methacholine challenge; poor response to asthma medications) and direct cord visualization (laryngoscopy with paradoxical motion of the vocal cords) sufficient for diagnosis of VCD as the principle diagnosis. VCD therapy of speech pathology was not effective in decreasing the CI’s symptoms. Medications were listed as Zyrtec (cetirizine - is used to treat allergy symptoms) at night. The MEB physical exam noted lungs clear to auscultation and chest X-ray was normal. Diagnosis was “Vocal cord dysfunction or paradoxical vocal cord motion.” PFTs 2 months prior to separation were normal (July 2003; FEV1 83%, FEV1/FVC 95%). Speech therapy records indicated the CI “did not appear to be hoarse or have any significant vocal problems with quality or pitch.” The summary indicated “significant difficulty with relaxation and tightness in his chest, which is affecting his overall performance” and relaxation techniques were given. There was no evidence of nasal polyps documented in the record. At the VA Compensation and Pension (C&P) exam performed 14 months prior to separation, the CI reported he experienced wheezing with episodic shortness of breath, and used “Singulair and albuterol two or three times daily to help control these symptoms.” PFTs from February 2002 (14 months prior to separation) were referenced with decreased FVC of 70-72% with no change with bronchodilators or Methacholine. Exam documented the chest was clear with diminished bases. Diagnosis was “Asthma, dependent on daily medication.” The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the CI’s VCD analogous to 6520 (larynx, stenosis of, including residuals of laryngeal trauma) at 0% while the VA rated the CI’s VCD analogous to 6602 (Asthma, bronchial) at 30%. There were no PFTs warranting any compensable rating IAW VASRD criteria for VCD or asthma proximate to separation. The VA’s analogous asthma rating of 30% was based on “daily use of Singulair and Albuterol” and a diagnosis of asthma a year prior to separation. The VA rating determination did reference the service treatment record including the laryngoscopy and the changed diagnosis from asthma to VCD. The NARSUM and treatment records indicated no chronic controller medication use proximate to separation, and normalization of PFTs. Analogous coding for the VCD as 6520 was considered predominate. 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 VCD 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 VCD condition and IAW VASRD §4.97, 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 Vocal Cord Dysfunction 6599-6520 0% COMBINED 0% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120619, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record xxxxxxxxxxxxxxxxxxxxxxxxxxx, DAF Director of Operations Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / xxxxxxxxxxxxxx), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for xxxxxxxxxxxxxxxxxxxxxxxxx, AR20130009571 (PD201200890) 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 xxxxxxxxxxxxxxxxxxxxxxxx Deputy Assistant Secretary (Army Review Boards)